International Health Care Convergence: The Benefits and Burdens of Market-Driven Standardization

Abstract

For over thirty years, health scholars have debated whether health care policies are converging, or becoming more alike, internationally. Convergence theories have always been particularly appealing in health care. Most countries generally struggle with the same challenges: how to provide quality care, to as many people as possible, for a reasonable price. Moreover, modern scientific medicine has not only influenced how countries around the world provide and regulate health care, but has also driven rising patient expectations. These commonalities invite theories of convergence: If policymakers in different jurisdictions face similar challenges, why wouldn't they adopt roughly similar solutions?

In this article, I take the existing scholarship and form a new framework for understanding several recent international health care trends. Rather than focusing on policy convergence driven primarily by the public sector, I argue that the private sector is encouraging health care practices and standards to converge internationally.

I use recent trends to examine this framework, including: international physician and nurse migration; international standardization of medical education; the medical tourism phenomenon; and international trade and standardization of pharmaceuticals, devices, and medical technologies. I also examine various trends pointing towards increased privatization and commercialization - particularly among developing countries - and discuss the unique role that the United States and organizations like the WTO, World Bank, and OECD play in promoting these trends.

I conclude by examining the benefits and burdens of market-driven convergence, including the perils of commercialization, internal brain drains, and other phenomena that might warn against promoting convergence and privatization without some limiting mechanisms.

Keywords: health, policy, law, international, trade, medicine, convergence, medical tourism, pharmaceuticals, physician migration