GATS and Health Systems

The General Agreement on Trade in Services (GATS) is one of a number of international agreements under the umbrella of the World Trade Organization (WTO), the largest multilateral trade body. The purpose of the WTO is to liberalize or remove barriers to trade by promoting the free movement of goods and services, labour and capital. GATS has been designed to regulate me asures affecting international trade in services, public services included. GATS might have enormous implications for public services, specially health care services.

Some of these include the inhibition of governments from shaping their own health care systems, the threatening of government-funded or -provided health services, the undermining of domestic regulation and the protection of public health.

The objectives of this topic are:

• to understand how GATS works,
• to explore the potential implications for health care services, and
• to discuss the different policy options particularly low-income countries might have.

Presentation
Miguel San Sebastian: GATS and Healthcare

Pre-reading
» The GATS threat to public health: a joint submission to the World Health Assembly, 2003. Available at:

http://medact.org/hpd_world_trade_organisation.php

» Timmermans K. Developing countries and trade in health services:
which way is forward? International Journal of Health Services 2004;
34(3):453-66.

» Chanda R. Trade in health services. Bulletin of the World Health Organization 2002; 80(2):158-63.
» Pollock AM, Price D. The public health implications of world trade negotiations on the general agreement on trade in services and public services. Lancet 2003; 362:1072-5.

» Adlung R, Carzaniga A. Health services under the General Agreement on Trade in Services. Bulletin of the World Health Organization 2001;79(4):352-64 (available also in Spanish).

Useful websites

» http://www.citizen.org/trade/wto/gats/
» http://www.policyalternatives.ca/
» http://www.gatswatch.org/
» http://www.wdm.org.uk/campaigns/GATS.htm
(with information in Spanish)
» http://www.wto.org/english/tratop_e/serv_e/serv_e.htm
(also in Spanish)

» http://europa.eu.int/comm/trade/issues/sectoral/services/index_en.htm

Further reading
» World Trade Organization. GATS: Fact and Fiction. Geneva: World Trade Organization, 2001.

Available at: http://www.wto.org/english/tratop_e/serv_e/gats_factfiction_e.htm
(also in Spanish).

» Hillary J. The wrong model: GATS, trade liberalization and childrens
right to health. London: Save the Children, 2001.

Available at: http://www.savethechildren.org.uk/scuk/jsp/index.jsp?flash=true

» Sexton S. Trading health care away? GATS, public services and
privatization. Corner House briefing no. 23. London: The Corner
House, 2001.

Available at: http://www.thecornerhouse.org.uk/briefing/index.shtml

» Pan American Health Organization / World Health Organization. Trade
in Health Services: Global, Regional and Country Perspectives.
Washington DC: Pan American Health Organization, 2002.

Available at: http://www.who.int/trade/resource/THS/en/

» World Health Organization / World Trade Organization. WTO agreements
and public health: a joint study by the WHO and the WTO secretariat.
Geneva: World Health Organization, 2002.

Available at:
http://www.who.int/trade/resource/wtoagreements/en/ (also in Spanish).

» Sinclair S, Grieshaber-Otto J. Facing the facts: a guide to the GATS
debate. Ottawa: Canadian Center for Policy Alternatives, 2002.

Available at: http://www.policyalternatives.ca/

» Smith DR. Foreign direct investment and trade in health services: a
review of the literature. Social Science & Medicine 2004; 59:
2313-2323.

» World Health Organization. GATS and health related services. Geneva:
World Health Organization, 2004.

Available at: http://www.who.int/trade/resource/foldout/en/

Discussion
questions

» Which do you think are the main problems with GATS? Which are the
main advantages?

» How do you think GATS could affect the health care system of your
country?

» What do you think could be the role of the health activists?

Assignment topics
» Identify which services your country has already committed to
negotiations.

» Identify the persons responsible for this type of negotiations within
the government and published documents available in your country,

» Identify people interested in the topic: prepare material,
disseminate information.
This topic developed by Miguel San Sebastian.