Trade Flows in Medical Goods and Services
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Mode 4: Presence of natural persons. Countries are seeking to attract health workers from abroad to fill domestic shortages. This form of trade is chiefly influenced by regulations concerning entry and presence as well as the qualification and recognition requirements in receiving countries. Although the number of individuals supplying medical services through temporary presence (as defined by GATS) represents a small proportion of health workers crossing borders (the latter generally seeking opportunities for employment or to establish themselves more permanently in a foreign jurisdiction),5 the movement may be driven by pull and push factors that drive labor migration more generally. Countries may impose limitations on the movement of health workers to other markets out of concern over the loss of human capital. Increasingly, global mobility of health care workers and related trade in medical services is affected by the importing country’s adherence to international governance mechanisms, such as ethical recruitment codes and intergovernmental agreements including the Commonwealth Code of Practice (Commonwealth 2003) and WHO’s Global Code of Practice on the International Recruitment of Health Personnel (WHO 2010), the latter being further discussed in box 1.2. These were established to prevent a brain drain from low- and middle-income countries and ensure adherence to certain principles and norms.
Box 1.2 WHO’s Global Code of Practice on the International Recruitment of Health Personnel—and the blurred boundaries between trade in medical services and migration of health workers Provision of health services by foreign-born or foreign-trained health workers has been characterized for decades by a recognition of the tension between (a) the right of health workers to pursue professional development opportunities and better working conditions abroad, and (b) the negative consequences that a substantial outflow of health workers from some countries could have on already stretched health systems (WHO 2006). The long-standing difficulties facing many high-income countries in producing enough health workers to meet domestic needs, the large wage differential across countries of varying socioeconomic development, and the chronic underinvestment by countries at all development levels in education and jobs for the health workforce (WHO 2016) have conspired to determine a substantial level of dependence in many countries (particularly in high-income countries) on foreign-born and foreign-trained health workers (WHO 2020) along with a growing trend in international mobility of health personnel, which had risen by 60 percent in the decade preceding 2016 (Dumont and Lafortune 2017). To facilitate collaboration and an ethical management of health personnel mobility, the World Health Organization in 2010 adopted a Global Code of Practice on the International Recruitment of Health Personnel (the “WHO Code”), whose provisions encompass (a) upholding the rights of internationally mobile health workers; (b) supporting countries’ efforts to meet health system needs through production and employment of domestically trained health workers; and (Continued )
