International Trade in Services.pdf - DSpace at Khazar University

Health without Borders 135
• Conventions on the education and training of medical personnel that encourage
the temporary crossborder movement of health personnel.
• Bilateral and regional free trade agreements: An increasing number of free
trade agreements cover health services, such as the most recent Economic Partnership
Agreement between the European Commission and the Caribbean
region. 6
• Bilateral investment treaties: This mushrooming category of agreements could
also be directly relevant to the trade in health services under Mode 3.
The conclusion of a bilateral or regional trade agreement is not a guarantee of liberalization
or deeper market access in partner countries. The flexibility that has
led to the success of these agreements also constitutes their weakness because a
number of exceptions could be carved out in each sector that potentially nullify or
impair the general commitments of the partners. The level of implementation of
the agreements also varies significantly from case to case. The example of the
Morocco–United States free trade agreement in table 4.9 illustrates how health
services could be subject to many more exceptions than other service sectors. It is
often the case that health is excluded from bilateral or regional negotiations, such
as in the context of the Union for the Mediterranean (the Euro-Mediterranean
Partnership).
In addition to these state-to-state agreements, a number of arrangements that
also facilitate trade could be concluded between public and private institutions or
among private institutions. Typically, hospitals or universities conclude twinning
agreements with counterparts abroad that include provisions on the exchange of
health personnel for training or education purposes. Depending on the public
authority delegated to them, professional associations in the medical profession
can also agree on the mutual recognition of diplomas and qualifications with foreign
counterparts. The involvement of private insurance networks in health insurance
conventions could help remove the ultimate obstacle to trade in health services:
the absence of health insurance portability.
Finally, regional cooperation is a potential solution to some health care shortages
and can mitigate some of the risks associated with increased trade. For
instance, the development of health centers of excellence in Africa could help
neighboring countries share the cost of medical education and infrastructure
investment.
Multilateral initiatives and agreements
A vast literature exists on health services, the GATS, and multilateral trade negotiations.
It is not the purpose of this chapter to analyze the GATS provisions pertaining
to health or the World Health Organization (see Blouin, Drager, and