3.2 Low levels of GATS commitments in medical services trade

Commitments under GATS. GATS commitments for medical services are low compared with other sectors. Even where a sector is committed, there are many limitations. GATS offers flexibility to choose which service sectors to liberalize and how. As shown in figure 3.2, “medical and dental services” is the most committed medical services subsector (52 members, or 37 percent of total members, counting the EU-25 schedule as one); followed by “hospital services” (49 members, or 35 percent); “other human health services” (25 members, or 18 percent); and “nurses, midwives, and other paramedical personnel” (22 members, or 16 percent).

Mode 1 (cross-border supply) has the lowest level of commitments (averaging approximately 20 percent across the subsectors, with almost a third being partial commitments). Mode 2 (consumption abroad) and mode 3 (commercial presence) are committed by an average 25 percent of members, but mode 2 shows the fewest limitations. Mode 4 (movement of personnel) commitments are very limited in scope and linked to the horizontal commitments made for this mode (that is, indistinguishably for all sectors in the schedule of commitments, mainly referring to intracorporate transferees and business visitors).34 The low levels of commitments for medical services trade has consequences in terms of transparency and predictability—especially important in times of crisis.

Bilateral or regional commitments. In the context of bilateral or regional trade agreements, many economies have made more commitments with favored partners, often reflecting the relative openness of current policies on medical service sectors.

Figure 3.2 Low levels of GATS commitments in medical services trade

Share of WTO members (%) 100 90 80 70 60 50 40 30 20 10 0

Mode 1Mode 2Mode 3Mode 4Mode 1Mode 2Mode 3Mode 4Mode 1Mode 2Mode 3Mode 4Mode 1Mode 2Mode 3Mode 4

Medical and dental services Nurses, midwives, and other paramedical personnel Hospital services Other human health services

Full commitment Partial No commitment Source: World Trade Organization and World Bank I-TIP services database, GATS module (accessed in 2022), https://i-tip.wto.org/services. Note: General Agreement on Trade in Services (GATS) modes of supply: (1) cross-border supply, (2) consumption abroad, (3) commercial presence, and (4) presence of natural persons. I-TIP = Integrated Trade Intelligence Portal.