International Trade, Trade Agreements, Intellectual Property, and Health
International Trade, Trade Agreements, Intellectual Property, and Health
Liberalizing trade in health services: Helping countries achieve policy coherence
Dr Sameen Siddiqi
Regional Adviser,
Eastern Mediterranean Regional Office, WHO
3International Trade, Trade Agreements, Intellectual Property, and Health
Trade vs. Public Health Policy Objectives of TiHS
Protect against burden of ill-health
Good health for all populations
Improve health of population served
Respond to people’s expectations
Public Heath policy objectives
International specialization
Efficient allocation of resources
Eliminate barriers to free trade
Economic Growth
Improved percapita income
Trade policy objectives
4International Trade, Trade Agreements, Intellectual Property, and Health
Liberalization of Trade in Health Services
• Trade in health services can occur:– Outside Trade Agreements– Covered under – Multilateral (GATS), Regional,
or Bilateral Trade Agreements
• Implications of liberalizing trade in health services under GATS?– Benefits vs. risks on access, quality, equity,
efficiency of health services / outcomes
5International Trade, Trade Agreements, Intellectual Property, and Health
What are Modes of Supply?Border
Consumers(C)
ServicesNaturalperson
Suppliers(S)
CB
CA
CP
NPS
Services
CB - Cross Border Supply; CA - Consumption AbroadCP -Commercial Presence; NP - Movement of Natural Persons
6International Trade, Trade Agreements, Intellectual Property, and Health
WHO’s Global Work in Trade in Health Services
7International Trade, Trade Agreements, Intellectual Property, and Health
Eastern Mediterranean Regional initiative in TiHS - 2003
Recommendations• Enhance knowledge on nature, and extent
of TiHS; risks and opportunities it offers• Develop institutional research capacity in
EMR • Assess the “effect” of TiHS on health
system• Raise TiHS on policy agenda, evolve a
planned response• Assist countries to develop strategies:
– protect public health interest – maximize benefits of trade liberalization
8International Trade, Trade Agreements, Intellectual Property, and Health
Tools and guidelines for assessing trade in health services
• First assessment tool developed by WHO HQ in 2003
• Regional adaptation of tool in EMRO, 2004
• Update assessment tool in HQ - 2006• Development of a diagnostic toolkit - 2007
Close Collaboration between EMRO and WHO HQ
9International Trade, Trade Agreements, Intellectual Property, and Health
WHO Eastern Mediterranean Region
High income
Middle income
Low income
10International Trade, Trade Agreements, Intellectual Property, and Health
Foreign Health Professionals Working in MOH Oman - 2003
Categories of staff Omani Non-Omani
% Omani
Physicians 624 2,011 24%
Dentists 52 92 36%
Pharmacists 41 77 35%
Nurses 3,616 3,703 49%
Assistant Pharmacists 399 205 66%
Workforce in MOH 11,290 7,268 61%Source MOH, Oman, 2003
11International Trade, Trade Agreements, Intellectual Property, and Health
Tunisian Health Professional Practicing Abroad in 2004
Country Physicians Technicians Nurses Total Percent
S Arabia 65 336 827 1228 53%
Qatar 6 229 130 365 16%
UAE 9 107 163 279 12%
Kuwait - 1 55 56 2%
Europe 1 2 278 281 12%
Others 21 18 81 120 4%
Total 102 693 1534 2329 100%
Source : Tunisian Agency of Technical Cooperation; 2005
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Commercial Presence – FDI in Hospital Sector in Jordan
2001 2002 2004
Arab - 5.65 1.63
North American
0.21 - 7.0
European 7.0 - -
Total 7.21 5.65 8.63
(Million US$)
Source: Jordan Investment Board, Amman
13International Trade, Trade Agreements, Intellectual Property, and Health
Jordan’s Schedule of Commitment in Health under GATS
• National Treatment– Equal, except non-Jordanians deposit JD 50,000– Full ownership of hospital
• Three year exemption on duties and taxes• Market Access Limitations
– Minimum 50 bedded hospital– One of the owners must be a physician– 75% of physicians, nurses must be nationals – At least half of staff members nationals – Director medical laboratories must be national
14International Trade, Trade Agreements, Intellectual Property, and Health
What does a commitment mean?• Commitment is a Guaranteed Minimum
Treatment to foreign service suppliers• Specify for each mode of supply- extent of
– market access - full, partial or none – national treatment - foreign service suppliers are
granted treatment no less favorable than that accorded to national service suppliers
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Yemeni Patients Consuming Health Care Abroad
Travel and Health Expenditure by Yemeni Patients on Foreign Treatment - 2000-03
66
68
70
72
74
76
78
80
82
1 2 3 4
Year
•No visa or foreign exchange restrictions for patients
•2003 estimate for all patients – 40,000
•Jordan is the most frequently visited country
•Other countries include Saudi Arabia, Egypt, Syria
US
$ m
illi
on
2000 2001 2002 2003
Source: Expenditures extracted from balance of payments estimates of Central Bank of Yemen - 2004
16International Trade, Trade Agreements, Intellectual Property, and Health
Consumption Abroad: Jordanian Perspective
• Jordan is the biggest promoter of “medical tourism” in the region;• Directorate of medical tourism established in partnership with private
sector• MOH has office at airport to facilitate entry • 120,000 patients sought medical services in Jordan in 2002 (private
hospitals share 55%) • In 2001 estimated revenues from “medical tourism” in Jordan – US$
620 million • Patients visit from Yemen, Bahrain, Sudan, Syria, Libya, Palestine and
Saudi Arabia
17International Trade, Trade Agreements, Intellectual Property, and Health
Cross-Border Supply: Telehealth• E-health link between USA hospitals and MedNet in
Beirut for 2nd opinions• MO Communication and IT, Egypt approved a large
initiative to develop a Tele-medicine Network• Pakistan provides medical transcription services to
US institutions• Telemedicine link between university hospitals and
research centers in S. Arabia and USA
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Policy Coherence in Trade and Health Services
• Lack of policy coherence between MO Trade and MOH in most countries– MO Trade & Commerce in Pakistan has a special WTO Wing,
yet weak collaboration with MOH;– Oman has a Higher Committee for WTO Issues and MOH is its
permanent member;– MOH works closely with MO Trade and Tourism to promote
medical tourism in Jordan– CSOs are active in influencing TiHS policies in Pakistan,
Jordan
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Optimizing the effects of trade liberalization on health services
• Mitigating negative consequences– Capacity development of health trade professionals– Establishment of trade units in MOH– Promoting coordination mechanisms between stakeholders – Introducing “flanking measures” at modal level
• Promoting tele-health in remote areas• Earmarking revenue from medical tourism for essential public
health interventions
20International Trade, Trade Agreements, Intellectual Property, and Health http://gis.emro.who.int/healthsystemobservatory/main/Forms/main.aspx
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