Exporting health care: the impact of free trade in health care

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 countrys 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 countrys 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.

TOPIC: Patient safety
RELATED LEGAL SERVICES: Medical negligence

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Tom Ballantyne

Maurice Blackburn Melbourne
Tom Ballantyne is a Principal in Maurice Blackburn’s medical negligence department. He is a Law Institute of Victoria Personal Injury Accredited Specialist who sees clients in Melbourne, Dandenong and Frankston. Tom joined the firm as a trainee lawyer in 2006, and has practiced exclusively in medical negligence claims since 2007. He also spent two years working in the United Kingdom. “I was led to practice law at Maurice Blackburn because I always wanted to work in an area that would make a difference to people. It’s rewarding to help people navigate a distressing and sometimes life-changing experience. I’m inspired by helping people achieve a measure of justice and financial stability.” Tom’s skills include running complicated litigation across all areas of health care – obstetrics, delay in diagnosis, orthopaedics and emergency departments. He has achieved significant results for clients including settling cases involving catastrophic injuries and lifetime care needs, and is one of three Maurice Blackburn lawyers listed by the prestigious Doyles Guide as a leading lawyer in his field. “I provide legal advice and act for people injured by malpractice and poor medical treatment, such as birth injuries, delay in diagnosis of cancer and other diseases, orthopaedic and other types of surgery, wrongful birth, catastrophic injuries, and fatal accidents." Tom also represents families at Coronial Inquests, acting on behalf of the families of people who have died following poor medical treatment. Tom also has a passion for promoting medical law issues in the community. He is the author of The Legal Prescription blog, which covers topical legal and medical issues. He has also been published in the Law Institute Journal. Memberships & accreditations Law Institute of Victoria Member Law Institute of Victoria Personal Injury Accredited Specialist Australian Lawyers Alliance State Committee Medical Negligence Representative Awards Doyles Guide - Medical Negligence Compensation Lawyer, Vic - Leading lawyer, 2016 ...

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