Trade Minister Andrew Robb.
Trade Minister Andrew Robb. Photo: Sanghee Liu

Need a new liver?  Why not head to France. A hip replacement? Japan could be the place for you.

to a leaked document, the highly secretive Trade in Services Agreement
(TiSA) negotiations that will resume in Geneva on Monday will include
discussion of wide-ranging reforms to national public health systems to
promote "offshoring" of health care services. 

Tony Abbott and Joe Hockey have been saying
that healthcare expenditure is unsustainable, but Andrew Robb is quietly
engaged in negotiations that could potentially see scarce healthcare
dollars going overseas 

But health unions and trade experts say the
negotiations, which are being led by Australia, the US and the European
Union, could lead to massive growth of "medical tourism" to the
detriment of investment in Australian public hospitals and local

The leaked discussion paper – published by the
non-government organisations Associated Whistle-Blowing Press and Public
Services International – has for the first time revealed TiSA countries
including Australia are actively discussing measures to boost the
"cross-border delivery of health services".  


"Thanks to the secrecy that's surrounded these talks, we haven't
known what is being negotiated in our name, and the Australian public
haven't been aware of the potentially huge health implications," said
Michael Whaites, NSW Nurses and Midwives' Association organiser and

"Prime Minister Tony Abbott and Treasurer Joe Hockey
have been saying that healthcare expenditure is unsustainable, but Trade
Minister Andrew Robb is quietly engaged in negotiations that could
potentially see scarce healthcare dollars going overseas," Mr Whaites

"You can ask whether the government is working in a
co-ordinated manner, and indeed what is their real intention on the
future of Medicare?" 

The leaked "concept paper on health care
services within TISA negotiations," reportedly tabled by the Turkish
government  in negotiations in Geneva last September, argues there is
"huge untapped potential for the globalisation of healthcare services,"
creating massive business opportunities from what is a $US6 trillion
($7.7 trillion) per year industry. 

The proposed regime would
involve health professionals authorising patients to be treated in other
TiSA countries (for reasons including long waiting times in the home
country or inadequate expertise for specific medical problems); and the
patients's costs being reimbursed through their home country's social
security system, private insurance coverage or other healthcare

According to the Department of Foreign Affairs and
Trade, a further TiSA negotiation round in December 2014 made "good
progress" in dealing with issues that included "facilitation of patient

However, Professor Jane Kelsey, an expert on trade in
services at the University of Auckland, warned that
health-service-exporting countries such as Australia would find that
qualified staff are diverted to health export services "that often have
better pay and facilities, eroding the personnel base for public
facilities and perpetuating inequalities in the health care system".  

and training investments may also be diverted "to benefit foreign
healthcare users, rather than local citizens and taxpayers".  

countries including Australia, Canada, Japan, South Korea, Taiwan, the
EU (representing its 28 member countries) and the US are engaged in the
TiSA negotiations, which began in 2013. 

Mr Robb said the TiSA
will "strengthen job-creating services" and that the Australian
government wants an agreement "that supports each party's right to
protect public health".  

"As is common practice with many
negotiations on international treaties, draft negotiating texts of the
TiSA are not public documents," Mr Robb wrote in a letter to the nurses
and midwives' union.