Globalization and trade in health services

A novelty of globalization, over previous centuries of internationalization of trade across borders, has been the increasing focus on services, in addition to primary and manufactured goods, which has been facilitated by advances in transport and telecommunications. While there are many services which impact upon health, over the past two decades there has been a considerable rise in trade in services directly related to healthcare and health systems; largely as a direct result of the development of the General Agreement on Trade in Services (GATS) by the World Trade Organization in the mid-1990s. This trade takes a number of different forms, including the cross-border provision of medical services, foreign direct investment in health services, movement of health workers across borders and, perhaps most prominently, ‘medical tourism’, where patients move to access services abroad and which is examined in greater detail in this Handbook. While the overall volume of trade in health-related services is not fully known, and data poses difficulties across the different types of travel, available data sources suggest that although health-related services represent only a small proportion of the overall trade in services, this is a significant growth area. This chapter reviews the different types of trade in health services as defined under the GATS agreement and discusses the relationship between these different modes.