The Trade in Services Agreement, a 'services only' free trade agreement negotiated between Australia, the European Union, the United States and other smaller nations, may have a direct impact on health service delivery. However, the details of the agreement have not, and are unlikely to be, fully disclosed to the public
What we do know is that the original proposal, tabled at the Trade in Services Agreement negotiations, would see patients being treated overseas if their own public health system could not accommodate them in a timely and efficient manner. The country ‘exporting’ the health service would then be reimbursed by private insurance or the ‘importing’ country’s public health care arrangements.
In theory, this arrangement could have some benefits. It would allow countries to fill the gaps in their public health systems – waiting lists in Australia could be reduced and a lack of medical or technical expertise could be overcome. However, Free Trade Agreements remain somewhat controversial and there could be unforeseen, negative consequences.
The key problem with the Trade in Services Agreement is that no-one really knows the specifics of the agreement. Few understand the laws around the ability of private companies to challenge governments if policy is not to their liking (such as tobacco companies), and how this could affect health policy more generally. Are we going to be paying private companies subsidies so they can compete on an equal footing with robust public health systems, such as Medicare? Due to the secrecy surrounding the agreement, no-one is sure.
It has been made public that Australia held firm on proposals by the Americans to extend the validity of drug patents, which would have made it difficult for cheaper pharmaceuticals to be produced and may have affected Australians' access to cheaper medications. As such, we can be fairly confident that the price of medication in Australia has not increased as a result of the agreement.
As for the unknowns, the most obvious is the impact on our own public health care system and patient safety considerations. If the ‘export’ health sector becomes more profitable, it could divert resources and staff away from our domestic system – although it's important to emphasise that the public has not been privy to the details of whether we're exporting our practitioners. We already have a problem with staffing in hospitals, particularly in regional areas. It could also mean that we start losing the benefit of the medical staff coming out of our universities, who may go where the money and resources are. Furthermore, there has been a lot of concern about how the agreement will affect health policy in developing nations, particularly around access to medications.
There may also be concerns about patient safety and a rise in ‘medical tourism’– it is difficult to harmonise and maintain standards across more than 50 different countries. What happens when things go wrong overseas? Will the domestic health system then have to foot the bill for the ongoing treatment and rehabilitation?
Without access to the full agreement, it is difficult for Australians to fully understand the implications of the Trade in Services Agreement on their health care system. However, ‘importing’ medical treatment to fill gaps in a country’s public health system seems to be putting the cart before the horse. Surely that money would be better spent investing internally to improve care?
Tom Ballantyne is a senior associate in Maurice Blackburn's Melbourne office.