8 January 2002
Assessment of GATS and Trade in Health Services
An International Consultation on Monitoring and Research Priorities
9-11 January 2002, Geneva, Switzerland
Meeting Objectives and Program Agenda
Rationale/Background
The February 2000 launch of WTO negotiations to further liberalize trade in services under GATS has highlighted the need for better information on the risks and benefits of trade liberalization in specific sectors. Each session of the GATS Council has a standing agenda item on “assessment of services trade”, to encourage sharing of new data and information on trends in services trade and the impact of implementing countries’ GATS commitments.
With respect to the health sector, however, there are virtually no empirical studies on the impacts on equity, access or quality in country health systems resulting from either: a) trade in health services and services strongly related to health care, such as health insurance, or
b) country GATS commitments or other forms of trade liberalization via unilateral, bilateral or regional action. In addition, there is a lack of valid, reliable, and internationally comparable data on health-related services trade. It is generally believed that health-related services trade is growing, but by how much is unknown.
As service sectors related to health are proposed for trade liberalization in ongoing GATS negotiations, it becomes increasingly important to address the monitoring and research challenges through international cooperation. The interdisciplinary nature of the work also suggests the importance of bringing together experts in 1) health policy analysis and research, 2) trade policy analysis and research, and 3) trade-in-services statistics -- to discuss how best to address the research and data collection challenges.
Objectives and Expected Outcomes
Sponsored by WHO’s Department of Health and Development (HDE), this 3-day International Consultation on Assessment of GATS and Trade in Health Services has three key objectives that also establish its expected outcomes:
1. Identify public policy issues and questions – at the national and international level – on which better information, data and research on trade in health services should be focused.
2. In line with these public policy issues, propose multi-country, regional or global research projects to assess the health system impacts of trade in health-related services, and of GATS commitments and other forms of trade liberalization.
3. In line with research priorities, propose strategies for systematic and comparable cross-country data collection on trade in health-related services, and measures of key health system impacts.
Program Agenda
Wednesday 9 January 2002
9:00Registration
9:30 Welcome, Introductions and Objectives/Expected Outcomes
Andrew Cassels, HDE Director
Debra Lipson and Nick Drager, HDE
10:00Policy Issues/Questions in Services Trade Affecting the Health Sector
What are the key health and trade policy issues related to services trade, and what types of research or information would be helpful to evaluate policy options or negotiating positions? Among the issues that may be discussed are: conditions or regulations needed to ensure FDI contributes to national health objectives; compensation to developing countries for training provided to health professionals who migrate; and proposals to extend health insurance reimbursement to services obtained abroad.
Panel of Government Officials/Representatives
- Thailand – Suwit Wibulproprosert, Ministry of Health
- India – Srivinas Tata, Ministry of Health
- Canada -- Jake Vellinga, HealthCanada
- Brazil – Sergio dos Santos, Ministry of Trade, Geneva Mission to WTO
Followed by Q and A
12:00Lunch
13:15Other Perspectives on Key Health-and-Services Trade Policy Issues
- WTO Services Division – Hamid Mamdouh
- NGO – John Hilary, Save the Children Fund, UK
- Private Sector Representative, Herve Bourel, Allianz
14:00Discussion
The importance and relevance of the policy issues raised by participants in morning and afternoon discussions vary depending on one’s perspective. Discussion will examine differences between trade and health officials, for countries at different levels of development, by immediate versus longer-term policy implications, and which are more important globally, regionally, and for specific countries. The session aims to produce a set of key policy questions on which international cooperation in research and data collection would be most useful.
15:15Break
15:45Evaluating Trade-Policy-Health System Relationships
This session will examine various perspectives on the relationships between: 1) cross-border trade in services and international and national trade policies, and 2) their economic, development, and health system impacts. Commentators and group discussion will examine the economic, political, and national health system context that determine the types and strength of economic and health system effects.
Presenters:
Health Perspective -- David Woodward and Debra Lipson, WHO HDE Dept.
Trade & Development Perspective – David Diaz, Chief, Trade in Services, UNCTAD
Commentator:
Indrani Gupta, Institute of Economic Growth, New Delhi
Thursday, 10 January 2002
9:00Working Groups on Research Questions and Methods
9:00 -- Charge to Working Groups
9:15-11:15 Four Working Groups will discuss key research questions, approaches and methodologies for studying the health systems effects of trade, and trade-related policies (divided by mode of services trade). The groups will discuss: a) the need for theoretical and/or empirical research, b) valid indicators of relevant health system effects, c) measurement of country trade policy orientation and liberalization, and d) other research design or implementation issues. Each group will be asked to prepare recommendations and priorities for concrete, promising multi-country research projects or approaches.
Mode:Group Leader
1: Cross-border SupplyAlwyn Didar Singh, Govt. of Punjab, India
2: Movement of PatientsDavid Warner, University of Texas, Austin
3: Commercial Presence/FDIWattana Janjaroen, Chulalongkorn University
4: Movement of ProfessionalsTim Martineau, Liverpool School of Tropical Medicine
11:15Break
11:45 Trends in International Trade in Services
This session will examine the measurement and data collection challenges involved in conducting the types of research discussed in the working groups. It begins with a presentation on what is currently known about trends in international services trade, followed by discussion on the strengths and weaknesses of current methods of measuring trade in services, and of systems for collecting services trade statistics, for capturing health services trade flows
Presenter:
Guy Karsenty, WTO Statistics Division
12:45Lunch
14:00Measurement and Data Collection Issues on Trade in Services
Panelists will review recent developments in improving trade-in-services statistics and discuss potential opportunities to better define, collect and disaggregate data on health services trade.
OECD Task Force on Statistics in Intern’l Trade in Services – William Cave
UNCTAD, FDI Statistics, Masataka Fujita
Julian Arkell, Consultant
15:30Break
16:00Regional Initiatives in Collecting Health Services Trade Information
This session will feature short presentations on new initiatives to collect accurate and comparable information on health services trade within regional groupings, and discussion on how this can best support research priorities and policy makers’ information needs.
Americas – Cesar Vieira, PAHO
Southeast Asia – Than Sein, SEARO
WHO EURO – Laura Maclehose, European Observatory on Health Care Systems
Friday 11 January 2002
9:00Working Groups on Health Services Trade Data Collection
9:00 -- Charge to Working Groups
9:15-10:30 – Each of four Working Groups will discuss ways to improve comparable multi-country data on health services trade, and measures of trade or trade-related health policy affecting it, by mode. This may include special surveys of providers, payors or consumers, adding questions onto existing surveys or data collection systems, or devising indices of policy liberalization. Each group will be asked to develop recommendations and identify “best candidate” countries or regions that have a certain threshold of health services trade, available data, or potential to engage with existing data collection systems.
ModeGroup Leader
1: Cross Border SupplyAlwyn Didar Singh,
Govt. of Punjab, India
2: Movement of Health Care ConsumersJean-Pierre Poullier, WHO
3: Commercial Presence/FDIMasataka Fujita, UNCTAD
4: Temp. Movement of Health ProfessionalsBarbara Stillwell, WHO
10:30Break
11:00 Working Group Reports
Each of the 4 groups would report on two sets of recommendations for:
1) Health system impact research issues and strategies
2) Monitoring trends/collecting data on health services trade and changes in trade/health policies
12:45Lunch
14:00 Summing Up/Next Steps
The final session will briefly summarize major conclusions of the meeting:
- On which key policy questions should global or multi-country research focus?
- What types of health system effects are most important for each type of health services trade, and which indicators are most appropriate for measuring them?
- How can data on health services trade, and measures of trade policy or trade-related health policy affecting it, be improved and further developed?
Most of the discussion will focus on how best to take the recommendations forward:
- How should research project/data collection priorities be supported by WHO?
- Should summary/conclusions of this meeting be distributed beyond this group? To whom?
- Is there a need for an ongoing committee, task force, or informal working group to follow-up on this work? Participants? Terms of reference?
16:00Adjourn
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