Mode 1 & 2 to see higher synergies in exports

In healthcare exports, Mode 1 & 2 could see higher synergies

Dr. Pralok Gupta, Associate Professor, Centre for WTO Studies & Member, Committee for Advanced Trade Research, TPCI, talks about India’s prospects for healthcare services exports.

IBT: How do you see the change in global approaches to healthcare infrastructure and capabilities post the pandemic experience?

Dr Pralok Gupta: Health service providers are focusing more and more on online delivery and use of telemedicine and digital tools. Also, there is an increasing focus on supply chain issues – building more resilience, developing stocks of critical inputs like oxygen, testing equipment, etc.

In such situations, supply chain issues move beyond the domain of healthcare providers and become more public policy issues. The government is actively involved in creating capacities, like developing dedicated plants for oxygen, increasing the supply of certain imports or creating manufacturing avenues for some of the critical inputs. For instance, in India, we are making dedicated efforts to reduce our reliance on APIs.

In developed countries, there are shortages of healthcare service providers. So, they are relaxing their norms to attract talent from other countries, at least for key areas and skills. We must note, however, that mobility is a very sensitive issue for developed countries, so they constantly review the relaxation for medical professionals as well.

IBT: How do you see India’s healthcare services export composition changing?

Dr. Pralok Gupta: India has done remarkably good in Mode 2 or medical tourism, except for the pandemic years. It is likely to revive now as the fear of COVID comes down and normalcy get restored. The other one is Mode 4. Some countries have relaxed their norms to allow doctors, nurses, etc. But it’s kind of a nuanced relaxation for certain key professionals. We need to analyze what kinds of relaxation is being given and proceed accordingly.

And the third change is Mode 1 or online delivery of services. In the pre-pandemic world, it was not that prominent. But now it has gained traction both in domestic and international contexts.

Mode 1 has an important role to play in revival of Mode 2 as well. For instance, consider somebody is having a kidney transplant in India. It requires continuous attention for a prolonged period of time and follow up on aspects like medicines and precautions. But it may not be possible for the foreign patient to visit India again and again. This is where Mode 1 would be very helpful.

The critical aspects of treatment where doctor-patient physical interaction is important, can be done when the patient is coming to India (Mode 2). But post-operative follow up can be taken care of by online follow-up/telemedicine (Mode 1).

But the challenge here is that in some countries, Mode 1 requires certain kind of data flow regulations also, so data protection, sharing and privacy issues come into play. Some countries may have stringent data protection requirements, which India may not be able to follow, like EU, which will make data sharing difficult.

IBT: Are we able to utilize our commitments in existing FTAs effectively? What should be the approach to future FTAs?

Dr. Pralok Gupta: Generally, there are not very significant or very liberal commitments in health care services across FTAs that India has signed so far. And usually, countries are a bit apprehensive on committing on sensitive sectors like health care. But having said that, in some FTAs, for example, in Singapore, we had very good commitments wrt MRA for nurses, dentists and medical professionals.

As far as realization of commitments is concerned, it’s been a mixed success. For dental services, we could not get an MRA still, though there was a timeframe for that in the agreement itself of three years. It was signed in 2005, but now we are in 2022. For nursing services, however, we were successful in getting an MRA, which initially recognised four nursing institutions of India to supply the nurses to Singapore. In a later review, it was increased to seven institutions.

For future FTAs, unless there is a dedicated mechanism or good provisions for MRAs, it would be very difficult to increase our healthcare services exports.

Usually, the concern is that mutual recognition is in the domain of regulators which are independent, so the government cannot force them to recognize certain qualification.

These are the realistic situations which make it difficult to get MRA provisions in the FTAs. But even here, facilitative elements or some kind of pushing the regulators (if not compelling, at least some kind of moral persuasion or pushing), or starting some kind of facilitated dialogue, can help to at least move in the direction of signing an MRA.