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South Asian countries are having a large intra-regional trade in health services. However, a large part of health services trade in the region is informal, whereas the formal health services trade, which is rather small in size, faces a large number of barriers—implicit or otherwise.
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Interestingly, multilateral liberalization of trade in goods has taken place for the last half century. However, liberalization of trade in services began only in 1994 with end of Uruguay Round. The General Agreements on Trade in Services (GATS) is the first and the only set of multilateral rules covering international trade in services. The agreement was concluded at the Uruguay Round (1986–1993). It came into force in January 1995. The GATS sought to gradually liberalize and expand trade in the service sector. It had a “built-in agenda” mandating members to kick off progressive liberalization negotiation on services from January 2000. The Guidelines and Procedures of Negotiations were adopted by the Council for Trade in Services on March 2001 as provided in the GATS Article XIX: 3; see Kelegama (2009).
The rising competition for foreign patient has been accompanied by initiatives in the marketing of medical institutions. Such initiatives, sponsored by governments, universities or private firms, consist of dissemination of information on the institutions and patients. For example, the so-called health tourism fairs are one of the most common mechanisms used by governments and institutions, either directly or through marketing agencies. Likewise, a telemedicine link has been established between Apollo Hospitals at Hyderabad, Delhi and Chennai in India and Lahore Medical Imaging Center, Lahore in Pakistan. This is the first telemedicine link between India and Pakistan. Such kind of link is an excellent effort, which will go a long way in bringing together the medical community and people of the two countries. This will enable people of Pakistan to have easy access to specialists and superspecialists without travelling to India. The telemedicine link has been launched in a move to facilitate exchange of medicare and health facilities at reduced cost in South Asian countries. The Apollo Telemedicine Networking Foundation has also established telemedicine centres in Nepal and Sri Lanka.
A good number of patients come to India from Bangladesh, Nepal, Bhutan, Sri Lanka, Pakistan and Afghanistan for medical treatment every year. Likewise, many patients come to Pakistan from Afghanistan for the medical treatment. Lack in domestic health infrastructure forces the Bangladeshi patients to move to India for treatment. In general, Mode 2 (consumption abroad) is the most popular mode through which trade in health services has been taking place between the two countries.
For instance, in an effort to enhance domestic capabilities in medical services as well as reduce foreign exchange costs derived from outflows of patients, several Asia Pacific countries are allowing foreign medical institutions to establish “local branch campuses” or “subsidiaries”. For example, India’s Apollo Group has opened branches in Bangladesh and Sri Lanka, and Escorts Heart Centre in Bangladesh, Nepal and Sri Lanka.
International trade in health services focuses on the mobility of patients; no comprehensive information on the movement of medical professionals is adequately available. A similar lack of information exists in relation to cross-border supply of medical education services. As mentioned, ample demand for health services, triggered by the needs of the labour market, and the emergence of new technologies are rapidly expanding the market share of telemedicine. Such an expansion is likely to have a growing international component, but its potential for changing the current patterns of trade in the sector is difficult to assess at this stage.
A recent estimate of Bangladesh Investment Development Authority reveals that Bangladeshis spend $2.04 billion annually on health care abroad. The amount is estimated to be 1.94% of the country’s GDP; see https://www.dhakatribune.com/feature/health-wellness/2017/11/30/doctor-trust-bangladesh.
The STRI methodology which translates qualitative information on services barriers into an aggregated quantitative score by sector is based on four modes defined by the GATS. This categorization also allows one to capture the issue of complementarity and substitution between modes. The authors have gathered qualitative information through questionnaires completed by government agencies and various country reports that are available in the region as well as supplementary research. The qualitative information has been used to determine the values of the different components of the sectoral aggregate and modal indexes. The weight of each component has been determined through pair-wise comparison. The transition from qualitative to quantitative analysis involves many benefits, but is not without risks. The two main benefits of synthesizing qualitative information in a quantitative index are first, to enable the comparison of restrictions across countries at the sectoral level, and second, to determine the impact of barriers on trade in services and on different variables of economic performance. This provides a more objective basis for domestic policy debates, as well as for bilateral, regional and international negotiations through more transparent evaluations of reciprocity in concession-making. The main risk, however, of such an exercise is that a traditional researcher faces when moving from qualitative information on policy to a synthetic quantitative index: some dose of subjectiveness. The methodological improvements proposed by researchers on these subjects such as the use of pair-wise comparison techniques try to minimize the subjectivity.
- Springer Singapore
- Chapter 1
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