Transatlantic Trade and Investment Partnership (TTIP)

What is TTIP?
The Transatlantic Trade and Investment Partnership is a proposed free trade agreement (FTA) between the EU and USA. As a bi-lateral trade agreement, TTIP is about reducing the regulatory barriers to trade for large businesses, things like food safety law, environmental legislation, banking regulations and the sovereign powers of individual nations.

Why are so many organisations concerned about free trade agreements such as TTIP?
Since the start of TTIP negotiations in 2013, there have been concerns about the transparency of the process. Concerns have been expressed that public services, particularly health services, could be at risk of privatization.

The European Commission has stated that public services will not fall within the scope of TTIP but many organisations, including the CPME, UEMO and WMA remain unconvinced that the provisions to exclude public services will be sufficient.

TTIP will also seek regulatory convergence between the EU and the USA. In many areas the regulations in the US are much less strict. Food safety is one example of this: 70% of all processed foods sold in US supermarkets now contain genetically modified ingredients. By contrast the EU allows virtually no genetically modified foods. There is also a risk to job security and an increase in unemployment within the EU as jobs switch to the USA where labour standards and trade union rights are lower.

What are the particular concerns for health care provision across Europe and the medical profession?
One of the main aims of TTIP is the introduction of Investor-State Dispute Settlements (ISDS). This will allow companies to sue governments for compensation if they believe that policies have a negative impact on their investments.

This raises two serious concerns

  1. If, once a public service has been privatised, it would not be possible to return that service into public control due to the large sums of compensation that would be involved. Any move from public to private would be irreversible
  2. Businesses who successfully claim that legislation has damaged their profits could be owed  millions of Euros in compensation.

EU member states’ freedom in how they choose to regulate their healthcare services could be restricted by the potential liability under the ISDS provisions.

Exclusion of healthcare services from TTIP
TTIP questions the rights and regulations established by European Union legislation and Member States’ laws regulating healthcare and healthcare systems. In particular it subjects Member States to potential challenges by governmental bodies or investors through the proposed investor-to-state dispute settlement mechanism.  CPME, UEMO and WMA have been calling for TTIP to explicitly acknowledge that trade or investment should not be encouraged by lowering standards, policies or legislation at EU or national level that are aimed at safeguarding high quality healthcare and healthcare systems. TTIP should not deter the EU or Member States from maintaining existing, or adopting new standards, policies and legislation. Public healthcare services can only be protected by excluding them from the scope of TTIP.

Further considerations for the healthcare profession
One of the objectives of TTIP is to remove unnecessary barriers to trade. Current proposals imply that this could include extending cooperation between the EU and US through developing new structures and processes for mutual recognition across a number of different sectors. Concerns have been raised by a number of different European sectoral organisations. The main reasons for concern are that legal, regulatory and safety standards differ greatly between the European Union and the USA across different sectors. Mutual recognition for doctors would make it easier for doctors qualified in the EU to work in the USA and this is attractive. However, there is considerable variation in the content and standard of medical training from state to state in the USA. Finding an agreement that would cover all doctors qualified in the USA would risk lowering standards to match the state with the lowest standards. In some states the requirements for training are less than those outlined in the Mutual Recognition of Professional Qualifications Directive. Firstly, it is necessary to identify whether the systems are compatible before steps are taken towards mutual recognition. Doctors across Europe have been raising concerns, since 2014, regarding the inclusion of public healthcare services in TTIP because of the risks to the provision of high quality care and healthcare services.