The growing international trade in health services has created several negative implications for health care systems. It promotes commercialization of health care and enhances the existing tiered health care systems. It stimulates external and internal migration of health workforces, both of which result in increasing inequity of health care access. It also enhances the erosion of ethics among health professionals, resulting in an increase in malpractice litigation. In this increasingly complex and dynamic situation, developing countries require strong national mechanisms with adequate capacity to effectively govern their health care systems. This is to ensure that the poor will not be deprived of access to essential health services.