Trade Policy Note Final-rev08 - Development

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Annex 5F: Health services The provision of health services to the poor is central to the achievement of MDGs 4,5 and 6. The pressures for foreign participation in health sectors have arisen at a moment when the impact of the WTO and other trade agreements on health is a subject of major concern to the international community. Commitments on health in GATS and other trade agreements can impact the provision of basic health services to the poor. 155 . As already noted, the 2001 WTO Ministerial Declaration on the Trade- Related Aspects of Intellectual Property Rights (TRIPS) Agreement and Public Health was deemed necessary to protect developing countries against bilateral pressures from powerful trading partners who were undermining their rights to generic access to medicines. International health experts have strongly and continually cautioned prudence to developing countries in committing themselves to allowing foreign providers of health services, including health insurance, companies from entering their markets. While the role of the private sector in providing health services varies from country to country, most WTO members have declined to make commitments in this sector. Many countries desire the latest medical technology and high-tech hospitals and training facilities. The existence of such facilities is also seen as an inducement to foreign investment. However, there is a concern that the foreign private sector will drain human and financial resources from the national sectors, both public and private, and lead to a two tier health system, one for the rich and one for the poor. As the greatest challenge facing developing countries in the health sector is to provide affordable access to quality services for the rural poor, the presence of foreign private suppliers could make little contribution to, and more likely frustrate these efforts. Foreign participation in the health services sector can also take place through the provision of health insurance. International health experts consider that while, in theory, greater access for health insurance companies could stimulate competition and reduce costs, in actual practice, evidence shows that greater competition among health insurers segments and destabilizes the market in addition to undermining the ability to build larger, more equitable risk pools that spread costs between rich and poor, healthy and sick. In particular, it is crucial to prevent wealthier population groups from opting out of national health insurance schemes. Foreign health insurance should not operate in a manner that undermines universal compulsory health insurance systems. The experience of some developing countries with Health Maintenance Organizations (HMOs), which create a captive supply of medical staff, has been particularly discouraging 156 International health experts advise that the entry of foreign suppliers makes it more urgent for countries to create an effective regulatory framework for the health insurance sector, and that until such a system is in place it could be harmful for developing countries to make full commitments in the health insurance sub-sector under GATS financial service schedules. 157 155 For links to the international debate on trade in health services see Choike , Health and Health Services, Goods for Sale (www.choike.org/nuevo_eng/informes/1007.html). 156 See, for example, “Consensus Paper on Managed Care Organizations”, developed by Association of Private Hospitals of Malaysia, 10 April 2001 (www.hospitals -malaysia.org). 157 See Lipson, Debra, GATS and Health Insurance Services, Background Note for WHO Commission on Macroeconomics and Health, CMH Working Paper 4:7, June 2001 (http://www.cmhealth.org/docs/wg4_paper7.pdf). 80
A number of developing countries are exporting health services. Patients come to developing countries for medical treatment not only because of lower costs, but also to obtain traditional medical treatment, and often to enjoy more labor intensive and compassionate treatment from medical staff. However, health export policies can impact, both positively and negatively, domestic heath care, in particular, access to health services by the poor. Such access on people living in poverty can depend on the number of medical staff and facilities in the exporting country and the regulatory structure that is established. 158 Developing countries that expend resources on the treatment of foreign patients are likely to be diverting resources from domestic needs. In addition, by offering more attractive employment conditions, they exacerbate shortages of skilled staff in public facilities, on which the poor rely. The export of health services through Mode 2 (“health tourism”) requires a comprehensive strategy based on an analysis of the potential gains and the impacts on the national health system and access for the poor. These impacts will differ among countries, as a function of specific characteristics of the health system of each potential exporting country, but in many cases, could be negative. 158 See WHO/UNCTAD study International Trade in Health Services: a Development Perspective UNCTAD/ITCD/TSB/5, WHO/TFHE/98.1 (Geneva: 1998). 81
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NATIONAL DEVELOPMENT STRATEGIES POL
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Preface The outcome document of the
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A “New Generation” of Bilateral
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TNCs TRIMs TRIPS TRQ UNCTAD UNESCO
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The case and options for widening t
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outcomes are less clear. Moreover,
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countries struggle to ensure that t
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Goal B : to empower people to becom
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Tigers), has not followed the Brett
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III. TARIFFS AND INDUSTRIAL POLICY
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across the board tariff bindings. F
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Such tariff policy should ensure th
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Export duties can also be an elemen
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IV. EXPORTS AND POVERTY Can develop
Page 29 and 30: Increase Productivity Exports shoul
Page 31 and 32: Box 14: Export Policies and WTO and
Page 33 and 34: percent of domestic consumption) wa
Page 35 and 36: developing countries with a few not
Page 37 and 38: Different products emerge at the to
Page 39 and 40: safeguard measures on agricultural
Page 41 and 42: suppliers in the domestic market fo
Page 43 and 44: Investment Policy is Central to Tra
Page 45 and 46: water and sanitation. Sustainabilit
Page 47 and 48: traditionally done in trade in good
Page 49 and 50: Mode 1 service exports, often terme
Page 51 and 52: It is now incumbent on developing c
Page 53 and 54: commercial value to their tradition
Page 55 and 56: The Proliferation of FTAs Over rece
Page 57 and 58: services liberalization in these ag
Page 59 and 60: copyright protection may be extende
Page 61 and 62: (q) SPS and TBT. Within the framewo
Page 63 and 64: Market Access Even after the abolit
Page 65 and 66: were established almost exclusively
Page 67 and 68: Annex 3B: Fisheries, Putting the pr
Page 69 and 70: also enshrined in the Code of Condu
Page 71 and 72: poorest people. 140 Governments in
Page 73 and 74: Annex 5B: Energy services Attainmen
Page 75 and 76: Box 25: Strategies for Strengthenin
Page 77 and 78: On the contrary, a sharp decline ha
Page 79: small farmers find themselves left
Page 83 and 84: Commission on Intellectual Property
Page 85 and 86: Mathew, Sebastian (2003). Trade in
Page 87 and 88: UNDP (2005). Human Development Repo
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Trade Policy Note Final-rev08 - Development

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