Issues covered by the WTO’s committees and agreements

SERVICES: SECTOR BY SECTOR

Health and social services

International trade in health services has been growing rapidly in recent years although it remains small compared with trade in other types of services. New health services providers, in particular from developing economies, are seeking to attract foreign patients for various types of specialized medical treatment. Health worker mobility is increasing, in particular as a consequence of ageing populations and shortages of specialized personnel in some economies.


 

 

The health sector is seeking to attract foreign investment to generate additional resources, reduce the burden on the public health system or encourage the transfer of know-how. Rapid technological advances, digitization and decreasing costs have contributed in recent years to the rapid emergence of e-health, such as remote diagnosis, and the increasing use of mobile apps to monitor patients' health.

Health and social services includes hospital services (i.e. health services delivered under the supervision of doctors), other health services (i.e. ambulance services and residential health facilities), social services and “other” health and social services. These are covered under “health and social services” in the Services Sectoral Classification List (W/120).

Some health-related services are also covered under professional services: medical and dental services, services provided by midwives, nurses, physiotherapists and para-medical personnel.

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Current commitments and exemptions  

Health and social services is one of the service sectors with the lowest level of commitments. As of end-2020, the schedules of 53 WTO members (counting EU-25 as one)(1) contained commitments in at least one of the four sub-sectors of the health and social services sector. Most commitments are on hospital services (49), followed by “other human health services” (25). Social services have commitments from 15 members.

In addition, a total of 52 schedules (counting EU-25 as one) contain commitments in medical and dental services, and 22 for services provided by midwives, nurses, physiotherapists and para-medical personnel.

With the development of telemedicine (medical services provided remotely), cross-border supply of services (mode 1) is becoming increasingly important. Nevertheless, there are fewer commitments for mode 1 than for any other mode.

Mode 2 commitments (consumers moving abroad to consume services) tend to  have few limitations, while mode 3 commitments (a foreign company setting up subsidiaries or branches to provide services in another country) are often subject to restrictions, such as economic needs tests (a test using economic criteria to decide whether the entry into the market of a foreign firm is warranted on economic grounds), and limitations on  foreign capital participation.

Overall, mode 4 commitments (individuals travelling from their own country to supply services in another) are commitments that apply generally to all services sectors.

Only four members have listed exemptions to most-favoured nation (MFN) treatment (i.e. non-discrimination) in these sectors, namely Bulgaria, Cyprus, Dominican Republic and Jordan.

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Treatment of the sector in negotiations 

Health and social services attracted limited attention during the services negotiations that began in 2000, being the only major sector where no negotiating proposal and no collective request have been tabled. In the Special Session of the Council for Trade in Services, some members had identified the removal of limitations relating to non-portability of insurance schemes under modes 1 and 2 as objectives for the market access negotiations in this sector (TN/S/23).

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Additional information 

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  • Background paper on health and social services (Document code S/* and keyword “health or social”)  > search   > help

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Footnote

  1. The schedule of specific commitments currently in force for the European Union is that of the EU-25, that is including those that were members of the EU in 2006: Austria, Belgium, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Slovak Republic, Slovenia, Spain, Sweden and the United Kingdom. Back to text