Cover -- Title Page -- Contents -- Preface and Acknowledgments -- Contributors -- Acronyms and Abbreviations -- 1 Trade in Health Services and the GATS: Introduction and Summary -- Why This Book? -- An Overview of the Book -- "Top Ten" Key Questions Concerning Trade in Health Services and the GATS -- Why are Current Levels of Trade in Health Services Low? -- How will GATS Legally Affect a Country's Health Policy? -- What Effect Might Liberalization have on National Health Systems? -- What are the Likely Benefits from Greater Trade in Health Services? -- What can be Done to Limit the Possible Risks of Trade? -- When, and How Best, Might Negotiations be Undertaken? -- What is the Relationship between Trade in Health Services and Other Sectors? -- Should Trade Liberalization be under GATS or Other Trade Agreements? -- What is the Single Most Important Issue in Determining Whether to Commit under GATS? -- How Might a Country Best Obtain the Information Necessary to Inform Policy? -- Notes -- References -- 2 Strategic Considerations for Developing Countries: The Case of GATS and Health Services -- Introduction -- Context and State of Play: GATS and Services Trade Negotiations -- Health Services Sector and the GATS Negotiations -- Revealed Comparative Advantage of Developing Countries in Trade in Health Services -- Scope, Coverage, and Definitional Issues -- MFN Obligation and Exemptions -- Transparency-Ensuring Good Governance and Effective Market Access -- Market Access and National Treatment-Positive List Approach to Commitments -- Market Access -- National Treatment -- GATS 2000 Negotiations: Proposals and the Request/Offer Phase -- Requests -- Offers -- Movement of Natural Persons: Mode 4-The Need for Commercially Meaningful Commitments -- Mutual Recognition Agreements -- GATS Rules (Safeguards, Subsidies, and Government Procurement).

Emergency Safeguard Mechanism/Measures -- Subsidies -- Government Procurement -- GATS Rules-Issues for Consideration from a Health Perspective -- Regulatory Challenges-the Need for Flexibility -- GATS and Public Services-Strategic Challenges from Ambiguity -- The Public/Private Interface from a GATS Perspective -- Ambiguity-Potentially Far-Reaching Consequences -- Strategic Responses: Using Schedules for Individual Solutions -- Current Negotiations on Domestic Regulation-Strategic Challenges from a Double-Edged Sword42 -- GATS Article VI.4 and Its Negotiating Mandate: Coverage of Domestic Regulation -- Article VI.4-Constraining Policy Flexibility for Health or Facilitating the Movement of Natural Persons? -- Strategic Responses-Carefully Assessing Promised Benefits -- Challenges in the Process of Negotiating-the Need for Data and Clout -- Lack of Data and Understanding about the Effects of Health Services Liberalization (in the Multilateral Context) -- Lack of Data-Need for Informed Negotiations -- Strategic Responses: A Thorough and Comprehensive Assessment-A Tool to Address Informational Deficits -- Lack of Political and Negotiating Clout -- Bilateral Requests and Offers-Lack of Balance -- Strategic Responses: A Transparent Assessment, Negotiating Context, and Negotiating Tools-To Address Deficits in Negotiating Clout -- Assessment -- Context and Negotiating Tools -- Conclusions and Policy Recommendations -- Notes -- References -- Annex: Addressing Health-Related Services: Excerpts from Selected Initial and Revised Offers -- 3 Update on Gats Commitments and Negotiations -- Current Patterns of Access Commitments in Health Services -- Limitations on Trade in Health Services -- Social and Developmental Implications -- Current Negotiations -- Notes -- References -- 4 Ten Steps to Consider before Making Commitments in Health Services under the Gats.

Introduction -- The Threshold Issues -- Public, Private, or Both? -- Nationals or Foreigners? -- Trade vs. Trade Agreements -- Liberalization and Regulation -- Making Commitments Under The Agreement: A Flow Chart -- What is Covered by the Agreement? -- The Governmental Services Carve-Out -- Monopolies and exclusive service providers -- Unfinished Business -- Government procurement -- Subsidies -- Can I Decide to Leave out Health Services from any Market Opening Commitments? Do Some GATS Disciplines Apply Regardless of Whether or Not I Make Market Opening Commitments? -- If I Don't Include Health Services in My Commitments, What Obligations Apply? -- Most Favored Nation (MFN) -- Transparency -- Review procedures for administrative decisions -- Basic competition disciplines -- If I am Considering Making or Requesting Commitments on Health Services, How Do I Define Them? -- Defining the Sector -- How Else are Services Described in the Agreement? What Do Commitments Cover? -- Modes of Supply -- Horizontal vs. Sectoral Commitments -- What Does a GATS Commitment Involve? -- What Does Market Access Mean? -- What if I have a monopoly or exclusive supplier for a service? -- What Does National Treatment Mean? -- What about subsidies for national suppliers? -- What Does a Commitment Mean? Is it Necessarily Liberalization? -- Do Commitments Have to Take Effect Immediately? -- As a Developing Country, Do I Have to Liberalize? -- Now That I've Made a Commitment, Are There Any Other General Obligations that Now Apply? -- What Impact Does the GATS Have on my Ability to Regulate Health Services? -- What Other Obligations Might Apply to How I Regulate Services? -- What are my options for regulating foreign suppliers in my country? -- So what about the general conditions that apply to both foreign and national suppliers, are there any disciplines applying to them?.

Negotiations Under Article VI.4 -- Additional Commitments on Regulatory Practices -- What About Recognition of Qualification of Health Professionals? -- What If I Change my Mind? What If I No Longer Want to Keep a Commitment? -- Renegotiating Commitments -- Balance of Payments -- Safeguards -- Exceptions -- A Word of Caution -- What Happens Next? -- A Final Thought -- Notes -- References -- ANNEX I: Detailed Definitions -- ANNEX II: Example of Commitments on Health Services Under GATS -- 5 Making Commitments in Health Services Under the GATS: Legal Dimensions -- Introduction: GATS, Health Policy, and International Law -- The "Tale of Two Treaties" Problem -- Undertaking International Legal Analysis of GATS -- The Threshold Question: Is a Health-Related Service within the Scope of GATS? -- Broad Scope of GATS and Health Policy -- Exclusion for "Services Provided Pursuant to the Exercise of Governmental Authority" -- Four Pillars of GATS' Legal Architecture -- General Obligations That Apply to All Measures Affecting Trade in Services -- Substantive Duties -- Most-Favored-Nation Principle -- Rules Affecting Domestic Regulatory Powers Linked to Specific Commitments -- Rules Affecting Domestic Regulatory Powers Not Linked to Specific Commitments -- Procedural Duties -- Conclusion on General Obligations under GATS -- The Rules on Specific Commitments and Progressive Liberalization -- The Relationship between the Second Pillar and the First and Third Pillars of GATS' Legal Architecture -- The Challenge of the "List It or Lose It" Process in Making Specific Commitments -- Modifying a Schedule of Specific Commitments -- The Challenges Created by the Specific Commitment Rules and Process -- Market Access and Health Policy -- The Scheduling of Specific Commitments -- The Unilateral Liberalization Option.

Exceptions to General Obligations and Specific Commitments -- Current Status of Specific Commitments in Health-Related Service Sectors and Current Negotiations -- Making the Health Policy Voice Heard: Lessons from Other WTO Agreements -- Notes -- References and Further Reading -- 6 Economic Dimensions and Impact Assessment of GATS to Promote and Protect Health -- Impact Assessment of Trade Liberalization in Health Services -- Screening and Scoping -- Measures under Assessment -- Mode 1-Cross-border Supply -- Mode 2-Consumption Abroad -- Mode 3-Commercial Presence -- Mode 4-Presence of Natural Persons -- Trade Policy Scenarios -- Key Impact Indicators -- Causal Chain Analysis -- Mode 1-Cross-Border Supply -- Mode 2-Consumption Abroad -- Mode 3-Commercial Presence -- Mode 4-Presence of Natural Persons -- Additional Benefits and Costs of GATS Commitments -- Assessment of Flanking Measures -- Mitigating Measures -- Mode 1-Cross-border Supply -- Mode 2-Consumption abroad -- Mode 3-Commercial Presence -- Mode 4-Presence of natural persons -- Enhancing Measures -- Mode 1-Cross-border supply -- Mode 2-Consumption abroad -- Mode 3-Commercial Presence -- Mode 4-Presence of natural persons -- Monitoring and Post-Evaluation -- Notes -- References -- 7 Trade in Health Services Under the Four Modes of Supply: Review of Current Trends and Policy Issues -- Introduction -- Mode 1-Cross-Border Supply -- E-health in Industrial Countries -- E-health in Developing Countries -- Standards and Certification -- E-education -- Ethical and Privacy Issues -- Regulatory Issues -- Legal and Insurance Issues -- Mode 2-Movement of Consumers -- Factors Motivating Patients to Seek Care Abroad: Quality -- Availability -- Payment Issues -- Geographical Proximity -- Mode 3-Commercial Presence -- The Nature of the Current Public/Private Environment in Health.

The Current Regulatory Environment.