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

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Presentation on theme: "International Trade, Trade Agreements, Intellectual Property, and Health Liberalizing trade in health services: Helping countries achieve policy coherence."— Presentation transcript:

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2 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

3 3 International 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

4 4 International 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

5 5 International Trade, Trade Agreements, Intellectual Property, and Health What are Modes of Supply? Border Consumers (C) Services Natural person Suppliers (S) CB CA CP NP S Services CB - Cross Border Supply; CA - Consumption Abroad CP -Commercial Presence; NP - Movement of Natural Persons

6 6 International Trade, Trade Agreements, Intellectual Property, and Health WHO’s Global Work in Trade in Health Services

7 7 International Trade, Trade Agreements, Intellectual Property, and Health Eastern Mediterranean Regional initiative in TiHS 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

8 8 International 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 Development of a diagnostic toolkit Close Collaboration between EMRO and WHO HQ

9 9 International Trade, Trade Agreements, Intellectual Property, and Health WHO Eastern Mediterranean Region High income Middle income Low income

10 10 International Trade, Trade Agreements, Intellectual Property, and Health Foreign Health Professionals Working in MOH Oman Categories of staffOmaniNon- Omani % Omani Physicians6242,01124% Dentists529236% Pharmacists417735% Nurses3,6163,70349% Assistant Pharmacists % Workforce in MOH11,2907,26861% SourceMOH,Oman,2003

11 11 International Trade, Trade Agreements, Intellectual Property, and Health Tunisian Health Professional Practicing Abroad in 2004 CountryPhysiciansTechniciansNursesTotalPercent S Arabia % Qatar % UAE % Kuwait % Europe % Others % Total % Source : Tunisian Agency of Technical Cooperation; 2005

12 12 International Trade, Trade Agreements, Intellectual Property, and Health Commercial Presence – FDI in Hospital Sector in Jordan Arab North American European7.0-- Total (Million US$) Source: Jordan Investment Board, Amman

13 13 International 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

14 14 International 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

15 15 International Trade, Trade Agreements, Intellectual Property, and Health Yemeni Patients Consuming Health Care Abroad 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$ million Source: Expenditures extracted from balance of payments estimates of Central Bank of Yemen

16 16 International 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

17 17 International Trade, Trade Agreements, Intellectual Property, and Health Cross-Border Supply: Telehealth E-health link between USA hospitals and MedNet in Beirut for 2 nd 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

18 18 International 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

19 19 International 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

20 20 International Trade, Trade Agreements, Intellectual Property, and Health Thank You


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