A leaked paper from trade negotiations being conducted by the US, EU member states, and almost two dozen other countries has raised concerns that the Trade in Services Agreement (TISA) could be used to privatize healthcare systems around the world.

The document was published Wednesday by an international non-profit called the Associated Whistleblower Press, which claims that it came from the Turkish government and was discussed by EU officials last September in Geneva.

A call to the press office of the Turkish embassy in Washington went unanswered. The US Trade Representative did not respond to a request for comment at the time of publication.

Odile Frank, a healthcare expert at the France-based global trade union Public Services International, told AWP that the proposal “would raise health care costs in developing countries and lower quality in developed countries in Europe, North America, Australia and elsewhere.”

Of note, the paper bemoans the lack of market mechanisms in determining how health services are allocated. It says the health sector has “played only a very miner [sic] role in international trade…because the health care services is [sic] funded and provided by state or welfare organizations and is virtually no interest for foreign competitors due to the lack of market-oriented scope for activity.”

“Other than the nature of the health care sectors, there are also regulatory and structural access barriers suppressing the potential volume of trade in health services,” the proposal continues. “In short, there is a huge untapped potential for the globalization of healthcare services even though it is being reflected in the growing cross-border delivery of health services through movement of consumers (patients), personnel or by electronic means.”

The two-page paper concludes by calling for a health services annex to TISA which would facilitate the logistics and financing of medical tourism.

While it notes that “health is not a typical commodity or service but a public good” and that the end result of trade negotiations “should be compatible with other legitimate social objectives like universal access,” a legal expert who reviewed the Turkish proposal dismissed the good intentions.

“What would ultimately matter in TISA is the legal text itself, irrespective of the explanations,” University of Auckland Law Professor Jane Kelsey said.

Kelsey also noted that while the paper says trade reform is needed due to service shortages, the policy could result in further investment deficiencies—in countries that would both import and export patients.

“Money is drawn out of the national health system, whose low level of investment is cited as one of the rationale for offshore treatment, and makes the problem selfperpetuatig [sic],” she remarked.

Monitoring and compliance after procedures could also be problematic, she said, as could autonomy over healthcare policy and any bid to change it after agreeing.

Kelsey also noted that state-state and investor-state dispute settlement mechanisms would almost certainly complicate healthcare regulations. The latter could allow companies to claim that a policy change “impacted adversely on its profitability, or took away its business altogether” forcing the national government that hosted it to “face an investment claims for many millions of dollars.”

In December, The Sentinel reported on previously leaked TISA documents published by AWP, which purported to show that the deal could hinder regulatory enforcement, privacy protections, and Net Neutrality regulations.

Preliminary negotiations over TISA launched in February 2012. In addition to the US, EU member states and Turkey, parties to the talks now include Australia, Canada, Chile, Colombia, Costa Rica, Hong Kong, Iceland, Israel, Japan, Liechtenstein, Mexico, New Zealand, Norway, Pakistan, Panama, Paraguay, Peru, South Korea, Switzerland, and Taiwan.

Read the leaked paper here.

Read Kelsey’s analysis here.