Global trading in health services: potential trade and system-based challenges for traders

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Archie A. Alexander Prasutr Thawornchaisit


Many countries with excess capacities for health services leverage them to increase their GDPs by engaging in cross-border
trading (CBT) of health services. CBT of health services may be limited due to trade challenges arising from the General
Agreement on Trade in Services (GATS (Modes 1-4) and Non-GATS agreements) and system-based (e.g. health or legal
system) challenges. The objective of this study was to learn whether trade or system-based challenges to CBT of health services
exist, and if they do, do they challenge CBT of health services. The authors (researchers) employed an Arksey and O’Malley
scoping review methodology to identify peer-reviewed and gray literature discussing trade and system-based challenges to
CBT of health services. Electronic searches utilized a browser (Google ChromeTMor Mozilla Firefox R ) and an internet web
search engine (GoogleTM(e.g. Web, Scholar and News plus News Archives) or Microsoft Bing R : Attempts = 0) or a metasearch
engine (DuckDuckGo c : Attempts = 0) to query databases (Public = Google, Google Scholar, EBSCO and Medline) and Private
= Lexis Advance R ). Results and analysis of retrieved articles identified trade challenges in GATS Modes 1-4 (e.g. resource
reallocation and costs) and Non-GATS (e.g. protectionist trade policies) and system-based barriers (e.g. medical and regulatory
liability, health privacy regulation and business regulation). Trading in Modes 2 (medical and health tourism) and 4 (medical
manpower exchange) enjoyed the greatest share of these markets, although Mode 3 trades (foreign commercial presence) may
be a growing market. In conclusion, countries, including Thailand and its ASEAN partners, may face trade- and system-based
challenges to expansion of their CBTs in health services. More studies are necessary to learn the true impact on CBTs in health


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