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H EALTH AND RELATED SERVICES 151<br />
Mode 2<br />
Trade in health services via consumption abroad is<br />
typified by medical tourism especially in India.<br />
Consumers from many of the SAARC countries travel<br />
to India for specialised healthcare. There are no direct<br />
regulatory impediments for this mode of supply.<br />
However, there are factors such as lack of portability<br />
of insurance that could act as constraints. This mode<br />
has futuristic potential for growth, and commitments<br />
for facilitating access needs to be taken up in the<br />
SAARC negotiations.<br />
Mode 3<br />
Commercial presence in health services through FDIs<br />
in hospitals and healthcare centres is an area in which<br />
there are practically no regulatory constraints in the<br />
SAARC countries. This has not resulted in any significant<br />
flow of investments within the SAARC region.<br />
Operational constraints in this regard need to be ironed<br />
out.<br />
Mode 4<br />
Trade via movement of health service providers among<br />
countries of the SAARC region is an aspect that needs<br />
to be addressed as a fundamental component of services<br />
liberalisation in the SAARC negotiations. Most of the<br />
movement by healthcare professionals (doctors,<br />
dentists, nurses and paramedics) from India and Sri<br />
Lanka, primarily, have been to wealthier destinations<br />
in the UK, USA, Canada, Australia and the Middle-<br />
East (Hamliton and Yau 2004, Buchan and Sochlaski<br />
2004 and Adikioli 2006). Countries in South Asia are<br />
also said to have a high degree of internal migration,<br />
from rural and backward areas, to cities (Adikioli<br />
2006). Interestingly, however, any movement between<br />
lesser developed SAARC countries to more developed<br />
ones (e.g. Bangladesh to India), has not been mapped<br />
as yet. As with Mode 1, Mode 4 will depend to a large<br />
extent on the mutual recognition of doctors qualified<br />
in any SAARC country by all the other SAARC<br />
countries.<br />
COMMITMENTS IN HEALTH AND MEDICAL<br />
AND DENTAL SERVICES UNDER GATS<br />
The nature of GATS commitments by SAARC countries<br />
predominantly focus on Modes 3 and 4. Only Nepal<br />
has made commitments in Mode 1. All others have<br />
left this as unbound. Pakistan in fact states that Mode<br />
1 is left out of its schedule because it is technically ‘not<br />
feasible’. Commitments on Mode 2 have been made<br />
only by Nepal and Pakistan. Despite lack of significant<br />
GATS commitments, mode 2 service delivery in the form<br />
of services to patients from other SAARC countries has<br />
been prevalent especially in India. Both Mode 1<br />
(especially telemedicine) and Mode 2 (in the form of<br />
medical tourism) have significant potential for future<br />
growth, and this will be discussed separately in this<br />
chapter. Appendix Table A14.1 presents a summary of<br />
commitments by SAFTA member countries in health<br />
and related services. The extent of commitments under<br />
GATS by each of the SAFTA member country is as<br />
follows:<br />
Bangladesh 7<br />
Bangladesh has not undertaken any commitments on<br />
Health and Medical services under the GATS as yet.<br />
However, as will be discussed later in this chapter, its<br />
domestic regulatory regime in fact allows for foreign<br />
participation in the delivery of health services.<br />
Bhutan<br />
As mentioned before, Bhutan is not a member of the<br />
WTO as yet, hence it does not have any GATS-related<br />
commitments. As will be discussed later in this chapter,<br />
FDI is allowed for hospitals subject to Government<br />
approval.<br />
India 8<br />
India’s GATS schedule specifies the following for<br />
Hospital Services.<br />
Mode 1: No commitments have been undertaken.<br />
Mode 2: No commitments have been undertaken.<br />
Mode 3: Under Mode 3, India has committed to allow<br />
for foreign equity participation up to 51% in the setting<br />
up of hospitals in India. It also mandates incorporation<br />
of the entity in India for such commercial presence.<br />
Mode 4: No commitments have been undertaken. No<br />
7<br />
See, GATS/SC/8, 15 April 1994, available at www.wto.org<br />
8<br />
See, GATS/SC/42, 15 April 1994, available at www.wto.org