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International Trade, Trade Agreements, Intellectual Property, and Health Liberalizing trade in health services: Helping countries achieve policy coherence.

Apr 01, 2015

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Page 1: International Trade, Trade Agreements, Intellectual Property, and Health Liberalizing trade in health services: Helping countries achieve policy coherence.
Page 2: International Trade, Trade Agreements, Intellectual Property, and Health Liberalizing trade in health services: Helping countries achieve policy coherence.

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

Page 3: International Trade, Trade Agreements, Intellectual Property, and Health Liberalizing trade in health services: Helping countries achieve policy coherence.

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

Page 4: International Trade, Trade Agreements, Intellectual Property, and Health Liberalizing trade in health services: Helping countries achieve policy coherence.

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

Page 5: International Trade, Trade Agreements, Intellectual Property, and Health Liberalizing trade in health services: Helping countries achieve policy coherence.

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

Page 6: International Trade, Trade Agreements, Intellectual Property, and Health Liberalizing trade in health services: Helping countries achieve policy coherence.

6International Trade, Trade Agreements, Intellectual Property, and Health

WHO’s Global Work in Trade in Health Services

Page 7: International Trade, Trade Agreements, Intellectual Property, and Health Liberalizing trade in health services: Helping countries achieve policy coherence.

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

Page 8: International Trade, Trade Agreements, Intellectual Property, and Health Liberalizing trade in health services: Helping countries achieve policy coherence.

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

Page 9: International Trade, Trade Agreements, Intellectual Property, and Health Liberalizing trade in health services: Helping countries achieve policy coherence.

9International Trade, Trade Agreements, Intellectual Property, and Health

WHO Eastern Mediterranean Region

High income

Middle income

Low income

Page 10: International Trade, Trade Agreements, Intellectual Property, and Health Liberalizing trade in health services: Helping countries achieve policy coherence.

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

Page 11: International Trade, Trade Agreements, Intellectual Property, and Health Liberalizing trade in health services: Helping countries achieve policy coherence.

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

Page 12: International Trade, Trade Agreements, Intellectual Property, and Health Liberalizing trade in health services: Helping countries achieve policy coherence.

12International Trade, Trade Agreements, Intellectual Property, and Health

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

Page 13: International Trade, Trade Agreements, Intellectual Property, and Health Liberalizing trade in health services: Helping countries achieve policy coherence.

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

Page 14: International Trade, Trade Agreements, Intellectual Property, and Health Liberalizing trade in health services: Helping countries achieve policy coherence.

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

Page 15: International Trade, Trade Agreements, Intellectual Property, and Health Liberalizing trade in health services: Helping countries achieve policy coherence.

15International Trade, Trade Agreements, Intellectual Property, and Health

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

Page 16: International Trade, Trade Agreements, Intellectual Property, and Health Liberalizing trade in health services: Helping countries achieve policy coherence.

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

Page 17: International Trade, Trade Agreements, Intellectual Property, and Health Liberalizing trade in health services: Helping countries achieve policy coherence.

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

Page 18: International Trade, Trade Agreements, Intellectual Property, and Health Liberalizing trade in health services: Helping countries achieve policy coherence.

18International Trade, Trade Agreements, Intellectual Property, and Health

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

Page 19: International Trade, Trade Agreements, Intellectual Property, and Health Liberalizing trade in health services: Helping countries achieve policy coherence.

19International Trade, Trade Agreements, Intellectual Property, and Health

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

Page 20: International Trade, Trade Agreements, Intellectual Property, and Health Liberalizing trade in health services: Helping countries achieve policy coherence.

20International Trade, Trade Agreements, Intellectual Property, and Health http://gis.emro.who.int/healthsystemobservatory/main/Forms/main.aspx

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