Globalisation and Health Service Provision

The British Context

• Expansion of NHS Funding• More Private / International Providers• Primary Care Trusts / Care Trusts• Foundation Hospitals / Franchises• Private Finance Initiative

• = ‘Non-Commercial Basis’ ?

World Trade Organisation

• TRIPS

• GATS

• - Most Favoured Nation

• - National Treatment

Modes of Supply

• Cross Border Trade (e.g. ‘Tele-health’)

• Consumption Abroad

• Commercial Presence

• Presence of Natural Persons

Article 1.3

• Government services are exempt where they are:

‘supplied neither on a commercial basis, nor in competition with one or more service suppliers’.

Summary

• Services are Internationalising

• Governments are Privatising

• GATS Facilitates Both

• Watch the Doha Round Carefully!

International Organisations

• WHO / GPPPs

• International Monetary Fund (IMF)

• World Bank

• World Trade Organisation (WTO) / GATT

A Typology of Healthcare Companies

• Providers of Services

• Producers of Goods

• Suppliers of Services

• Health Insurers

• Premises Companies