International Trade in Services.pdf - DSpace at Khazar University

102 International Trade in Services
The difficulties in sustaining public health insurance schemes, the aging of the
population, and related supply bottlenecks in the health system are among the
drivers of frustrations and outbound medical tourism in the North. Most developing
countries face far more critical health issues, including critically low medical
density and the poor quality of the infrastructure and services, which, combined
with other factors, result in poor public health and higher mortality rates. In all
these countries, trade in health services should be seen not only as a source of
income in the balance of payments, but also as a primary means to remedy shortages
and improve domestic health systems. Therefore, the main challenge will be to
find adequate accompanying policies that maximize the positive domestic spillovers
and minimize the negative domestic spillovers of trade in health services.
The media and many expert studies have focused mainly on North-South trade
(in the case, for example, of the movement of patients) or South-North trade (in
the case, for example, of the movement of doctors and nurses). The potential of
South-South trade has often been ignored or neglected, in sharp contrast with the
reality of trade. In Tunisia, for example, Libyans represent more than 80 percent of
the foreign medical patients; similarly, more than 80 percent of the Omani
patients treated abroad go to India. There is a case for more cooperation in the
South. This may involve the creation of regional health centers of excellence (for
medical education or treatment) that would help in spreading out the cost of
medical education and infrastructure and in reaching a critical mass for writing
off investments in technologies.
Objectives and outline of the chapter
A number of studies and volumes have been published that cover the trade in
health services extensively (see, for example, Blouin, Drager, and Smith 2006). The
scope of this chapter is more modest. It is an effort to summarize existing knowledge
and to select the most relevant information to help individuals or organizations
involved in the design of health or trade reforms and policies so that they
may understand the potential benefits and risks of trade in the health sector, as
well as ways to maximize the former and minimize the latter. It is designed to
assist nontrade (health) experts in understanding how trade can help improve
health systems and the access to health services and to assist trade specialists in
understanding the specific characteristics of the health sector.
The second section explores what a country could expect from increased
imports or exports of health services and suggests accompanying policies aimed at
maximizing the benefits and minimizing the costs of liberalization. Thereafter,
strategies are outlined that may foster trade in the health sector and combine
domestic reforms and offensive trade negotiations.