Transnational Provisioning and The Trading of Health-Related Services in the UK, India and China, 2019-2023

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This research was about the transnational engagements between wealthy countries and emerging economies and the relationship with commercialisation of healthcare. To explore this issue, used publicly available online resources to chart the activities of key organisations from the UK, India and China and their evolving international relationships. Then conducted conversations and interviews with a wide range of representatives from public and private organisations in the three countries. Three types of data are included in the deposit: 60 documents profiling relevant organisations or transnational projects and which were compiled from publicly available online sources; 19 documents with notes from conversations describing the activities of specific organisations; and 144 documents with notes from conversations about experiences and viewpoints on the activities and issues involved.

This study addresses the contemporary attempts by public and private organisations to position the UK within a globalised commercial healthcare economy. It asks how and why this ambition is being realised in England and in two major 'emerging economies' perceived as potential areas of market growth (India and China), and considers the implications for public or state-owned healthcare, health training organisations and healthcare users in the three settings. The study objectives are to: 1) describe and analyse the key drivers, actors, markets and supporting social and political infrastructures of commercialised transnational provisioning of healthcare; 2) investigate these and their everyday workings and moral economies through three detailed qualitative case studies of UK-India and UK-China healthcare provisioning in the areas of a) labour sourcing and processes, b) training and management consultancy and c) joint infrastructure ventures, and 3) consider the implications for healthcare planning and governance in the three countries, and communicate these to scholarly, practitioner, advocacy and policy audiences. The context for this research is a period of globalisation in which there have been significant changes in how service sectors are organised, and how public services are managed and provided. In the healthcare sector, there has been an increasing expansion of markets and of opportunities for investment in a global healthcare industry; greater cross-border consumption of healthcare, and increased consumer rights consciousness among patients. In England there have been cumulative market-based reforms to the structure of the National Health Service (NHS), while China and India have seen trade policy reforms, growth of specialist private hospital care and related diagnostic services, and expansion of fee-based provision. The run up to the UK's 'Brexit' departure from the European Union is posing new demands for recruitment of international staff, and public healthcare organisations are facing pressure to 'become more entrepreneurial' to cope with budgetary pressures. Labour markets in middle-income countries are proving a vital source of health workers - provisioned either by third-party commercial agencies or by private hospital chains - while the rising burden of non-communicable diseases amongst ageing and middle-class populations in China and India is driving new demand for healthcare services that offer potential new markets and sources of revenue for UK-based healthcare organisations, notably hospitals, insurance companies, professional bodies and university health schools. In what seems to be a significant step change for the 'NHS identity', marketing has begun with sights set on offshore provisioning to new audiences, primarily in these emerging economies. This project seeks to understand these new developments, which reflect wider global trends in commercialisation, labour markets and trade in social sector services. The case studies will include the transnational outsourcing of back-office administrative activities, training and management consultancies, and joint ventures for hospital development. It will explore projects between organisations in England and in Guangdong, Fujian and Jiangsu (China) and in Delhi, Andhra Pradesh and Maharashtra (India) examining all elements of the 'provisioning chain' from governance and financing, through to production, delivery of / access to healthcare facilities and services, and consumption. Our study findings will be important for raising public awareness and understanding in the three settings of the increasingly globalised nature of the healthcare economy, the types of changes being promoted, and their possible effects. Our public and policy engagement activities will aim to inform policy development within healthcare organisations directly, and also indirectly through engagement with local community organisations.