Report

14 Health and Related Services 1
INTRODUCTION
The chapter attempts to assess the extent of liberalisation
and the regulatory requirements for delivery of
Health services in each of the SAARC countries, i.e.
Bangladesh, Bhutan, Maldives, Nepal, Pakistan, Sri
Lanka and India. The specific health services that are
studied are ‘Medical and Dental services’, listed under
the ‘Business Services’ section, and ‘Hospital Services’
listed under the ‘Health related and Social Services’
section of the WTO Secretariat’s Services Classification
list, commonly referred to as the W-120 Services
Classification list. 2 The other kind of health services
covered under the W-120 List are services provided by
nurses, midwives, physiotherapists and para-medical
personnel. These are also addressed in this chapter.
This chapter is divided into four broad sections:
• The first section provides an overview of the
commitments under GATS that have been made
by the SAARC countries. The purpose of this
overview is to present the aspects that need further
improvement from the perspective of further
liberalisation under the SAARC framework.
• The second discusses the domestic regulatory
requirements that either facilitate or restrict trade
in health services. The purpose of this segment of
discussion is to flag areas for improvement that are
necessary in the SAARC discussions on trade in
health services. The discussion on domestic regulations
also highlights areas where autonomous
liberalisation are at a higher level than GATS
commitments, and could be areas where SAARC
negotiations could push for firm commitments.
• The third analyses the impact of the regulatory
requirements on the Modes of delivery healthcare
services in the SAARC countries.
• Based on the analysis above, the last section
highlights the focus areas for discussions under the
SAARC negotiations on health services.
At the outset, the main modes of service delivery
and a brief outline on the constraints and opportunities
for the same in the SAARC region, are provided below:
Mode 1
Cross-border delivery of health services through
telemedicine can enable healthcare providers in one
SAARC country to provide services to a consumer in
another SAARC country. While telemedicine is slowly
taking roots within countries like India, the practice of
telemedicine is being attempted by a few hospitals
within India, such as Apollo. 3 The government of India
has also undertaken initiatives such as the on ‘Development
of Telemedicine Technology’, for delivery of
services within India. 4 The government of India is also
reportedly considering guidelines for standardising
delivery of telemedicine services. 5 This is however yet
to be formalised. Cross-border services within the
SAARC region have however been confined to limited
instances of telediagnostic and telepathology services
from India to Nepal and Bangladesh. 6 With the growth
of information technology, however, there is potential
for growth of Mode 1 as a mode of supply among
SAARC countries. This will depend to a large extent
on the mutual recognition of doctors qualified in any
SAARC country by all the other SAARC countries. This
aspect, therefore, needs to be taken up as a potential
area for opening up in the SAARC negotiations.
1
The chapter is based on the report authored by R.V. Anuradha.
2
WTO Secretariat, Services Sectoral Classification List, MTN.GNS/W/120, 10 July 1991 http://channels.apollolife.com/
telemedicine/info/index.htm
4
http://www.spsood.com/telemedicineinindia.htm
5
http://www.mit.gov.in/telemedicine/Report%20of%20TWG%20on%20Telemed%20Standardisation.pdf
6
Ibid.