TISA: Leaked document uncovers secret discussions that undermine access to health care
The text, entitled “A discussion note concerning the health services in the TISA negotiations”, refers to a “huge untapped potential for the globalisation of health care services”, mainly because “health care services are funded and provided by state or wellfare organizations and are of virtually no interest for foreign competitors due to a lack of market-oriented scope for activity”. The proposal points out the advantages of international trade in health services for the industry. The pet subject of the EU is that TISA will “create jobs and stimulate economic growth”.
What is striking is the ideological transition from health care as a social and public service to a market-oriented model where health becomes a commodity. After all, the focus is on opening up the health market for commercial investors. But what about our health? Because that is what it is all about in the first place, right? Is the leaked proposal compatible with ensuring the stated promise of universal access?
According to the European Commission (and also repeated in the document), “countries remain free to keep public monopolies and regulate public services as they see fit”. The TISA- agreement would only apply to the commercial segment of the healthcare market, but this will not be without consequences for the public health sector and universal access to healthcare. As a matter of fact, the existence of a commercial market for health care is a precondition for the entry of foreign investors through trade and investments agreements. First of all, this increases the pressure for privatization in the health sector. Secondly, the existence of a parallel commercial healthcare market could hamper the public health sector. The biggest risk is, therefore, the creation of a two-tier health system, with high-tech specialised care for those who can afford it and basic public health care for the less well-off. This enlarges the health gap.
In the leaked text we find a specific reference to ‘medical tourism’ or 'facilitating patients to find treatment abroad'. For importing countries (countries who send out the patients) there might be a risk that it becomes a reason to invest less in the public health sector and education of health workers. Contrarily to the promised revenues, resources will be drawn out of the national health systems of these countries and be injected into the foreign medical tourism industry through tax revenues and insurance premiums. For the exporting countries (countries who provide medical tourism services), often developing countries that are hoping for economic growth via medical tourism, there is a risk that the profits do not trickle down to the local population. Next to that, there is a huge risk for an ‘internal brain drain’ in the developing countries, whereby the medical industry, who will take care of the foreign patients in the big cities, will entice health workers away from the public sector in the rural regions. On top of that, medical tourism services are often too expensive to afford for the local population in developing countries, which seriously hampers their access to health care.
Today there isn't enough scientific evidence on the positive impact of medical tourism on health systems and population health. There are, however, documented risks for the quality and universality of health care. Therefore, it is of utmost importance to respect the precautionary principle. No agreement that could undermine access to healthcare must be signed. Even more so because the TISA is a binding agreement and it becomes therefore difficult if not impossible to reverse any negative consequences in a later stadium.
It is unacceptable that these negotiations, affecting a fundamental part of social protection such as healthcare, take place without broad public consultation. Even more so because important risks are linked to signing this agreement. That is why we demand that the contents of the TISA negotiations are entirely made available for public debate. We call upon protest against any agreement that contains risks for public health and the public policy space for health.
Press release by CGSP Wallone and TWHA to the frenchspeaking Belgian press
Leaked document by Associated Whistle Blowing press
Analysis by Public Services International
Smith, R.D., 2004. Foreign direct investment and trade in health services: a review of the literature. Social science & medicine (1982), 59(11), pp.2313–23.
Whittaker A (2008). Pleasure and pain: medical travel in Asia. Global Public Health 3(3):271-290.
Schrecker, T., Labonté, R., De Vogli, R. Globalisation and Health: the need for a global vision.
The Lancet. 2008; 372:1670- 1675.
Chen, B.Y.Y. & Flood, C.M., 2011. Medical Tourism ’ s Impact on Health Care Equity and Access in Low- and Middle-Income Countries: Making the Case for Regulation. journal of law, medicine & ethics, pp.286 – 300.
Smith R, Martínez Álvarez M, and Chanda R. Medical Tourism: a review of the literature and
analysis of a role for bi-lateral trade. Health Policy 2011; 103(2–3):276-82.
JCrooks VA, Kingsbury P, Snyder J and Johnston R (2010). What is known about the effects of
medical tourism in destination and departure countries? A scoping review. International Journal for
Equity in Health 9:24
Chanda, Rupa. Trade in health services. Bulletin of the World Health Organisation. 2002, vol.80, n.2
Smith, R.D., Chanda, R. & Tangcharoensathien, V., 2009. Trade in health-related services. Lancet, 373(9663), pp.593–601.