Trade Policies in Medical Goods and Services
Box 2.2
Development of export-oriented medical services in selected countries
India Health care providers from India such as doctors, nurses, and technicians go to Australia, Canada, the Middle East, the United Kingdom, and the United States, mainly on short-term assignments to provide health care services. These assignments supply countries that have shortages of health care professionals while allowing Indian health care providers to upgrade their skills abroad. Conversely, foreign patients from high-income countries (such as the United Kingdom and the United States) as well as lower-income countries (such as Bangladesh, Nepal, and Sri Lanka) also come to India in search of less costly, high-quality treatments, namely surgery and specialized health services. Neighboring countries including those in Central Asia also benefit from India’s exports of telehealth services. Thailand Thailand has developed a large medical tourism sector geared toward foreign patients. To mitigate internal brain drain, doctors and nurses receive public funding of their education. In return, they are required to serve three years in the public system (including in rural areas) before working in private hospitals. Policies to keep these doctors in the public health sector while also maintaining the quality of the sector have also been implemented. These included increasing the salaries of physicians, nurses, and dentists in all community hospitals. Tunisia Tunisia has used its geographic proximity to both Africa and Europe to attract foreign patients. Incentives to upgrade the health care system include tax exemption for medical equipment and devices; exemption of value added tax for treatments of foreign patients; a 50 percent tax cut on investments in medical institutions and infrastructure; partnerships with foreign companies; development of medical cities; and investment zones to attract foreign medical companies. European Union The EU’s eHealth Action Plan 2012–2020 provides several guidelines on supporting patients’ rights in cross-border health care services by focusing on supporting research, development, and innovation; promoting international cooperation; and achieving wider interoperability of telehealth services. Source: Gillson and Muramatsu 2020.
form of quantitative measures as well as specified legal forms authorized for firms) and discriminatory measures disadvantaging foreign services and services suppliers. For medical services, the restrictions can be partly explained by the fact that authorities set policy objectives to ensure health care access and quality, and consequently the need to use existing resources efficiently and attract new resources—all while controlling the overall cost of the health care financing system. Data collected by the WTO and World Bank illustrate the many significant barriers to trade in medical services—including, among others, foreign equity limits, nationality requirements, foreign exchange limitations, and restrictions on advertising (figure 2.4).10
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