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This book observes that an in-depth study exclusively focusing on health service trade not only strengthens the overall services trade capacity of the South Asian region, but also promotes global as well as regional trade. There is a dearth of analytical research on estimating barriers to trade in health services, particularly in the context of South Asia, and as such, this book assesses the potential benefits and economic costs of barriers to trade in health services in select South Asian economies. It also analyzes the impact of liberalization and regulatory reforms on economic welfare. It broadly addresses issues relating to trade in health services, the GATS (General Agreement on Trade in Services), such as: Why are the current levels of trade in health services low? How will the GATS legally affect a country’s health policy? What effect might liberalization have on national health systems? And what are the likely benefits of greater trade in health services? It also provides specific answers to the following questions: Does the substantial role of the government in health – as health service provider, financial supporter, regulator and promoter – have implications for the treatment of the sector under the GATS? What is the impact of liberalization of international trade in health services on the quality and availability of health services in developing SAARC countries? Given the importance of consumption abroad for trade in health services, and the gradual opening of health markets through Modes 1 and 3 (cross-border supply and commercial presence), how can problems associated with trade in these Modes be prevented? And are these problems sufficiently addressed by GATS disciplines? Answers to these questions will be of great use to researchers, policy makers as well as practitioners and NGOs of South Asia.



Chapter 1. Introduction

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.
Arindam Banik

Chapter 2. Demystifying Catastrophic Expenses in Indian Healthcare Sector

India has started taking initiatives for Universal Health Coverage, which focuses on access to healthcare as well as financial protection. But out of pocket expenses on health still remains high. The chapter tries to find out the implications of high incidence of catastrophic expenditure and the role of the government. The analysis indicates that learning from the experiences of low income and developing countries, India may think of providing primary healthcare for free for all and creating “community health workers”. Thus, India may achieve better health outcomes and reduce the incidence of catastrophic health expenses.
Paramita Mukherjee

Chapter 3. Health Sector in Bangladesh

With an overview of the health service sector of Bangladesh, this study focuses on health service trade in Bangladesh and possible regional cooperation to enhance health service trading in the South Asian Association for Regional Cooperation (SAARC) region. Health Care seeking behaviour of the Bangladeshi patients are examined using Mean Score of Relative Importance (MSRI) analysis. Health service trade in Bangladesh under four modes are also examined. This study also addressed the prospects and challenges associated with health service trade.
Sheikh Md. Monzurul Huq

Chapter 4. Health Sector Scenarios in Sri Lanka: Policy Designing and Implications

In the year 2005, WHO adopted the resolution that all countries across the globe should start extending and facilitating access to all essential health services to all its citizens so that catastrophic health shocks are completely eliminated from the economies. While the MDGs emphasised on piecemeal steps towards achieving small target indicators such as MMR and IMR, SDGs take a holistic approach; therefore, targets before the countries have become more stringent. From governance point of view, the most critical step lies in defining “all essential health services’’, which WHO has enlisted, which is suggestive in nature since regions and countries do vary in terms of the type, severity and extent of diseases that they are exposed to, and the kind of health concerns that they already have. The landmark report of WHO released in 2010 [Health systems financingthe path to universal coverage] mentions that health financing is a major concern and a big hindrance in achieving UHC, especially in the low-income countries.
Sahana Roy Chowdhury

Chapter 5. Health Sector Scenarios in Pakistan: Policy Priorities and Challenges Ahead

The need for an affordable and accessible and equitable health care of a given quality is one of the key ingredients for inclusive development for any country. The disease burden is unpredictable and uncertain and can also impact the vulnerable and the poor at the margin very catastrophically. Despite the challenges faced by the government in providing accessible health care to the people, there have been commendable achievements in the health sector in Pakistan.
Gaurav Kumar Jha, Sahana Roy Chowdhury

Chapter 6. Health Services in Nepal

This case study analyzes the trade in health service in South Asia through Nepal’s perspective. Nepal is a landlocked least developed country (LDC) in South Asia. The Government of Nepal is cognizant about the benefit of global economic integration. In 2004, the country is acceded to the World Trade Organization (WTO) through the normal process of accession. In the same year, it also joined the regional trading agreements such as the South Asian Free Trade Agreement (SAFTA) and the Bay of Bengal Initiative for Multi-Sectoral Technical and Economic Cooperation (BIMSTEC). Further, the country has a bilateral preferential trade agreement with three countries (India, Tibet, and Pakistan).
Bhuban B. Bajracharya

Chapter 7. India: Emerging as Major Destination of Quality Healthcare Services

A survey of 190 patients who had come to India from other South Asian countries to avail of medical services was conducted during the period of 1914–1915 to understand the trade-related barriers and their effect on actual patients. This chapter captures the essential aspects of the survey.
Arindam Banik, Pradip K. Bhaumik

Chapter 8. Summary and Conclusions

Healthcare policymakers in South Asia struggle with the conflicting goals of providing ready access to medical care with rising costs. The challenges are particularly acute where outcomes are uncertain, and there exists poor quality of treatment in the respective countries due to underdeveloped health infrastructure. To investigate the impact of these, this study is aimed at understanding the structure of health services and their assessments. The study has also evaluated the economic costs of barriers to trade in health services in select South Asian economies such as Bangladesh, India, Pakistan, Sri Lanka and Nepal based on primary survey.
Arindam Banik


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