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Trade in Health Services in ASEAN
Assoc.Prof. Thongnard Kumchai
Chiangmai University,Thailand
Contents
• Global trends in international trade in
the health services sector
• Trade in Health Services in ASEAN
• Summary
World Trade Organization: goods and services
Agriculture
products
Industrial
products
WTO
Services
WTO
1. Goods
(Multilateral Agreements on Trade in Goods-MTAs)
2. Services
(General Agreement on Trade in Services-GATS)
3. Intellectual Property
(Agreement on Trade Related Intellectual Property
Rights-TRIPS)
Agricultural and food products
Trade in Services
•
•
Service is increasingly becoming an
important sector in each economy
Main instrument is the General Agreement
on Trade in Services (GATS)
GATS
• Obligations
• Most Favoured National Treatment
• Market Access
• National treatment
• Transparency
• Domestic Regulation
• Liberalization commitments
Increase in share of service sector
Share of services in GDP vs. income
90
Percentage share of services in GDP
80
70
Philippines
60
Singapore
50
40
Thailand Malaysia
30
Cambodia
Vietnam
Indonesia
5
7
20
10
4
6
8
ln(GDP per capita)
9
10
11
Service sectors
Business
Communications
Construction
Logistics
Education
Environment
Financial
Health services
Tourism
Recreation, culture and sports
Transportation
Other services
Health Services
sub-sectors
Specialized Services
Dental Care
Medical Check-Up
Health Promotion
Thai Spa
Traditional Thai Massage
Long Stay
Food, Drugs and Herbal Products
Food
Drug
Cosmetics
Progress in WTO round of negotiation
Latest situation in WTO
WTO time out
“Time out to review the situation,
time out to examine available
options and time out to review
positions,”
‘Today there are only losers.’
Pascal Lamy
WTO Director General
Global Situations and Trends
Global trends in
international
trade
FTA
Delay in
WTO
negotiation
More
countries
engage in
FTA
Multilateral, Regional, and Bilateral
Multilateral
Which way?
?
Regional
FTA logo
Bilateral
THINK ASEAN
ASEAN Economic Community
• AEC
•600 millions of people
ASEAN Vision 2020
Free flow of Services,
Investments, Goods,
and Capital
ASEAN Community 2015
• To speed up efforts to create a
single market by 2015,five years
ahead schedule.
ASEAN Community 2015
ASEAN Security
Community (ASC)
ASEAN Economic
Community (AEC)
ASEAN Socio-Cultural
Community (ASCC)
The Peaceful, prosperous, and people-centric ASEAN
Regional production base
Single regional market
ASEAN Framework Agreement on Services-AFAS
•
To enhance cooperation in services and eliminate
substantially restrictions
•
To liberalize trade in services beyond those undertaken
under GATS (i.e.GATS plus)
•
AFAS adopts the structure and approach of GATS/WTO
•
The negotiation is conducted through the Coordinating
Committee on Services-CCS
ASEAN priority sectors
Goods and manufacturing
Electronics
Wood-based products
Automotives
Rubber-based products
Textiles and apparels
Agro-based products
Fisheries
Services
Infocomm technology (ICT) e-ASEAN
Healthcare
Air travel
Tourism
Logistics
GATS Commitments
•
Trade in services is distinguished into four
different modes :
• Mode 1 Cross – border Supply
• Mode 2 Consumption Abroad
• Mode 3 Commercial Presence
• Mode 4 Presence of Natural Persons
Cross – border supply
• Telemedicine
• Tele – education and consultation
e-Health
General citizen
Cross – border supply
1. Question of ethical and legal aspects
2. Question of professional licensing
3. Question of “gatekeeper”
Consumption abroad
• Potential area
•
•
•
•
•
•
Health care services
…. Good quality health personnel
…. Hi – tech medical equipment
Dental care
Cosmetic surgery
Tour + health package
Short stay + health package
Health insurance
Commercial Presence
Country A invest in hospital service in country B
or
Country B invest in hospital service in country A
CCS
Priority
Services
Sectors
Other
Services
Sector
Trade Agreements
2006 Foreign equity ≥ 49
%
2010 Foreign equity ≥ 70 %
2015 : Foreign equity ≥ 70%
Presence of natural persons
• MRA on Nursing Services
2006
• MRA on Medical Practitioners 2009
• MRA on Dental Practitioners 2009
ASEAN MRA on Dental Practitioners
• Objectives
• 1. facilitate mobility of dental practitioners within
ASEAN;
• 2.exchange information and enhance cooperation
in respect of MRA
• 3.promote adoption of best practices on standards
and qualifications; and
• 4.provide opportunities for capicity building and
training of dental practitioners
•
Summary
Trade in Health services
WTO/RTA/FTA
•Health care sector is a priority sector in trade
agreement.
•Globalization is a key driver of change in the
healthcare system.
•The internet will revolutionize the future of
medicine
•Open economies and free market obviously have
impact to healthcare delivery system.
THINK ASEAN