The Association of Southeast Asian Nations (ASEAN) is the geo-political and economic cooperation across ten countries: Brunei Darussalam, Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand, and Vietnam. To promote free trade and services across boundaries, an initiative called the ASEAN Economic Community (AEC) will start in 2015 (1). According to the Mutual Recognition Arrangement (MRA) of this regional movement, physicians, nurses, and dentists are among seven selected professional groups (physician, nurse, dentist, accountant, engineer, architect, and surveyor) that can be qualified to practice in another country (2). The flow of health professionals and cross-border health services is seen as crucial to the success of AEC but needs to be evaluated (3).
Literature on the potential implications of international trade in health services has focused only on the exchange of health care providers and patients across borders or mal-distribution of health resources across urban and rural areas (4, 5). An analysis of current trade patterns based on a ‘four modes of supply’ framework has focused on location and movement of suppliers and consumers; (4) however, this framework may be too simplified for health care professionals, especially physicians. The four modes – cross-border supply, consumption abroad, commercial presence, and movement of individual service providers – did not touch upon the production of suppliers, which is also included in the current context. No framework that integrates both pre- and post-production as well as migration of health care professionals in ASEAN has been proposed in the literature.