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Trade in healthcare and health insurance services: The GATS as a supporting actor (?)

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  • Adlung, Rudolf

Abstract

The General Agreement on Trade in Services (GATS) is broader in policy coverage than conventional trade agreements for goods and, at the same time, offers governments more flexibility, in various dimensions, to tailor their obligations to sector- or country-specific needs. An overview of existing commitments on healthcare and health insurance services shows that WTO Members have made abundant use of these possibilities. While most participants elected not to undertake bindings on healthcare services at the end of the Uruguay Round, nor to make offers in the ongoing negotiations, insurance services have been among the most frequently committed sectors. If there is a common denominator, regardless of the Members concerned (except for recently acceded countries), it is the existence of a lot of 'water' between existing commitments and more open conditions of actual access in many sectors. This may also explain, in part, why there have been very few trade disputes under the GATS to date - far fewer than under the GATT in merchandise trade. Also, governments appear to be generally hesitant in politically and socially sensitive areas to take action in the WTO. There are indications, however, that the same 'players' have acted differently in other policy contexts. For example, it appears that under recent preferential trade agreements (PTAs) the European Communities has been even more cautious in committing on hospital services and protecting scope for (discriminatory) subsidies than under the GATS. Yet, this is not necessarily true for the obligations assumed by many countries, including individual EC Member States, under bilateral investment treaties (BITs). These treaties overlap with the GATS, as far as commercial presence is concerned, and may be used by aggrieved investors to challenge policy restrictions in host countries. However, though frequently invoked, BITs do not meet the same standards, in terms of transparency, open (consensual) rulemaking and legal certainty, as commitments under the GATS.

Suggested Citation

  • Adlung, Rudolf, 2009. "Trade in healthcare and health insurance services: The GATS as a supporting actor (?)," WTO Staff Working Papers ERSD-2009-15, World Trade Organization (WTO), Economic Research and Statistics Division.
  • Handle: RePEc:zbw:wtowps:ersd200915
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    References listed on IDEAS

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    1. Mia Mikic, 2007. "Health-related Services in Multilateral and Preferential Trade Arrangements in Asia and the Pacific," Working Papers 3007, Asia-Pacific Research and Training Network on Trade (ARTNeT), an initiative of UNESCAP and IDRC, Canada..
    2. Markus Krajewski, 2003. "Public Services and Trade Liberalization: Mapping the Legal Framework," Journal of International Economic Law, Oxford University Press, vol. 6(2), pages 341-367, June.
    3. Adlung, Rudolf & Roy, Martin, 2005. "Turning hills into mountains? Current commitments under the GATS and prospects for change," WTO Staff Working Papers ERSD-2005-01, World Trade Organization (WTO), Economic Research and Statistics Division.
    4. Adlung, Rudolf, 2009. "Services liberalization from a WTO/GATS perspective: In search of volunteers," WTO Staff Working Papers ERSD-2009-05, World Trade Organization (WTO), Economic Research and Statistics Division.
    5. Gootiiz, Batshur & Mattoo, Aaditya, 2009. "Services in Doha : what's on the table ?," Policy Research Working Paper Series 4903, The World Bank.
    6. Eschenbach, Felix & Hoekman, Bernard, 2006. "Services policies in transition economies: on the EU and WTO as commitment mechanisms," World Trade Review, Cambridge University Press, vol. 5(3), pages 415-443, November.
    7. Eric H. Leroux, 2007. "Eleven Years of GATS Case Law: What Have We Learned?," Journal of International Economic Law, Oxford University Press, vol. 10(4), pages 749-793, December.
    8. Rudolf Adlung, 2006. "Public Services and the GATS," Journal of International Economic Law, Oxford University Press, vol. 9(2), pages 455-485, June.
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    1. repec:asr:journl:v:7:y:2017:i:special:p:54-68 is not listed on IDEAS

    More about this item

    Keywords

    GATS; trade in services; international investment; public health;

    JEL classification:

    • F13 - International Economics - - Trade - - - Trade Policy; International Trade Organizations
    • F53 - International Economics - - International Relations, National Security, and International Political Economy - - - International Agreements and Observance; International Organizations
    • F59 - International Economics - - International Relations, National Security, and International Political Economy - - - Other
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • K33 - Law and Economics - - Other Substantive Areas of Law - - - International Law

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