International Trade in Services.pdf - DSpace at Khazar University

Health without Borders 123
population (recipients of the remittances) and, hence, public health. The benefits
for the exporting country’s health system are indirect only. Temporary movement
abroad provides local health care providers with a number of opportunities,
including access to training, new technologies, acquisition of additional skills and
specialization, and so on. Upon their return to their origin countries, these service
providers will help the local population (and their local colleagues) benefit from
the skills acquired abroad. Given the rapid evolution in medicine, these movements
across borders are particularly important to the sector.
The potential risks associated with health service exports
and the measures to mitigate them
The risks associated with exports in health services largely mirror those described
above for imports. They can therefore be quickly reviewed.
For Modes 1 and 2, the main risk is the diversion of scarce human and financial
resources to health care services entirely dedicated to the treatment of foreign
patients. The case of Thailand reveals that an additional 100,000 foreign patients
seeking medical treatment in the country could lead to an internal human
resource drain of 240–700 doctors (box 4.7). Exports of health services therefore
represent a challenge to the objectives of universal access and equity of access to
quality health services. The internal human resource drain also represents a loss of
public investment in medical education and training. Potentially, the richest local
clientele are also diverted to these high-end health care service providers to the
detriment of the profitability and sustainability of the public health sector. As suggested
in the case of Thailand, however, a number of accompanying policies could
help minimize these diversion risks, including through the cross-fertilization of
public and private health initiatives.
The risks associated with exports under Mode 4 primarily depend on the intentions
of the migrants. While the flow of expertise should be encouraged (Mode 4,
as a regulated scheme for the temporary movement of personnel, is a factor in the
flow of expertise), the human resource drain could have dramatic effects on local
public health. Opportunities for individuals can translate into losses for a society.
This is particularly true in the health sector, where medical density dramatically
varies across countries and across regions within countries. Well-regulated trade
under Mode 4 should contribute to preventing the human resource drain because
nothing can prevent people from leaving a country. (Agreements on Mode 4 can
include a scheme to foster the return of migrant workers.) Some countries, such as
the Philippines, have introduced special curricula and created private schools to
train nurses desiring to move abroad. The benefit of such schemes is to limit the
losses (in terms of education) and avoid diverting the local supply of health care