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Trade ministries from the World Trade Organization's (WTO's) 144 member states are presently deciding which public services to open to foreign competition under the complex liberalisation rules of the general agreement on trade in services (GATS). A frequent criticism of the WTO system is that it reduces national autonomy over public policy. However, respect for national sovereignty is asserted in the GATS treaty. Here, we examine claims made by the WTO and others that GATS exempts public services and does not require their privatisation. We discuss trade treaty processes that can subject public services to commercial rules, the treaty's flexibility with respect to national autonomy, and the effect of GATS in situations in which national autonomy is not protected. We conclude that national autonomy over health policy is not preserved under GATS, and that accordingly, there is a role for international standards that protect public services from the adverse effect of trade and market forces. [ABSTRACT FROM AUTHOR]

The World Trade Organisation (WTO) is drawing up regulatory proposals which could force governments to open up their public services to foreign investors and markets. As part of the General Agreement on Trade in Services (GATS) negotiations, the WTO working party on reform of domestic regulation is developing a regulatory reform agenda which could mark a new era of compulsion in international trade law. Article VI.4 of the GATS is being strengthened with the aim of requiring member states to show that they are employing least trade-restrictive policies. The legal tests under consideration would outlaw the use of non-market mechanisms such as cross-subsidisation, universal risk pooling, solidarity, and public accountability in the design, funding, and delivery of public services as being anti-competitive and restrictive to trade. The domestic policies of national governments will be subject to WTO rules, and if declared illegal, could lead to trade sanctions under the WTO disputes panel process. The USA and European Union, with the backing of their own multinational corporations, believe that these new powers will advantage their own economies. Health-care professionals and public-health activists must ensure that this secretive regulatory reform process is opened up for public debate. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Examines the impact of decentralization of long-term health care programs in the United States and Great Britain. How management responsibilities have shifted in both countries to state and local government; Increased privatization; Final goal of policy changes; Details about the provision of care in both countries; Government policies and their effects.

The authors discuss the impact of the Health and Social Care Bill of 2011 on the National Health Service (NHS) in England. They note the bill's movement toward eliminating the NHS through the British Parliament, and facilitating the introduction of a U.S.-style health system. Moreover, the authors cite significant legal consequences of Bill which include weakening the accountability of the Secretary of State to Parliament for the provision of services to patients in the NHS.

The author reflects on the declined trust in the protection of confidential patient data in England due to recent breaches. He examines the Care Bill, the exceptions for uses of confidential patient data, and the 2012 Health and Social Care Act. He talks about the Health and Social Care Information Centre and the entitlement that allows sharing of patient data with private companies. Also included are three amendments recommended for the Care Bill.

Opinion. Focuses on the impact of the British government's private finance initiative (PFI) on the structure and operations of the National Health Service (NHS). Items of NHS expenditure eligible for PFI; Terms of the PFI capital costs agreements; Advantages to the NHS of transferring the risks of capital costs to the private sector.

Reviews four reasons why artificial intelligence systems have not fulfilled their promise of serving as a useful diagnostic aid in medical cases. The reasons emerging from a meeting of the American Association for Artificial Intelligence; The future of artificial intelligence, which may lie in reducing variation in the quality of medical practice and lowering its cost; View that artificial intelligence should streamline the management of most patients.

Reports that the greatest threat to nursing-home residents in the United States is the attempt by Congress to repeal the 1987 federal nursing-home regulations. What the regulations require; The Tenth International Case-mix Conference in San Antonio, Texas; International findings on caring for the elderly.

Looks at the research which shows how the United States (U.S) health-care industry is responding to budget cuts. United States Health Maintenance Organization's (HMO) realization; HMOs and providers diversifying into subacute care.

Reports on the holding of the 1994 International Conference on Strategic Issues in Health Care Management in Scotland. Theme of the conference; Disappointment of the British orientation of the meeting; Narrow range of participants; Obstacles to the patient advocate role; Role of the internal market in priority setting.

Examines a controversial draft European Union directive on health care. How the directive could alter health care in all 25 member states because of its potential to reduce the autonomy of each country in health care services; Efforts of Frits Bolkestein, the internal market commissioner, who has set out proposals designed to remove barriers to cross-border trade including everything from estate agencies to amusement parks, health care and social services; Concern that the directive will dilute the governments' powers to regulate business in their own territories; Content of the directive; Implications on national health care systems; Questions raised by the directive.