1. The globalization of health care Alessandro Scancella Pierre-Yves Ecoeur Jean-Benoît Mulliez

2. What is globalization of health care? It is a trade of:It is a trade of: Goods: medicines, vaccines and other health technologiesGoods: medicines, vaccines and other health technologies Services: movement of health professional, patients, health related investments and supply of health care services across countriesServices: movement of health professional, patients, health related investments and supply of health care services across countries Intellectual propertyIntellectual property Dr Mirza, regional adviser for the world health organization, extracted from « the foundation for health and wellbeing international conference on primary health care »

3. Trade of professionals Two main flows:Two main flows: People from less developed country going to richer country to settle and graduate with professional credencies.People from less developed country going to richer country to settle and graduate with professional credencies. Richer countries recruiting people from poorer ones to face the demand. Example of Polish degree recognition in FranceRicher countries recruiting people from poorer ones to face the demand. Example of Polish degree recognition in France

4. Trade of patients Also called medical tourism, it is becoming a tendency to go abroad for surgery.Also called medical tourism, it is becoming a tendency to go abroad for surgery. Quality of the service (example of American couples)Quality of the service (example of American couples) Price of the service (example of India or Hong Kong where a save of 85% can be reached) (the economist)Price of the service (example of India or Hong Kong where a save of 85% can be reached) (the economist) This represents 3 million people (rapport Deloitte” consumers in search of value” 2008)This represents 3 million people (rapport Deloitte” consumers in search of value” 2008)

5. Trade of Services high level service (specialist that have been trained in place like US or UK; other country as Singapore have local medical school considered some of the best in the world)high level service (specialist that have been trained in place like US or UK; other country as Singapore have local medical school considered some of the best in the world) Outsourcing: Diagnostic procedures as MRI scans,( ex… It is possible to send images over internet to Indian radiologists that could interpret then. A radiologist in India earn 1/10 of a US one)Outsourcing: Diagnostic procedures as MRI scans,( ex… It is possible to send images over internet to Indian radiologists that could interpret then. A radiologist in India earn 1/10 of a US one) Medical treatment (e.g...in 2007 750000 Americans left the US for medical treatment)Medical treatment (e.g...in 2007 750000 Americans left the US for medical treatment) Remotely controlled long distance surgeryRemotely controlled long distance surgery

6. Trades of goods tools tools medical equipment (technologies)medical equipment (technologies) Medicine ( but here we have more barriers across different country so different law)Medicine ( but here we have more barriers across different country so different law)

7. From an ethical point of view… Issues raised about medicinesIssues raised about medicines The « always lower prices » idea is threatening the pharmaceutical labs. Some fake medicines factories have been discovered in China that were providing either non- working or harmful medicines.The « always lower prices » idea is threatening the pharmaceutical labs. Some fake medicines factories have been discovered in China that were providing either non- working or harmful medicines. The price of medicines is established by pharmaceutical manufacturers (GSK, Pfizer, Sanofi-Aventis…) to ensure the R&D funding for research on other molecules.The price of medicines is established by pharmaceutical manufacturers (GSK, Pfizer, Sanofi-Aventis…) to ensure the R&D funding for research on other molecules. Lower prices means lower R&D funds and therefore a concentration on best-seller medicines (anti-fat pills for example)

8. From an ethical point of view… Issues raised by the displacements of populationIssues raised by the displacements of population Citizens of countries where health care is « cheap » may be « over passed » by rich people from abroadCitizens of countries where health care is « cheap » may be « over passed » by rich people from abroad No a common framework about healthcare qualityNo a common framework about healthcare quality Negative impact on employment in the health care sector of the rich countries who export their patients.Negative impact on employment in the health care sector of the rich countries who export their patients.