Seminar on International Trade in
Services and TRIPS and Public Health
22 MARCH 2014
10:00 – 11:30 IBNOU SINA CONFERENCE HALL- FAIR GROUNDS
CASABLANCA, KINDGOM OF MOROCCO
Health
"
Sea Sand Scalpel and Safari : Medical
Tourism
the
new
face
of
International Trade in Health
Services"
By Carolyne Tumuhimbise
Trade Adviser- AUC
Tumuhimbisec@africa-union.org
Scope of Presentation
Examples of Health Services exports
Modes of Supply of Health Services: Focusing on
Consumption Abroad
Trend in Health Services exports
Examples of Health Tourism Exports in Africa
Challenges with Health services exports
Condition for Successful health services exports
Opportunities for developing Countries
Examples of health Services
Health Services include hospital services (i.e.
health services delivered under the supervision of
doctors ),
deliveries and related services, nursing services,
paramedic services, ambulance services and
residential health facilities other than hospitals),
other human health services (i.e morphological
or chemical pathology, bacteriology, virology
immunology etc) social services and
medical and dental services, veterinary services
and the services provided by nurses, midwives
etc. are grouped separately under “professional
services”. Under W120
What do we mean by "international
Trade in Health Services?"
The WTO General Agreement on
Services (GATS)- multilateral legal
framework for international trade in
nearly every type of service.
It also defines 4 modes under which
services can be traded i.e. Cross
border Supply (Mode1), Consumption
Abroad
(Mode
2),
Commercial
Presence (Mode 3) and Movement of
natural Persons (Mode 4)
Mode I ( Cross Border Supply)
Shipment of laboratory samples, diagnosis, and
clinical
consultation
via
traditional
mail
channels, as well as electronic delivery of health
services, such as diagnosis, second opinions, and
consultations.
Benefits: can enable health care providers to
cater to remote and underserved segments of the
population; help alleviate human resource
constraints;
enable
more
cost-effective
surveillance of diseases; improve the quality of
diagnosis and treatment; and help upgrade skills
through interactive electronic means.
Mode II ( Consumption Abroad)
"Medical Tourism" "Sea - Sand Scalpel and Safari"
This creates the most potential for
developement for developing countries.
"Patients without borders" a medical
traveler as anyone who travels across
international borders for the purpose of
receiving medical care.
USD 20-24bn and Approx. 8m patients
spending an average of USD 3,000-5,000 per
visit, including all medically-related costs,
cross-border and local transport, inpatient
stay and accommodations. Source "Patients
without Borders" 2013
Mode III Commercial Presence
●
●
Establishment of hospitals, clinics, diagnostic
and treatment centres, and nursing homes.
Corporate hospitals in developing countries are
also establishing commercial presence overseas.
For example AAR Services based in Kenya
with branches in Uganda and Tanzania, Life
Health care (formerly Afrox) in South Africa
with operations in Botswana and UK
Mode IV(Movement of Natural
Persons)
●
●
The movement of health personnel, including
physicians,
specialists,
nurses,
paramedics,
midwives, technicians, consultants, trainers, health
management personnel, and other professionals.
The biggest arguement agaisnt this mode of export
has been that brain drain feeds the health systems
of the North with skilled professionals
doesnt
contribute to the consolidation or development of a
productive export sector at the national level. Such
brain drain rather saps national capacity.
Most medical export services cover
specialised expertise like:
 Cosmetic surgery
Dentistry (general, restorative, cosmetic)
Cardiovascular (transplants)
Orthopedics (joint and spine; sports medicine)
Cancer (often high-acuity or last resort)
Reproductive (fertility, women's health)
Weight loss (LAP-BAND, gastric bypass)
Scans, tests, health screenings and second opinion
●
Body Contouring/reconstruction
Trends in Trade in International
Health Services M.II
●

Traditionally international health services have been south to
North, seeking treatment in developed countries where more
qualified staff and moreefficient structures provided healthcare
that was unavailable in theirhome countries.
In 2011, medical tourism contributed to 9% of the world’s gross
domestic product (GDP) of US$ 6 trillion. (CNN Travel 22 March
2013)
International trade in health services share in the world market
for tourism services rose from 1.2% in 1997 to 1.5% in 2010 (AfDB
2013)
In 2010, the apparent market share of the South reached 54%,
while that of the North was 46% ( AfDB - Economic Brief 2013)
Health Services Exports in Africa:
Medical Tourism countries in Africa include; South Africa, Tunisia,
Egypt, Morocco and Lybia
Tourism in Africa is comprised of Tourists from north and south
for example Africans comprised 2,196,000 medical visitors to
South Africa. They constituted nearly 80% of all medical tourists
to South Africa
African medical tourists mainly target Asia - India in 2012
generated over N 40.94 billion (US$ 260 million) from Nigeria’s
medical tourists alone (International Medical Travel Journal
2013)
Surgery in South Africa costs roughly a third of surgeries
performed the United Kingdom (UK). For example, a facelift in
Britain costs about GBP 9,000 (US$ 13,953), while the same
services in South Africa costs about ZAR 53,276 (US$ 5,428).(20) In
South Africa luxury hotel fees and tourist activities, such as a
post-op safari, are included in the price.
The Medical Tourism Association (MTA) of South Africa
promotes the industry and represents its value chain. This helps
ensure that services in the industry are consistent, standardised,
and integrated.
Africa cont....
●
It costs $3500-4000 for knee replacement surgery in
Tunisia and $40,000 in USA, $16000-17000-UK, $75009000 in France.
Tunisia, 84%of foreign patients came from neighbouring
countries in 2003 (70%in 2007); (AfDB 2013)
an estimate of approximately 37,000 jobs generated
directly by healthcare exports in Tunisia, including close
to 20,000 in subsistence and accommodation services,
close to 10,000 medical jobs (physicians, nurses) and
approximately 8,000 hospital support staff jobs
Popular services in Egypt’s medical tourism industry
include cosmetic surgery and dental work, in part due to
the country’s flourishing film industry and celebrity
aesthetics. Source Discover Medical Tourism)
Challenges with Medical services
Exports
Medical Dualism- Countries like South African
have managed to have a booming medical
tourism and still provide public health access
diversion of medical resources towards the
treatment of foreigners to the detriment
ofnational patients.
Brain drain
Incentives to invest in exporting medical
services can be geared towards public health
care
Barriers like regulations and standards
Factors that Create Health
Servicess Exports:
Government and
infrastructure
private
sector
investment
in
healthcare
Demonstrable commitment to international accreditation, quality
assurance, and transparency of outcomes
International patient flow
Potential for cost savings on medical procedures
Political transparency and social stability
Excellent tourism infrastructure
Sustained reputation for clinical excellence
History of healthcare innovation and achievement
Successful adoption of best practices and state-of-the-art medical
technology
Availability of internationally-trained, experienced medical staff
Potential for international health
Services Exports
Huge number of Africans and Arabs
leaving the continent indicate is an
opportunity for both African and Arab
countries to provide those services.
But there is need for a balance between the
direction towards health services exports
and public health care provision
Shukran