How the World Trade Organisation is shaping domestic policies in health care

Lancet. 1999 Nov 27;354(9193):1889-92. doi: 10.1016/S0140-6736(99)11060-2.


High up on the agenda of the World Trade Organisation (WTO) is the privatisation of education, health, welfare, social housing and transport. The WTO's aim is to extend the free market in the provision of traditional public services. Governments in Europe and the US link the expansion of trade in public services to economic success, and with the backing of powerful medico-pharmaceutical, insurance, and service corporations, the race is on to capture the share of gross domestic product that governments currently spend on public services. They will open domestic European services and domestic markets to global competition by government procurement agreements, dispute-settlement procedures, and the investment rules of global financial institutions. The UK has already set up the necessary mechanisms: the introduction of private-sector accounting rules to public services; the funding of public-sector investment via private-public partnerships or the private finance initiative; and the change to capitation funding streams, which allows the substitution of private for public funds and services. We explain the implications of these changes for European public-health-care systems and the threat they pose to universal coverage, solidarity through risk-pooling, equity, comprehensive care, and democratic accountability.

MeSH terms

  • Delivery of Health Care / organization & administration*
  • Economic Competition
  • Europe
  • Health Policy*
  • Humans
  • International Agencies*
  • International Cooperation
  • Organizational Innovation
  • Privatization*
  • United States