Assoc.Prof. Thongnard KumchaiChiangmai University,Thailand
Trade in Health Services in ASEAN
Contents
•Global trends in international trade in the health services sector
•Trade in Health Services in ASEAN
•Summary
Industrialproducts
Services
Agricultureproducts
WTO
World Trade Organization: goods and services
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)
WTOWTO
Agricultural and food products
Trade in ServicesTrade in Services
• Service is increasingly becoming an important sector in each economy
• Main instrument is the General Agreement on Trade in Services (GATS)
GATSGATS
• Obligations• Most Favoured National Treatment
• Market Access• National treatment
• Transparency• Domestic Regulation
• Liberalization commitments
Share of services in GDP vs. income
10
20
30
40
50
60
70
80
90
4 5 6 7 8 9 10 11
ln(GDP per capita)
Perc
enta
ge s
hare
of s
ervi
ces
in G
DP
CambodiaVietnam Indonesia
Thailand Malaysia
Singapore
Philippines
Increase in share of service sector
BusinessCommunications
ConstructionLogistics
EducationEnvironment
FinancialHealth services
TourismRecreation, culture and sports
TransportationOther services
Service sectors
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
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
Latest situation in WTO
Global Situations and Trends
Delay in WTO
negotiation
Global trends in
international trade
More countries engage
inFTA
FTA
FTA logo
?Regional
Bilateral
Multilateral
Which way?
Multilateral, Regional, and Bilateral
THINK ASEAN
• AEC•600 millions of people
ASEAN Economic CommunityASEAN Economic Community
Free flow of Services, Investments, Goods, and Capital
ASEAN Vision 2020ASEAN Vision 2020
ASEAN Community 2015ASEAN Community 2015
• To speed up efforts to create a single market by 2015,five years ahead schedule.
ASEAN Community 2015ASEAN Community 2015
ASEAN SecurityCommunity (ASC)
ASEAN EconomicCommunity (AEC)
ASEAN Socio-CulturalCommunity (ASCC)
The Peaceful, prosperous, and people-centric ASEAN
Regional production base Single regional market
• 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 Framework Agreement on Services-AFASASEAN Framework Agreement on Services-AFAS
ASEAN priority sectors
Goods and manufacturing Services
ElectronicsWood-based productsAutomotivesRubber-based productsTextiles and apparelsAgro-based productsFisheries
Infocomm technology (ICT) e-ASEANHealthcareAir travelTourism Logistics
GATS CommitmentsGATS 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 supplyCross – border supply
• Telemedicine• Tele – education and consultation
e-Health
General citizen
Cross – border supplyCross – border supply
1. Question of ethical and legal aspects2. Question of professional licensing
3. Question of “gatekeeper”
Consumption abroadConsumption 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 PresenceCommercial Presence
Country A invest in hospital service in country B
or
Country B invest in hospital service in country A
CCS Trade Agreements
Priority Services Sectors
2006 Foreign equity ≥ 49 %
2010 Foreign equity ≥ 70 %
Other Services Sector
2015 : Foreign equity ≥ 70%
Presence of natural personsPresence 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
•
SummarySummary
Trade in Health servicesWTO/RTA/FTA
Trade in Health servicesWTO/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
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