I've been watching the telemedicine industry with great interest. As with online education, I think there is great potential to offer medical services online. Not all of them, of course, but certainly many types of consultations could take place this way. If governments allow it, that is.
If they do allow it, there is the possibility of cross-border trade in services that were not previously tradable. Which makes me wonder, what do existing trade rules say about this, and what will future ones say?
Skimming through the CETA again recently, I came across this interesting nugget on the issue:
Telemedicine may only be provided in the context of a primary treatment involving the prior physical presence of a doctor.
This is from Germany's Annex I "Reservations for Existing Measures and Liberalisation Commitments," in the context of three kinds of services: (1) Medical and Dental Services, Midwives services, Services provided by nurses; (2) Human health and Social Care services, hospitals, ambulance services, rescue services; and (3) Veterinary services. This reservation would be a very strong restriction on Canadian telemedicine services offered in Germany.
Having come across this reservation, I searched for the word "telemedicine" in all of the CETA documents, but did not see any other instances. So does that mean it is allowed in places other than Germany?
At first glance, I don't think so. Generally speaking, there is a broader exemption from liberalization in this sector based on residency and/or citizenship. That is, only residents/citizens licensed locally can provide these services. So you won't be able to trade these services across borders via telemedicine very easily.
(That may not be the final word on this -- I was just skimming through quickly. It's not clear to me if all governments involved have excluded all medical services.)
So that's the CETA, which looks like it has "carved out" most medical services from trade liberalization. I suppose the domestic lobby is pretty strong here, and doesn't like competition. Then, of course, there's the question of how the TTIP will treat the issue. There is some misguided talk that the UK's NHS would be privatized under the TTIP, which is completely off base. But what will the TTIP do with telemedicine? Will there be any liberalization commitments in this sector as part of the TTIP?
