Trade Therapy: Deepening Cooperation to Strengthen Pandemic Defenses
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Trade in medical services faces many trade barriers
70 60 50 40 30 20 10 0
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Cr o pr ssoh bo ib rd In iti er su on ra nc e lim cov Cr os ita era stio ge bo ns rd er lim tra ita nsf tio ers Ec ns on FD om Ir es ic -n tr ic ee tio ds ns re te qu st (s ire up m Na pl en ti ie ts on rs ) (b al oa ity La rd o ne bo of r re ed r m di sid re e st a ct nc es rke or y t( t s) na te tu st/ e ra c N at l p on io er om na so ic lit ns ) (n y r at eq ur u Re al ire sid pe m rs en en on ts c (n y r s) at eq ur u al ire pe m rs en on ts s)
Mean share of economies with restriction (%)
Figure 2.4
All
Low-income
Lower-middle-income
Upper-middle-income
High-income
Source: World Trade Organization and World Bank, Services Trade Policy Database, http://i-tip.wto.org/services/. Note: The study, using 2022 data, covers 73 economies encompassing all income levels (9 high-income economies, 16 upper-middle-income, 28 lower-middle-income, and 20 low-income, as defined in World Bank classifications). Measures on foreign direct investment (FDI), economic-needs tests on suppliers, and nationality or residency restrictions on boards of directors refer to activities of private health establishments. Measures referring to natural persons cover medical doctors, dentists, nurses, midwives, and paramedic personnel. For some economies included in this study, data are being collected and are not yet publicly available.
Barriers to seeking care abroad and cross-border services. The nonportability of health insurance across borders may restrict trade in medical services. Trade in medical services often occurs when patients go to another country for treatment (mode 2, or consumption abroad). However, in many jurisdictions, health expenditure is covered through state-funded health insurance systems, where only domestic expenditures can be recouped except in exceptional circumstances—for example, when specialist care is not available domestically. National health systems increasingly encourage patients to seek medical care abroad to lower costs or reduce demand pressure. However, in many cases, the portability of public health insurance coverage is not assured (as shown in figure 2.4), posing a major impediment to trade through the movement of patients (mode 2) as well as to cross-border telehealth services. This is particularly striking in low- and lower-middle-income groups, where this is not assured for 45 percent and