International Trade, Trade Agreements , Intellectual Property, and Health

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. International specialization Improve health of population served Efficient allocation of resources Respond to people’s expectations Eliminate barriers to free trade Protect against burden of ill-health Economic Growth Good health for all populations Improved percapita income Trade vs. Public Health Policy Objectives of TiHS Trade policy objectives Public Heath policy objectives International Trade, Trade Agreements, Intellectual Property, and Health

4. 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 International Trade, Trade Agreements, Intellectual Property, and Health

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

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

7. 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 Eastern Mediterranean Regional initiative in TiHS - 2003 International Trade, Trade Agreements, Intellectual Property, and Health

8. 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 Tools and guidelines for assessing trade in health services Close Collaboration between EMRO and WHO HQ International Trade, Trade Agreements, Intellectual Property, and Health

9. Highincome Middleincome Low income WHO Eastern Mediterranean Region International Trade, Trade Agreements, Intellectual Property, and Health

10. Foreign Health Professionals Working in MOH Oman - 2003 Source MOH, Oman, 2003 International Trade, Trade Agreements, Intellectual Property, and Health

11. Tunisian Health Professional Practicing Abroad in 2004 International Trade, Trade Agreements, Intellectual Property, and Health Source : Tunisian Agency of Technical Cooperation; 2005

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

13. 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 International Trade, Trade Agreements, Intellectual Property, and Health

14. 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 International Trade, Trade Agreements, Intellectual Property, and Health

15. 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 2000 2001 2002 2003 Source: Expenditures extracted from balance of payments estimates of Central Bank of Yemen - 2004 International Trade, Trade Agreements, Intellectual Property, and Health

16. 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 International Trade, Trade Agreements, Intellectual Property, and Health

17. 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 International Trade, Trade Agreements, Intellectual Property, and Health

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

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

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