Trade in environmental services: opportunities and constraints

The environmental services sector has been growing rapidly during the last two decades. Moreover, privatization and increasing outward-orientation of environmental services during the 1990s has made this sector an important service sector for negotiations under the new round of GATS.This study explores the nature and structure of the environmental services sector, both globally and in India, with particular focus on recent trends such as privatization and foreign investment in this sector. It also discusses issues of classification and definition which have occupied centre stage in the multilateral negotiations in this sector. The study assesses the implications of liberalizing environmental services in India, taking into account the country's strengths, weaknesses, and interests in this sector. Based on this assessment, it suggests a negotiating strategy for India in environmental services in the ongoing GATS 2000 negotiations. Given the special features of this sector, the study also suggests domestic reforms and regulations to ensure equity and sustainability along with economic efficiency in the provision of environmental services in India.

Trade in health services and sustainable development

Effective health services form the backbone of health interventions. Accessibility, quality, capacity, organization, availability of human and physical resources and equity in the provision of health services are essential for a healthcare system to deliver desired health and related sustainable development outcomes. This paper focuses on the impact of health services trade on the realization of sustainable development goals and the various modalities through which this impact may occur. The focus on the intersection of health services and trade is motivated by the growing globalization and tradability of health services due to cross-border investment flows, mobility of health professionals and patients across borders, the use of information and communication technologies to deliver cross-border services and the transfer of ideas, research and management skills and knowhow between countries. The discussion highlights the positive and negative implications of health services trade for sustainable development goals and the fact that this impact depends on the specifics of the country and its national healthcare system, the regulatory environment governing the health sector and related sectors, the policies adopted to facilitate or constrain this trade and the associated externalities. The paper concludes by indicating two broad directions for policy action at the national level, if trade in health services is to facilitate the realization of SDGs and mitigate the negative effects on development. The first is to address structural issues in the healthcare system, the key structural issues being standards, infrastructure, human resources and technology. The second area for policy action is to ensure synergies between health services trade and the rest of the healthcare system. In addition to national policies, multilateral and regional cooperation can also promote sustainable development in the context of health services trade. Overall, the paper suggests that trade in health services can be strategically used to address several sustainable development goals, although it may pose potential challenges for equity and sustainability. Countries need to adopt a proactive approach to provide a supportive regulatory and infrastructural environment so that the many potential gains associated with health services trade can be facilitated and enhanced while the associated negative effects can be minimized or prevented. Trade should therefore not be viewed in a narrow way as a form of commercialization of health services but rather as a means to make health services more accessible, affordable and of better quality

India-EU relations in health services: prospects and challenges

<p>Abstract</p> <p>Background</p> <p>India and the EU are currently negotiating a Trade and Investment Agreement which also covers services. This paper examines the opportunities for and constraints to India-EU relations in health services in the context of this agreement, focusing on the EU as a market for India's health services exports and collaboration. The paper provides an overview of key features of health services in the EU and India and their bearing on bilateral relations in this sector.</p> <p>Methods</p> <p>Twenty six semi-structured, in-person, and telephonic interviews were conducted in 2007-2008 in four Indian cities. The respondents included management and practitioners in a variety of healthcare establishments, health sector representatives in Indian industry associations, health sector officials in the Indian government, and official representatives of selected EU countries and the European Commission based in New Delhi. Secondary sources were used to supplement and corroborate these findings.</p> <p>Results</p> <p>The interviews revealed that India-EU relations in health services are currently very limited. However, several opportunity segments exist, namely: (i) Telemedicine; (ii) Clinical trials and research in India for EU-based pharmaceutical companies; (iii) Medical transcriptions and back office support; (iv) Medical value travel; and (v) Collaborative ventures in medical education, research, training, staff deployment, and product development. However, various factors constrain India's exports to the EU. These include data protection regulations; recognition requirements; insurance portability restrictions; discriminatory conditions; and cultural, social, and perception-related barriers. The interviews also revealed several constraints in the Indian health care sector, including disparity in domestic standards and training, absence of clear guidelines and procedures, and inadequate infrastructure.</p> <p>Conclusions</p> <p>The paper concludes that although there are several promising areas for India-EU relations in health services, it will be difficult to realize these opportunities given the pre-dominance of public healthcare delivery in the EU and sensitivities associated with commercializing healthcare. Hence, a gradual approach based on pilot initiatives and selective collaboration would be advisable initially, which could be expanded once there is demonstrated evidence on outcomes. Overall, the paper makes a contribution to the social science and health literature by adding to the limited primary evidence base on globalization and health, especially from a developing-developed country and regional perspective.</p

Impact of Services Trade Liberalization on Employment and People Movement in South Asia

Services have been a key driver of overall economic growth in South Asia since the 1990s. This paper examines how the growth of services output, trade and investment have affected service sector employment in South Asia and the extent to which countries in this region are pro-actively undertaking skill development, training, and human resource management policies that are targeted at the service sector.services; service sector employment; service sector; south asia

The potential for bi-lateral agreements in medical tourism: A qualitative study of stakeholder perspectives from the UK and India

BACKGROUND: Globalisation has prompted countries to evaluate their position on trade in health services. However, this is often done from a multi-lateral, rather than a regional or bi-lateral perspective. In a previous review, we concluded that most of the issues raised could be better addressed from a bi-lateral relationship. We report here the results of a qualitative exercise to assess stakeholders' perceptions on the prospects for such a bi-lateral system, and its ability to address concerns associated with medical tourism. METHODS: 30 semi-structured interviews were carried out with stakeholders, 20 in India and 10 in the UK, to assess their views on the potential offered by a bi-lateral relationship on medical tourism between both countries. Issues discussed include data availability, origin of medical tourists, quality and continuity of care, regulation and litigation, barriers to medical tourism, policy changes needed, and prospects for such a bi-lateral relationship. RESULTS: The majority of stakeholders were concerned about the quality of health services patients would receive abroad, regulation and litigation procedures, lack of continuity of care, and the effect of such trade on the healthcare available to the local population in India. However, when considering trade from a bi-lateral point of view, there was disagreement on how these issues would apply. There was further disagreement on the importance of the Diaspora and the validity of the UK's 'rule' that patients should not fly more than three hours to obtain care. Although the opinion on the prospects for an India-UK bi-lateral relationship was varied, there was no consensus on what policy changes would be needed for such a relationship to take place. CONCLUSIONS: Whilst the literature review previously carried out suggested that a bi-lateral relationship would be best-placed to address the concerns regarding medical tourism, there was scepticism from the analysis provided in this paper based on the over-riding feeling that the political 'cost' involved was likely to be the major impediment. This makes the need for better evidence even more acute, as much of the current policy process could well be based on entrenched ideological positions, rather than secure evidence of impact

Must Skilled Migration Be a Brain Drain? : Evidence from the Indian Software Industry

We provide a first empirical attempt at understanding the scale and type of skilled migration from the Indian software sector and the consequences for firms experiencing loss of skilled workers. The paper draws on some unique survey evidence of software firms in India. The results are not generally consistent with an adverse or brain drain story but provide a more nuanced interpretation. Not only has skilled migration taken a variety of firms – including significant temporary migration – but the evidence suggests that the impact of mobility on performance in the sending firms has not been unambiguously adverse. There is some evidence of associated wage pressure at the height of the software boom in the late 1990s. But there is also evidence of a strong supply side response as workers acquired training and entered the sector

Developing Countries in the WTO Services Negotiations

The aim of this paper is to analyse developing countries' participation so far in the current round of services negotiations under the Doha Development Agenda. The paper analyses developing countries' negotiating positions, as evidenced by their multilateral negotiating proposals; their initial offers; and, to the extent allowed by the incomplete and sketchy information available, their participation in bilateral market access negotiations. A number of basic themes are raised: the essential role of services for economic development; the high costs imposed by trade protection; the benefits of liberalization; the need to make use of the WTO forum to enhance credibility and sustain domestic regulatory reform programmes; the challenges of regulatory reform and the importance of appropriate sequencing; and the benefits arising from seeking further market access overseas in those areas where developing countries have a comparative advantage

Medical tourism: a review of the literature and analysis of a role for bi-lateral trade.

OBJECTIVES: With increasing globalization, many countries are considering opening their health systems to greater cross-border movement of patients. This is usually done from the viewpoint of a multi-lateral trade relationship. This paper considers the issues that arise from this debate from a bi-lateral perspective. METHODS: A systematic literature review was carried out on 'Medical Tourism' from the perspective of a bi-lateral trade relationship, using the UK and India as a case study. RESULTS: There is a dearth of data and discussion on such bi-lateral trade. This limited evidence offers some suggestions. Exporting countries may benefit from medical tourism by generating foreign exchange and reversing the brain drain, but run the risk of creating a dual system, where the local population is crowded out. Importing countries can benefit from alleviating waiting lists and lowering healthcare costs, but may risk quality of care and legal liability. However, evidence from a bi-lateral perspective suggests that the positive aspects can be capitalised, and the negative ones reduced. CONCLUSIONS: The key recommendations from this paper are for more evidence to be collected at the country and international level, and for countries to consider trade in health services from a bi-lateral rather than multi-lateral perspective

Goans in Portugal: Role of history and identity in shaping diaspora linkages

CARIM-India: Developing a knowledge base for policymaking on India-EU migrationThe Portuguese colonial era in India began in 1502 and ended in 1961 with the annexation of Goa by India. This long standing colonial relationship led to a deep-rooted historical, cultural and social relationship between Goa and Portugal. Migration from Goa to Portugal, over different periods, played an important part in forging this relationship. This paper examines the history of migration from Goa to Portugal, the characteristics of the Goan community in Portugal, and its engagement with Goa and with India, based on secondary and primary sources of information. Section 2 discusses the different waves of migration from Goa to Portugal. It finds that Goans migrated to Portugal during the colonial period in search of education, then following the annexation of Goa by India in 1961, and subsequently during the 1970s when Goans “twice migrated” to Portugal from Mozambique and Angola following their independence. In recent decades, Goans have been migrating to Portugal to seek access to the larger European market. Today, there is a sizeable Goan community residing in Portugal. Sections 3 and 4 explore the question of identity as perceived by this community in Portugal. The findings indicate that history, the causal factors underlying migration, and the heterogeneity within the community in terms of background, economic and social status have a major influence on the notion of identity. One section of the community does not consider itself as a diaspora group or as expatriates or migrants as it sees itself as fully integrated with Portuguese society. Their connection is with Goa, not with India. Another section of the community views itself as belonging to India and also Goa, realizing that they have a distinct identity within Portugal. For the twice migrated, the issue of identity is even more complex as they identify with a third country and many have never lived in Goa or India. Section 5 discusses how this issue of identity has in manifested itself in different ways, such as through the community’ position on issues of minority representation within Portuguese society, through diaspora associations and networks, and the extent to which the community has engaged with and contributed back to Goa and India. It finds that due to the dilemma over identity, the community has had very weak economic and philanthropic ties with the homeland. Section 6 highlights the growing engagement between the Goan community in Portugal and India in recent years and some initiatives at the government level to deepen this engagement. However, it finds that a long term strategic vision has been lacking on the part of both the Indian and the Portuguese governments. Section 7 concludes by calling for a forward looking approach to engaging with the Goan diaspora community in Portugal. It recommends that this community be strategically leveraged not only to strengthen economic and cultural relations with Portugal but also to serve India’s larger foreign policy and geopolitical objectives in the Lusophone countries of Latin America and Africa.CARIM-India is co-financed by the European University Institute and the European Union