International Free Trade in Medical Care “TRADE CREEP” AND IMPLICATIONS OF THE TRANSATLANTIC TRADE AND INVESTMENT PARTNERSHIP AGREEMENT FOR THE UNITED KINGDOM NATIONAL HEALTH SERVICE Meri Koivusalo and Jonathan Tritter The ambitious and comprehensive Transatlantic Trade and Investment Partnership Agreement (TTIP/TAFTA) agreement between the European Union and United States is now being negotiated and may have far-reaching consequences for health services. The agreement extends to government procurement, investment, and further regulatory cooperation. In this article, we focus on the United Kingdom National Health Service and how these negotiations can limit policy space to change policies and regulate health services in relation to pharmaceuticals, medical devices, and health industries. The negotiation of TTIP/TAFTA has the potential to “harmonize” more corporate-friendly regulation, resulting in higher costs and loss of policy space, an example of “trade creep” that potentially compromises health equity, public health, and safety concerns across the Atlantic. Negotiation of the Transatlantic Trade and Investment Partnership Agreement (TTIP/TAFTA) between the European Union and the United States began in June 2013. The motivation for the negotiations is the expected economic benefit from increased trade on the basis of not simply removing tariffs, but essentially creating a transatlantic marketplace based on trade and regulatory cooperation. The contents of the negotiation mandate imply that the agreement would not only seek to deepen existing multilateral commitments in trade, but also to expand these in relation to government procurement, investment liberalization of trade and investment protection, and the enhancement of regulatory cooperation with a specific focus on pharmaceuticals and medical devices (1). International Journal of Health Services, Volume 44, Number 1, Pages 93–111, 2014 © 2014, Baywood Publishing Co., Inc. doi: http://dx.doi.org/10.2190/HS.44.1.f http://baywood.com 93