WHO Measuring Trade in Health Services ETH/SDE Training Course on the Public Health Implications on Multilateral Trade Agreements and Public Health World Health Organization and the University of Lausanne Lausanne, 14-18 June 2004 Dr. Jens Gobrecht
What gets measured gets managed! What doesn't, doesn't!
If there is no data what development could be tracked? how could policies be adjusted? on what basis would you negotiate?
Trade in Health Goods
Trade in health Goods PCTAS-WHO Developed in collaboration between the International Trade Centre (ITC) and WHO Data of the PCTAS-WHO Database is based on the COMTRADE database of the United Nations Statistics Division (UNSD) Covers trade data on imports and exports from 1999 to 2002 WHO contributed a new categorisation of trade in healthrelated goods according to the needs of several departments in WHO This categorisation is now included as an integral part of the PC-TAS Database of ITC
PCTAS-WHO 1. Supplies and Disposables A. Medical Supplies (DD) B. Syringes, Needles and Catheters (DE) C. Medical X-Ray Films (DF) D. Contact lenses (DG) E. Surgical Gloves (DH) F. Clinical Thermometers (DI) 2. Small Devices/Equipment A. Medical. Surgical Sterilisers (DJ) B. Other Medical & Surgical Instruments (DK) C. Orthopaedic & Prosthetic Appliances (DL) D. Therapy Apparatus (DM) E. Dental Instruments & Appliances DN) F. Ophthalmic Instruments & Appliances (DO) 3. Major Equipment (Investment) A. Electromedical Equipment (DP) B. Medical X-ray, alpha, beta, gamma ray Equipment DQ) 4. Blood and Blood-products (DR) 5. Vaccines (DS) 6. Pharmaceuticals / Drugs (DT) 7. Contraceptives and Condoms (DU)
Trade in Health Services
Trade in Services 1999 cross-border trade in services amounted to 1350 billion US$ - this corresponds to 20% of total cross-border trade Service sector is the largest and fastest growing sector of world economy (WTO)
World Exports, 1980-2002 World exports of commercial services and merchandise, 1980-2002 Million dollars 7000000 6000000 5000000 4000000 3000000 2000000 1000000 0 Services Merchandise 1980 1983 1986 1989 1992 1995 1998 2001 Year
World Trade Increases Increases in world exports of commercial services and merchandise, 1980-2002, related to 1980 500.0 Increase in % 400.0 300.0 200.0 100.0 Services Merchandise 0.0 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 Year
Trade in Health Services There are very few empirical studies on the trade-impact on equity, access or quality in country health systems. There are no disaggregated data available on the amount on international trade in health services.
Trade in Health Services Trade in services is a relatively small sector compared to trade in goods BUT In the health sector trade in services is regarded as having by far the highest potential to grow
Trade in Health Services Growing trade in health services + Increasing globalization of economies and markets = Possible bigger impact on health systems and health services
Data
Why data on trade in health services? To inform governments and decision makers about the magnitude and the trends in trade of health related services. To assess the openness of a country for trade in the health sector. To assess the impact of multinational trade agreements (GATS) & increasing liberalisation of markets on the amount of trade in health related services and other variables (e.g. health and economy).
What Data Quantitative data! Figures and numbers that describe the magnitude of trade-flows of health services between countries
Criteria for Data Collection Policy relevant Collectable on a regular (e.g. yearly) basis to enable time lines and trends Least burdensome to collect Consistent and comparable across countries Consistent with international data collection mechanisms / standards.
Steps - to - take Development of a classification of health services Identification of appropriate indicators Identification of possible data sources Development of an international framework for data collection Helping countries to develop data collection mechanisms Initiating pilot projects in/with volunteer countries/institutions Collecting and analyzing data on the country level Compiling and processing the data on international level
Questions for Discussion What are Health Services? What are the appropriate indicators to measure trade in health services? Where and how can we get these data?
What are Health Services? Health-specific Service Sectors of the GATS Corresponding CPC 1 BUSINESS SERVICES Section B A. Professional Services h. Medical and dental services 9312 j. Services provided by midwives, nurses, physiotherapists and 93191 para-medical personnel 8 HEALTH RELATED AND SOCIAL SERVICES (other than those listed under 1.A.h-j.) A. Hospital services 9311 B. Other Human Health Services 9319 (other than 93191)
What are Health Services? ICHA-HP - CLASSIFICATION OF PROVIDERS OF HEALTH CARE HP.1 Hospitals HP.2 Nursing and residential care facilities HP.3 Providers of ambulatory health care HP.4 Retail sale and other providers of medical goods HP.5 Provision and administration of public health programmes HP.6 General health administration and insurance HP.7 Other industries (rest of the economy) HP.9 Rest of the world
Questions for Discussion What are Health Services? What are the appropriate indicators to measure trade in health services? Where and how can we get these data?
Questionnaire on Trade-Flows of Health Service according to GATS-Modes Developed in co-operation operation between WTO, OECD and WHO
Desirable Data Collection Table 1: Desirable Data Collection by Country Cross-border trade Consumption abroad Commercial presence Movement of natural persons Imports Exports Imports Exports Imports Exports Imports Exports Value of traded health services (e.g. ehealth, eeducation, transcripts of medical records, health insurance Country where service is provided Type of service (some health related services might be hidden within larger aggregates) Value of traded health services (e.g. ehealth, eeducation, transcripts of medical records, health insurance Country where the service is consumed Expenditure for traded health services in currency value (this data might need to be provided by the country providing the treatment) Number of patients Country of origin Type of treatment Expenditure for traded health services in currency value Number of patients Receiving country Type of treatment FDI Inflows (currency) Inward stocks (currency) Country of origin Type of investment FATS Value of turnover Turnover in host country as % of national total turnover of the respective industry Value added Country of origin of FA Number of employees of FA Employment of FA as % of total national employment in respective industry FDI Outflows (currency) Outward stocks (currency) Receiving country Type of investment FATS Value of turnover Turnover in host country as % of national total turnover of the respective industry Value added Country receiving FA Number of employees of FA (Employment of FA as % of total national employment in respective industry) Number of health personnel (inflows) Category of health professionals Inward stocks Inward stocks as % of national total Country of origin Duration of stay Value of remittances from foreign employees into their home country. Number of health personnel (outflows) Category of health professionals Outward stocks Outward stocks as % of national total Receiving country Duration of stay Value of remittances sent home by of domestic health workers employed abroad.
Cross-Border Supply - Mode 1 Imports/Exports Value of traded health services (e.g. ehealth, eeducation, transcripts of medical records, health insurance) Country where service is provided Country where the service is consumed Type of service (some health related services might be hidden within larger aggregates)
Consumption Abroad - Mode 2 Imports/Exports Expenditure for traded health services in currency value (this data might need to be provided by the country providing the treatment) Number of patients Country of origin Receiving country Type of treatment
Commercial Presence - Mode 3 Imports/Exports of Foreign Direct Investment (FDI) Inflows (currency) Outflows (currency) Inward stocks (currency) Outward stocks (currency) Country of origin and destination Type of investment
Commercial Presence - Mode 3 Imports/Exports of Foreign Affiliate Trade in Services (FATS) Value of turnover Turnover in host country as % of national total turnover of the respective industry Value added Country of origin of FA and receiving country Number of employees of FA Employment of FA as % of total national employment in respective industry
Movement of Natural Persons Imports/Exports Mode 4 Number of health personnel (inflows/outflows) Category of health professionals Inward stocks Inward stocks as % of national total Outward stocks Outward stocks as % of national total Country of origin/receiving country Duration of stay (plan/entitlement) Value of remittances.
Questions for Discussion What are Health Services? What are the appropriate indicators to measure trade in health services? Where and how can we get these data? Examples from YOUR country?
The End (Hurray!)