SERVICES: SECTOR BY SECTOR
Health and social services
International trade in health services is growing in many areas. Health professionals are moving to other countries, whether on a temporary or permanent basis, usually in search of higher wages and better working conditions. There have also been notable increases in foreign investment by hospital operators and health insurance companies in search of new markets. In addition, more and more countries are seeking to attract health consumers from other countries.
Health and social services includes hospital services (i.e. health services delivered under the supervision of doctors), other health services (i.e. ambulance services and residential health facilities), social services and “other” health and social services. It does not include medical and dental services, veterinary services and the services provided by nurses, midwives etc., which are grouped separately under “professional services”.
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Current commitments and exemptions
Health services is one of the least-committed sectors. Less than 50 WTO members (the EC-27 counting as one) have undertaken commitments in one of the four health services sub-sectors; most of the commitments concern hospital services. The level of commitments in relevant health-related professional services is in the same range.
With the development of tele-medecine (medical services provided via telecommunications), cross-border supply of services (Mode 1) is of increasing importance. Nevertheless, there are fewer commitments for Mode 1 than for any other mode.
Some countries view the treatment of foreign patients entering their territory (Mode 2) as offering interesting opportunities for economic development. As in other sectors, Mode 2 commitments tend to be rather liberal as most governments have limited ability to prevent consumers from seeking medical treatment abroad.
Mode 3 commitments (a foreign company setting up subsidiaries or branches to provide services in another country) offer an interesting avenue for countries wishing to encourage foreign investment in the health sector. Over 40 members have made commitments, often subject to restrictions, such as economic needs tests (a test using economic criteria to decide whether the entry into the market of a foreign firm is warranted on economic grounds), and limitations on the share of foreign capital.
Overall, Mode 4 commitments (movement of natural persons) remain limited in scope in this as well as in all other service sectors.
Only one exemption to most-favoured nation (MFN) treatment (i.e. non-discrimination) has been taken in this sector.
For consolidated information on countries’ commitments and exemptions on health and social services go to the services database. If you are seeking the commitments of a specific WTO member, go to “Jump to a specific sector for a given Member”, select health and social services from the sector dropdown list, select the Member of interest and click “go”. To see a table showing which Members have made commitments in health and social services choose “See which Members have made commitments in a specific sector”, select Health and social services and click “go”.
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Health and social services have attracted very limited attention in the services negotiations, which began in January 2000. It is the only major sector where no negotiating proposal and no collective request have been tabled.
In the Special Session of the Council for Trade in Services, some members have identified the removal of limitations relating to non-portability of insurance schemes under Modes 1 and 2 as objectives for the market access negotiations in this sector (TN/S/23).
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Some useful links and other resources
WHO-WTO (2002), “WTO Agreements and Public Health — A Joint Study by the WHO and the WTO Secretariats”.
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