IDEAS home Printed from
   My bibliography  Save this article

Export of health services from developing countries: The case of Tunisia


  • Lautier, Marc


Although the subject of health services exports by developing countries has been much discussed, the phenomenon is still in its early stage, and its real implications are not yet clear. Given the rapid development in this area, little empirical data are available. This paper aims to fill this gap by providing reliable data on consumption of health services abroad (GATS mode 2 of international service supply). It starts by assessing the magnitude of the volume of international trade in health services. This is followed by an in-depth analysis of the case of Tunisia based on an original field research. Because of the high quality of its health sector and its proximity with Europe, Tunisia has the highest export potential for health services in the Middle-East and North Africa (MENA) Region. Health services exports may represent a quarter of Tunisia's private health sector output and generate jobs for 5000 employees. If one takes into account tourism expenses by the incoming patient (and their relatives), these exports contribute to nearly 1% of the country's total exports. Finally, this case study highlights the regional dimension of external demand for health services and the predominance of South-South trade.

Suggested Citation

  • Lautier, Marc, 2008. "Export of health services from developing countries: The case of Tunisia," Social Science & Medicine, Elsevier, vol. 67(1), pages 101-110, July.
  • Handle: RePEc:eee:socmed:v:67:y:2008:i:1:p:101-110

    Download full text from publisher

    File URL:
    Download Restriction: Full text for ScienceDirect subscribers only

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    1. Connell, John & Zurn, Pascal & Stilwell, Barbara & Awases, Magda & Braichet, Jean-Marc, 2007. "Sub-Saharan Africa: Beyond the health worker migration crisis?," Social Science & Medicine, Elsevier, vol. 64(9), pages 1876-1891, May.
    2. Botten, Grete & Grepperud, Sverre & Nerland, Solve Mikal, 2004. "Trading patients: Lessons from Scandinavia," Health Policy, Elsevier, vol. 69(3), pages 317-327, September.
    3. Jean-Paul Auray & Gérard Duru, 1995. "Le secteur santé au sein de la structure productive française," Revue d'Économie Financière, Programme National Persée, vol. 34(3), pages 71-80.
    4. Smith, Richard D, 2004. "Foreign direct investment and trade in health services: A review of the literature," Social Science & Medicine, Elsevier, vol. 59(11), pages 2313-2323, December.
    Full references (including those not matched with items on IDEAS)


    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.

    Cited by:

    1. Carmen, IORDACHE & Iuliana, CIOCHINA, 2014. "Medical Tourism Industry Challenges In The Context Of Globalization," Management Strategies Journal, Constantin Brancoveanu University, vol. 24(2), pages 62-70.
    2. Bochaton, Audrey, 2015. "Cross-border mobility and social networks: Laotians seeking medical treatment along the Thai border," Social Science & Medicine, Elsevier, vol. 124(C), pages 364-373.
    3. Connell, John, 2013. "Contemporary medical tourism: Conceptualisation, culture and commodification," Tourism Management, Elsevier, vol. 34(C), pages 1-13.
    4. Holliday, Ruth & Bell, David & Cheung, Olive & Jones, Meredith & Probyn, Elspeth, 2015. "Brief encounters: Assembling cosmetic surgery tourism," Social Science & Medicine, Elsevier, vol. 124(C), pages 298-304.
    5. Smith, Richard & Martínez Álvarez, Melisa & Chanda, Rupa, 2011. "Medical tourism: A review of the literature and analysis of a role for bi-lateral trade," Health Policy, Elsevier, vol. 103(2), pages 276-282.
    6. Yu, Ji Yun & Ko, Tae Gyou, 2012. "A cross-cultural study of perceptions of medical tourism among Chinese, Japanese and Korean tourists in Korea," Tourism Management, Elsevier, vol. 33(1), pages 80-88.
    7. Horton, Sarah & Cole, Stephanie, 2011. "Medical returns: Seeking health care in Mexico," Social Science & Medicine, Elsevier, vol. 72(11), pages 1846-1852, June.
    8. Jeroen Klijs & Meghann Ormond & Tomas Mainil & Jack Peerlings & Wim Heijman, 2016. "A state-level analysis of the economic impacts of medical tourism in Malaysia," Asian-Pacific Economic Literature, Asia Pacific School of Economics and Government, The Australian National University, vol. 30(1), pages 3-29, May.
    9. Catalina Liliana Andrei & Gabriela Tigu & Raluca Mariana Dragoescu & Crina Julieta Sinescu, 2014. "Analysis of Medical Tourism for Cardiovascular Diseases," The AMFITEATRU ECONOMIC journal, Academy of Economic Studies - Bucharest, Romania, vol. 16(Special 8), pages 1136-1136, August.
    10. Khoa Nguyen Duc & Nhu Y Dang Thi, 2020. "Economic Motives and Problems of Health Tourism in Asia Pacific," Czech Journal of Tourism, Sciendo, vol. 9(1), pages 22-40, December.
    11. Ismet ESENYEL & Serdar SAYDAM & Azadeh HESHAMI, 2015. "Strategic Management Perspective On The Challenges And Opportunities In Iran Health Tourism," Tourism Research Institute, Journal of Tourism Research, vol. 11(1), pages 24-43, September.
    12. Meghann Ormond, 2015. "En route : Transport and Embodiment in International Medical Travel Journeys Between Indonesia and Malaysia," Mobilities, Taylor & Francis Journals, vol. 10(2), pages 285-303, April.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Smith, Richard & Martínez Álvarez, Melisa & Chanda, Rupa, 2011. "Medical tourism: A review of the literature and analysis of a role for bi-lateral trade," Health Policy, Elsevier, vol. 103(2), pages 276-282.
    2. Coast, Joanna, 2018. "A history that goes hand in hand: Reflections on the development of health economics and the role played by Social Science & Medicine, 1967–2017," Social Science & Medicine, Elsevier, vol. 196(C), pages 227-232.
    3. Garcia-Lacalle, Javier & Martin, Emilio, 2010. "Rural vs urban hospital performance in a 'competitive' public health service," Social Science & Medicine, Elsevier, vol. 71(6), pages 1131-1140, September.
    4. Оksana Strelchenko & Svitlana Okhrimenko & Dmytro Pavlov, 2020. "The Role of the Institute of Medical Law in the Postmodern Society," Postmodern Openings, Editura Lumen, Department of Economics, vol. 11(3), pages 145-159, October.
    5. Berhanu Feysia & Christopher H. Herbst & Wuleta Lemma & Agnes Soucat, 2012. "The Health Workforce in Ethiopia : Addressing the Remaining Challenges," World Bank Publications - Books, The World Bank Group, number 2226, December.
    6. Hennig-Schmidt, Heike & Wiesen, Daniel, 2014. "Other-regarding behavior and motivation in health care provision: An experiment with medical and non-medical students," Social Science & Medicine, Elsevier, vol. 108(C), pages 156-165.
    7. Shailender Kumar Hooda, 2015. "Foreign Investment in Hospital Sector in India: Trends, Pattern and Issues," Working Papers 181, Institute for Studies in Industrial Development (ISID).
    8. repec:spo:wpecon:info:hdl:2441/1648 is not listed on IDEAS
    9. repec:hal:spmain:info:hdl:2441/1648 is not listed on IDEAS
    10. Gaël Dupont & Éric Heyer & Xavier Timbeau & Bruno Ventelou, 2001. "L'impact macroéconomique des réformes du secteur de santé français," Revue de l'OFCE, Presses de Sciences-Po, vol. 76(1), pages 117-138.
    11. Changyao Song & Shanshan Shi & Jamie M Chen & Xinjian Li, 2020. "Does inward FDI affect outward FDI in tourism in China?," Tourism Economics, , vol. 26(2), pages 344-349, March.
    12. Glinos, Irene A. & Baeten, Rita & Maarse, Hans, 2010. "Purchasing health services abroad: Practices of cross-border contracting and patient mobility in six European countries," Health Policy, Elsevier, vol. 95(2-3), pages 103-112, May.
    13. Jacek Klich, 2008. "Globalizacja usług zdrowotnych," Gospodarka Narodowa. The Polish Journal of Economics, Warsaw School of Economics, issue 4, pages 21-40.
    14. Di Maria, Corrado & Lazarova, Emiliya A., 2012. "Migration, Human Capital Formation, and Growth: An Empirical Investigation," World Development, Elsevier, vol. 40(5), pages 938-955.
    15. Richard Smith, 2012. "Trade in Health Services: Current Challenges and Future Prospects of Globalization," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 16, Edward Elgar Publishing.
    16. Shailender Kumar Hooda, 2017. "Foreign Investment in Hospital Sector in India," Foreign Trade Review, , vol. 52(4), pages 247-264, November.
    17. Camilla Jensen & Jie Zhang, 2013. "Trade in tourism services: Explaining tourism trade and the impact of the general agreement on trade in services on the gains from trade," The Journal of International Trade & Economic Development, Taylor & Francis Journals, vol. 22(3), pages 398-429, April.
    18. Martine Rutten, 2009. "The Economic Impact of Medical Migration: An Overview of the Literature," The World Economy, Wiley Blackwell, vol. 32(2), pages 291-325, February.
    19. Salter, Brian & Zhou, Yinhua & Datta, Saheli, 2015. "Hegemony in the marketplace of biomedical innovation: Consumer demand and stem cell science," Social Science & Medicine, Elsevier, vol. 131(C), pages 156-163.
    20. Weifan Zhang & Rebecca Liu & Chris Chatwin, 2016. "Chinese Medical Device Market and The Investment Vector," Papers 1609.05200,
    21. repec:hal:wpspec:info:hdl:2441/1648 is not listed on IDEAS
    22. Mehmet Gok & Erkut Altındağ, 2015. "Analysis of the cost and efficiency relationship: experience in the Turkish pay for performance system," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(5), pages 459-469, June.
    23. Burns, Darren K. & Jones, Andrew P. & Suhrcke, Marc, 2016. "The relationship between international trade and non-nutritional health outcomes: A systematic review of quantitative studies," Social Science & Medicine, Elsevier, vol. 152(C), pages 9-17.


    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:67:y:2008:i:1:p:101-110. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.