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FDI in Healthcare

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Abstract

The healthcare sector has historically been publicly funded in developing countries due to commitments of governments to provide universal access to health services at low cost. A major part of the empirical literature on FDI in healthcare is analytical in nature, with an apparent polarization of views for and against FDI. However, empirical evidence on the likely impact of FDI in health service is virtually non-existent. In this chapter, we formally investigate the effects of FDI in the healthcare sector on the welfare and human capital formation of a developing economy in terms of a three-sector, full-employment general equilibrium model with a non-traded sector that produces healthcare services the consumption of which directly raises the efficiency of the workers. The results of the analysis indicate that although FDI of the type which is specific to the healthcare sector raises the human capital endowment of the economy, it may adversely affect social welfare. On the contrary, FDI of the other type which is used in all the sectors of the economy is likely to be welfare improving under reasonable conditions. These results question the desirability of allowing entry of foreign capital in the healthcare sector that generates externalities.

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Notes

  1. 1.

    The consumption of healthcare services creates externalities by raising the efficiency of labour. So, its free market provision is not optimal. That is why there should be a consumption subsidy keeping in view the perspective of social welfare.

  2. 2.

    According to the recently released National Health Accounts (NHA) statistics in India, public health expenditure as a share of GDP increased from 0.96 % in 2004–2005 to just 1.01 % in 2008–2009 as compared to 5 % for high-income countries (Chanda 2002).

  3. 3.

    However, there are important constraints like high cost involved in setting up hospitals, long gestation period and the relatively low returns on investment that may dissuade foreign investment in healthcare sector. Outreville (2007) identifies some of the determinants of foreign investment of the largest MNCs operating in the healthcare industry.

  4. 4.

    See Smith (2004) for a detailed review of literature.

  5. 5.

    ‘Commercialization’ of healthcare refers to the increasing provision of healthcare services through market relationships to those able to pay; the associated investment in and production of those services for the purpose of cash income or profit; an increase in the extent to which healthcare finance is derived from payment systems based in individual payment or private insurance (Mackintosh 2003).

  6. 6.

    It is not unreasonable to assume that the average efficiency of the workers depends on their health conditions. This is particularly true in the developing countries, where dearth of adequate medical facilities and infrastructure impinges severely on the health of workers, leading to deterioration in their efficiency or productivity. Therefore, an expansion in the healthcare sector is expected to raise their efficiency.

  7. 7.

    Capital of type N includes advanced and precision medical equipments like cardiac pacemakers and valves, defibrillators and stents; electromedical therapeutic, monitoring and imaging devices and apparatus; in vitro diagnostics; and implantable orthopaedic and prosthetic devices and appliances. The United States, the European Union (EU) and Japan together account for about 90 % of global production of medical devices, a lion’s share of which comes to the developing countries with FDI in the healthcare sector (USITC 2007).

  8. 8.

    Trade liberalization of health service is a prominent feature of GATS commitments. For example, medical tourism and aspects of e-health, including teleradiology, telediagnostics and telepathology, have gained increased importance in recent years. However, this model does not consider trade in health services.

  9. 9.

    From the work of Bhagwati (1971), it is well known that in a small open economy, the optimal tariff is zero. However, the government in a developing economy like India finds no alternative but to keep some tariffs on importables mainly on account of political and social pressures keeping in view the employment-preserving effects of tariffs. Besides, tariff revenue is also an important source of government revenue.

  10. 10.

    An employment subsidy in the form of a wage subsidy by the same rate in the two unionized sectors may not be desirable in the present context because of the following reasons. It lowers the effective wage cost of labour in the two unionized sectors and raises the return to capital of type K, i.e. r (see Eq. 9.2). Consequently, this lowers the competitive wage, W (see Eq. 9.1), of the common workers. In a large democratic developing country like India, the implementation of this policy would be vehemently opposed by political parties and social activists on the ground that it would increase both poverty and income inequality.

  11. 11.

    This is only a simplifying assumption. It may be intuitively checked that the qualitative results of the model remain unaltered even if the stock of capital of type N consists of both domestic and foreign capital, which are perfect substitutes.

  12. 12.

    The use of fixed-coefficient technology in the non-traded sector (sector G) makes focus on the externality due to the consumption of healthcare services sharper and easily tractable.

  13. 13.

    See footnote 6 in this context.

  14. 14.

    This simplified assumption has been made in Brecher and Alejandro (1977), Khan (1982), Grinols (1991), Chandra and Khan (1993), Gupta (1997), Chaudhuri (2001a, b, 2005, 2007), etc. However, in the papers of Beladi and Marjit (1992a, b) and Marjit and Beladi (1996), foreign capital has been treated differently from domestic capital, and these two types of capital are not engaged in the same sector of the economy.

  15. 15.

    This is only a simplifying assumption. It may be intuitively checked that the qualitative results of the model remain unaltered even if the stock of capital of type N consists of both domestic and foreign capital, which are perfect substitutes.

  16. 16.

    In the standard trade theory, it is usually assumed that the government collects the tariff revenue from the import of the importables (commodity 2 in the present case) and pays it back to the consumers in a lump-sum manner. In this case, from the aggregate tariff revenue, the government holds back z amount (exogenously fixed) for financing the consumption subsidy and the rest is transferred to the consumers in a non-distortionary fashion.

  17. 17.

    It may be verified that even if the levels of demand for the other two commodities depend positively on P * G , implying commodities to be gross substitutes, all the results of the model continue to hold under an additional sufficient condition involving the term (∂D 2/∂P * G ).

  18. 18.

    Although the developing economies have chosen free trade as their development strategy and been implementing liberalized economic policies for the last two decades or so, they are yet to proceed a long way in liberalizing their economies sufficiently as desired by the international institutions like the IMF and the World Bank. In a developing country like India, there are still a lot of structural rigidities, technological and economic backwardness and different types of dualism which need to be removed fast for achieving high rate of economic growth and development. However, in many cases in a democratic set-up, the political parties and social activists stand in the way of implementing reformatory policies at the desired pace. See also footnotes 9 and 10 in this context.

  19. 19.

    Any changes in factor endowments cannot affect factor coefficients in sectors 1 and 2 as W and r do not change. Besides, in sector G we have fixed-coefficient technology of production. So, the a ji ’ s do not change due to changes in factor endowments.

  20. 20.

    The derivations and sufficient conditions are given in Appendix 9.1.

  21. 21.

    If all commodities are gross substitutes, we have (∂D 2/∂P * G ) > 0. It can be verified that the necessary and sufficient condition under which the results of Proposition 9.1 are obtained does not change.

  22. 22.

    As P * G  = (1 − s)P G and z = sP G D G (see Eqs. (9.9) and (9.12)), it is evident that P * G increases at a higher rate than P G .

  23. 23.

    The derivations and sufficient conditions are given in Appendix 9.1.

  24. 24.

    One can easily derive quite a few numbers of alternative sufficient conditions for this result to be valid. See Appendix 9.1 for details.

  25. 25.

    These are only sufficient conditions, not necessary ones. See Appendix 9.1 for derivations.

  26. 26.

    The sufficient condition, z ≥ W*ε h hL, implies that the magnitude of consumption subsidy on healthcare services (decrease in net lump-sum transfer of tariff revenue to consumers) is not less than the additional wage income generated by externalities. However, this is not at all a necessary condition. From derivations presented in Appendix 9.1, it is clear that one can derive quite a few numbers of alternative sufficient conditions for the results to be valid.

  27. 27.

    In the present case the human capital stock, C, does not change as it depends positively on the size of the healthcare sector which remains unaffected due to inflow of foreign capital of type K.

References

  • Beladi H, Marjit S (1992a) Foreign capital and protectionism. Can J Econ 25:233–238

    Article  Google Scholar 

  • Beladi H, Marjit S (1992b) Foreign capital, unemployment and national welfare. Jpn World Econ 4:311–317

    Article  Google Scholar 

  • Bhagwati JN (1971) The generalized theory of distortions and welfare. In: Bhagwati JN, Jones RW, Mundell R, Vanek J (eds) Trade, balance of payments and growth. North Holland, Amsterdam

    Google Scholar 

  • Brecher RA, Diaz Alejandro CF (1977) Tariffs, foreign capital and immiserizing growth. J Int Econ 7:317–322

    Article  Google Scholar 

  • Chanda R (2002) Trade in health services. Bull World Health Organ 80(2):158–163

    Google Scholar 

  • Chanda R (2008) Issues and concerns in an India-EU trade and investment agreement. Final report. Indian Council for Research on International Economic Relations, New Delhi

    Google Scholar 

  • Chandra V, Khan MA (1993) Foreign investment in the presence of an informal sector. Economica 60:79–103

    Article  Google Scholar 

  • Chaudhuri S (2001a) Foreign capital inflow, technology transfer, and national income. Pak Dev Rev 40(1):49–56

    Google Scholar 

  • Chaudhuri S (2001b) Foreign capital inflow, non-traded intermediary, urban unemployment, and welfare in a small open economy: a theoretical analysis. Pak Dev Rev 40(3):225–235

    Google Scholar 

  • Chaudhuri S (2005) Labour market distortion, technology transfer and gainful effects of foreign capital. Manch Sch 73(2):214–227

    Article  Google Scholar 

  • Chaudhuri S (2007) Foreign capital, welfare and unemployment in the presence of agricultural dualism. Jpn World Econ 19(2):149–165

    Article  Google Scholar 

  • Fujita M (2002) FDI trends in health care. Presentation on WHO international consultation on assessment of GATS and Trade in Health Services, Geneva

    Google Scholar 

  • Grinols EL (1991) Unemployment and foreign capital: the relative opportunity cost of domestic labour and welfare. Economica 57:107–121

    Article  Google Scholar 

  • Gupta MR (1997) Foreign capital and informal sector: comments on Chandra and Khan. Economica 64:353–363

    Article  Google Scholar 

  • Janjararoen W, Supakankunti S (2002) Chapter 8: International trade in health services in the millennium: the case of Thailand. In: Drager N, Vieira C (eds) Trade in health services: global, regional and country perspectives. PAHO, Washington, DC

    Google Scholar 

  • Khan MA (1982) Tariffs, foreign capital and immiserizing growth with urban unemployment and specific factors of production. J Dev Econ 10:245–256

    Article  Google Scholar 

  • Lethbridge J (2002) Private investment and international finance corporation investment in healthcare. (www.psiru.org)

  • Lipson D (2001a) GATS and Trade in Health Insurance Services. Paper no WG4: 7. Commission on Macroeconomics and Health, WHO, Geneva

    Google Scholar 

  • Lipson D (2001b) The World Trade Organisation’s health agenda: opening up the health services markets may worsen health equity for the poor. Br Med J 323:1139–1140

    Article  Google Scholar 

  • Mackintosh M (2003) Health care commercialisation and the embedding of inequality. Draft paper prepared for the RUIG/UNRISD project on globalization, inequality and health. United Nations Research Institute for Social Development (UNRISD)

    Google Scholar 

  • Marjit S, Beladi H (1996) Protection and gainful effects of foreign capital. Econ Lett 53:311–326

    Article  Google Scholar 

  • Mehmet O (2002) The emerging global labour market: some implications for international health. Draft paper for the WHO consultation on imbalances in the health workforce, Ottawa

    Google Scholar 

  • Outreville JF (2007) Foreign direct investment in the healthcare sector and most favoured locations in developing countries. Eur J Health Econ 8(4):305–312

    Article  Google Scholar 

  • Pollock A, Price D (2000) Rewriting the regulations: how the World Trade Organisation could accelerate privatization in healthcare systems. Lancet 356:1995–2000

    Article  Google Scholar 

  • Smith RD (2004) Foreign direct investment and trade in health services: a review of the literature. Soc Sci Med 59:2313–2323

    Article  Google Scholar 

  • USITC (2007) The economic effects of significant U.S. import restraints: fifth update. Investigation no 332-325, USITC Publication 3906. The United States International Trade Commission

    Google Scholar 

  • Waitzkin H, Iriart C (2001) How the United States exports managed care to developing countries. Int J Health Serv 31(3):495–505

    Article  Google Scholar 

  • White K, Collyer F (1998) Health care markets in Australia: ownership of the private hospital sector. Int J Health Serv 28(3):487–510

    Article  Google Scholar 

  • World Health Organisation (2002) Developing evidence-based ethical policies on the migration of health workers: conceptual and practical challenges. WHO, Geneva

    Google Scholar 

Download references

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Appendices

Appendices

9.1.1 Appendix 9.1: Derivations of Certain Useful Expressions

Totally differentiating Eqs. (9.3) and (9.7), one gets, respectively,

$$\left.\begin{array}{l}\widehat{R}=\left(\frac{{\widehat{P}}_G}{\theta_{N G}}\right)\hfill \\ {}{\widehat{X}}_G=\widehat{N}\hfill \end{array}\right\}$$
(9.A.1)

Differentiating Eqs. (9.5) and (9.6) and using (9.A.1) yield

$${\lambda}_{L1}{\widehat{X}}_1+{\lambda}_{L2}{\widehat{X}}_2=-\left({\lambda}_{L G}-{\varepsilon}_h\right)\widehat{N}$$
(9.A.2)
$${\lambda}_{K1}{\widehat{X}}_1+{\lambda}_{K2}{\widehat{X}}_2=\widehat{K}-{\lambda}_{LG}\widehat{N}$$
(9.A.3)

where ε h  = (dh/dX G )(X G /h) > 0 is the elasticity of the efficiency function of labour with respect to the output of sector G, i.e. X G .

It is assumed that the healthcare sector (sector G) is a net supplier of labour in efficiency unit, implying that λ LG  < ε h which means (λ LG  − ε h ) < 0.

Solving (9.A.2) and (9.A.3) by Cramer’s rule yields

$$\left.\begin{array}{llll}{\widehat{X}}_1&=\left(1/\left|\lambda \right|\right)\left[\widehat{N}\left\{{\lambda}_{K G}{\lambda}_{L2}-{\lambda}_{K2}\left({\lambda}_{L G}-{\varepsilon}_h\right)\right\}-{\lambda}_{L2}\widehat{K}\right] \ \ \mathrm{and}\\ {\widehat{X}}_2&=\left(1/\left|\lambda \right|\right)\left[{\lambda}_{L1}\widehat{K}+\left\{{\lambda}_{K1}\left({\lambda}_{L G}-{\varepsilon}_h\right)-{\lambda}_{K G}{\lambda}_{L1}\right\}\widehat{N}\right]\end{array}\right\}$$
(9.A.4)

where

$$\left|\lambda \right|=\left({\lambda}_{L1}{\lambda}_{K2}-{\lambda}_{L2}{\lambda}_{K1}\right)>0$$
(9.A.5)

(This is because sector 2 is more intensive in the use of capital of type K vis-à-vis sector 1 with respect to labour.)

Using (9.A.5) from (9.A.4), we find that

$$\left.\begin{array}{lll}&{\widehat{X}}_1<0; \ \mathrm{and} \ {\widehat{X}}_2>0 \ \mathrm{when} \ \widehat{K}>0; \ \mathrm{and} \\ &{\widehat{X}}_1>0; \ \mathrm{and} \ {\widehat{X}}_2<0 \ \mathrm{when} \ \widehat{N}>0 \end{array}\right\}$$
(9.A.4.1)

9.1.2 Appendix 9.2: Derivation for Change in Welfare

Differentiation of Eq. (9.14.1) gives

$$\begin{array}{llll}[b] d{D}_1+{P}_2^{*} d{D}_2+{P}_G^{*} d{D}_G&= d{X}_1+{P}_2^{*} d{X}_2+{P}_G d{X}_G+{X}_G d{P}_G+ t{P}_2 dM\\ &\quad - rd{K}_F- RdN-{D}_G d{P}_G^{*}\end{array}$$
(9.A.6)

(Note that z is a policy parameter, which here does not change. So we have dz = 0.)

We also note that X 1 = F 1(L 1, K 1) and X 2 = F 2(L 2, K 2) are the two production functions in sectors 1 and 2, respectively. Besides, we have fixed-coefficient technology in sector G where a LG units of labour (in efficiency unit), a KG units of capital of type K and a NG units of capital of type N together produce one unit output. The full-employment conditions for the three inputs are L 1 + L 2 + L G  = h(X G )L; K 1 + K 2 + K G  = K D  + K F  = K;  and N G  = N.

Hence, differentiating Eq. (9.11) and the production functions yields

$$\begin{array}{llll} d Y&= d{X}_1+{P}_2^{*} d{X}_2+{P}_G d{X}_G+{X}_G d{P}_G- rd{K}_F- RdN+ t{P}_2 d M\\ &={F}_L^1 d{L}_1+{F}_K^1 d{K}_1+{P}_2^{*}{F}_L^2 d{L}_2+{P}_2^{*}{F}_K^2 d{K}_2+{P}_G d{X}_G\\ & \ \quad +{X}_G d{P}_G- rd{K}_F- RdN+ t{P}_2 d M\end{array}$$

(Note that P G X G  = W*dL G  + rdK G  + RdN G ).

So,

$$\begin{array}{llll} d Y&= Wd{L}_1+{W}^{*}\left( d{L}_2+ d{L}_G\right)+ r\left( d{K}_1+ d{K}_2+ d{K}_G\right)+ Rd{N}_G\\ &\quad +{X}_G d{P}_G- rd{K}_F- RdN+ t{P}_2 dM\\ &=-\left({W}^{*}- W\right) d{L}_1+{X}_G d{P}_G+ t{P}_2 dM+{W}^{*}{h}^{\prime}\left(\cdot \right) Ld{X}_G \end{array}$$
(9.A.7)

(Note that (dL 2 + dL G  = h′(⋅)LdX G  − dL 1) and (dK 1 + dK 2 + dK G  = dK F ) as dK D  = 0 and dN G  = dN).

Differentiating Eq. (9.15) and using (9.A.7) we find

$$dM=\left(\frac{\partial {D}_2}{\partial Y}\right)\left[-\left({W}^{*}\!-\! W\right) d{L}_1\!+\!{X}_G d{P}_G+ t{P}_2 dM+{W}^{*}{h}^{\prime}\left(\cdot \right) Ld{X}_G\right]- d{X}_2$$

(Note that P *2 does not change.)

On simplification we get

$$\begin{array}{llll} &d M\left(\frac{1+ t\left(1- m\right)}{1+ t}\right)=\left(\frac{m}{P_2^{*}}\right)\left[-\left({W}^{*}- W\right) d{L}_1+{X}_G d{P}_G+ t{P}_2 dM\right.\\ &\qquad \qquad \qquad \qquad \qquad \ \left.+ {W}^{*}{h}^{\prime}\left(\cdot \right) Ld{X}_G\right]- d{X}_2\\&d M\!=\! v\left[\left(\frac{m}{P_2^{*}}\right)\!\left\{-\left({W}^{*}\!-\! W\right)\! d{L}_1\!+\!{X}_G d{P}_G\!+\! t{P}_2 dM+{W}^{*}{h}^{\prime}\!\left(\cdot \right)\! Ld{X}_G\right\}\!-\! d{X}_2\right]\end{array}$$
(9.A.8)

Use of (9.A.8) in (9.A.7) and simplification yield

$$dY= v\left[-\left({W}^{*}- W\right) d{L}_1+{X}_G d{P}_G- t{P}_2 d{X}_2+{W}^{*}{h}^{\prime}\left(\cdot \right) Ld{X}_G\right]$$
(9.A.9)

where v = [(1 + t)/{1 + t(1 − m)}] and m = P *2 (∂D 2/∂Y) is the marginal propensity to consume commodity 2.

Differentiating Eq. (9.13) one obtains

$$\left(\frac{1}{V_1}\right) dV= d{D}_1+{P}_2^{*} d{D}_2+{P}_G^{*} d{D}_G$$
(9.A.10)

Differentiation of Eq. (9.9), use of (9.A.6) and (9.A.9) in (9.A.10) and simplification give

$$\begin{array}{llll} \left(\frac{1}{V_1}\right) dV&=- v\left[\left({W}^{*}- W\right){a}_{L1} d{X}_1+ t{P}_2 d{X}_2\right]+ v{X}_G d{P}_G\\& \ \quad + v{W}^{*}{h}^{\prime } Ld{X}_G- s{P}_G d{D}_G\end{array}$$
(9.A.11)

(Note that dL 1 = a L1 dX 1.)

Differentiation of Eq. (9.8) yields

$${\widehat{D}}_G=\left(\frac{E_{P_G^{*}}^G}{P_G^{*}}\right) d{P}_G^{*}+\left(\frac{E_Y^G}{Y}\right) d Y$$
(9.A.12)

Using (9.A.4) and (9.A.9), Eq. (9.A.12) can be rewritten as follows:

$$\begin{array}{llll}{\widehat{D}}_G&={E}_{P_G^{*}}^G{\widehat{P}}_G^{*}+\left(\frac{v{ E}_Y^G{P}_G{X}_G}{Y}\right){\widehat{P}}_G\\ & \ \quad -\left(\frac{v{ E}_Y^G}{Y\left|\lambda \right|}\right)\left[\left({W}^{*}- W\right){a}_{L1}{X}_1\left\{{\lambda}_{K G}{\lambda}_{L2}-{\lambda}_{K2}\left({\lambda}_{L G}-{\varepsilon}_h\right)\right\}\right.\\ & \ \quad \left. + t{P}_2{X}_2\left\{{\lambda}_{K1}\left({\lambda}_{L G}-{\varepsilon}_h\right)-{\lambda}_{K G}{\lambda}_{L1}\right\}-{W}^{*}{h}^{\prime}\left(\cdot \right) L{X}_G\left|\lambda \right|\right]\widehat{N}\\ & \ \quad -\left[\left(\frac{v{ E}_Y^G{\lambda}_{L1}{X}_2}{Y\left|\lambda \right|}\right)\left\{\left({W}^{*}- W\right){a}_{L2}- t{P}_2\right\}\right]\widehat{K}\end{array}$$
(9.A.13)

Now, differentiating Eq. (9.9) and equation ((P * G  = (1 − s)P G ) and simplifying, we obtain

$${\widehat{P}}_G=\left(1- s\right){\widehat{P}}_G^{*}- s{\widehat{D}}_G$$
(9.A.14)

Rearranging terms in (9.A.13) and using (9.A.14) yield

$${H}_1{\widehat{D}}_G={H}_2{\widehat{P}}_G^{*}-{H}_3\widehat{N}+{H}_4\widehat{K}$$
(9.A.15)

where

$$\left.\begin{array}{llll}{H}_1&=\left[1+\left(\frac{sv{ E}_Y^G{P}_G{X}_G}{Y}\right)\right]>0; \\ {H}_2&=\left[{E}_{P_G^{*}}^G+\left(1- s\right)\left(\frac{v{ E}_Y^G{P}_G{X}_G}{Y}\right)\right]; \\ {H}_3&=\left(\frac{v{ E}_Y^G}{Y\left|\lambda \right|}\right)\left[\left({W}^{*}- W\right){a}_{L1}{X}_1\left\{{\lambda}_{K G}{\lambda}_{L2}-{\lambda}_{K2}\left({\lambda}_{L G}-{\varepsilon}_h\right)\right\}\right. \\ &\left.\left. \ \quad + t{P}_2{X}_2\left\{{\lambda}_{K1}\left({\lambda}_{L G}-{\varepsilon}_h\right)-{\lambda}_{K G}{\lambda}_{L1}\right\}-{W}^{*}{h}^{\prime}\left(\cdot \right) L{X}_G\left|\lambda \right|\right\}\right]; \ \mathrm{and} \\ {H}_4&=\left(\frac{v{ E}_Y^G{\lambda}_{L1}{X}_2}{Y\left|\lambda \right|}\right)\left[\left({W}^{*}- W\right){a}_{L2}- t{P}_2\right] \end{array}\right\}$$
(9.A.16)

Using (9.A.14) in (9.A.15) and simplifying, we obtain

$${\widehat{D}}_G=\left(\frac{{\overline{H}}_2}{{\overline{H}}_1}\right){\widehat{P}}_G-\left(\frac{H_3}{{\overline{H}}_1}\right)\widehat{N}+\left(\frac{H_4}{{\overline{H}}_1}\right)\widehat{K}$$
(9.A.17)

where

$$\left.\begin{array}{lll}&{\overline{H}}_1=\left({H}_1-\frac{s{ H}_2}{1- s}\right) \ \mathrm{and} \\ &{\overline{H}}_2=\frac{H_2}{1- s} \end{array}\right\}$$
(9.A.17.1)

For the sake of analytical simplicity, let us assume that D G is a negative function of P G , i.e. \(\left({\widehat{D}}_G/{\widehat{P}}_G\right)<0\) (from (9.A.14) we find that there is a one-to-one correspondence between P * G and P G ). This means (from (9.A.17) that

$$\left(\frac{{\widehat{D}}_G}{{\widehat{P}}_G}\right)=\left(\frac{{\overline{H}}_2}{{\overline{H}}_1}\right)<0$$
(9.A.17.2)

Using (9.A.16) and (9.A.17.1) and simplifying from (9.A.17.2), we get

$$\begin{array}{lr}\left(\frac{{\overline{H}}_2}{{\overline{H}}_1}\right)&=\left[\frac{\left\{{H}_2/\left(1- s\right)\right\}}{\left\{\left(\left(1- s\right){H}_1- s{H}_2\right)/\left(1- s\right)\right\}}\right]=\left[\frac{H_2}{\left(1- s\right)- s{E}_{P_G^{*}}^G}\right]<0\\& {} \ \left(-\right)\qquad\qquad\end{array}$$
(9.A.17.3)

It follows from (9.A.17.3) that

$${H}_2<0$$
(9.A.18)

Using Eqs. (9.A.18) and (9.A.16) from Eqs. (9.A.16) and (9.A.17.1), it is easy to check that

$$\left.\begin{array}{lll}&{\overline{H}}_1=\left({H}_1-\frac{s{H}_2}{1- s}\right)=\left(1-\frac{s{ E}_{P_G^{*}}^G}{1- s}\right)>0; \\ &{\overline{H}}_2=\frac{H_2}{1- s}<0; \\ &{H}_2<0; \\ &{H}_2<0 \ \mathrm{i}\mathrm{f} \ \left(\mathrm{i}\right) \ \left({W}^{*}- W\right){a}_{L2}\ge t{P}_2 \ \mathrm{and} \ \left(\mathrm{i}\mathrm{i}\right) \ {\varepsilon}_h \ \mathrm{i}\mathrm{s} \ \mathrm{low}; \\ &{H}_4>0 \ \mathrm{i}\mathrm{ff} \ \left({W}^{*}- W\right){a}_{L2}> t{P}_2 \end{array}\right\}$$
(9.A.19)

From (9.A.1) one gets

$$\left(\frac{{\widehat{X}}_G}{{\widehat{P}}_G}\right)=0$$
(9.A.20)

Now, Walrasian stability in the market for the non-traded healthcare sector requires that

$$\left(\frac{{\widehat{D}}_G}{{\widehat{P}}_G}\right)-\left(\frac{{\widehat{X}}_G}{{\widehat{P}}_G}\right)<0$$
(9.A.21)

This is automatically satisfied as \(\left(\left({\widehat{D}}_G/{\widehat{P}}_G\right)<0\kern0.5em \mathrm{and}\kern0.5em \left({\widehat{X}}_G/{\widehat{P}}_G\right)=0\right)\) (see Eqs. (9.A.17.2) and (9.A.20)).

At equilibrium in the market for sector G, we have

$${\widehat{D}}_G={\widehat{X}}_G$$
(9.A.22)

Using (9.A.17) and (9.A.1) and collecting terms from (9.A.22), one gets

$${H}_5{\widehat{P}}_G={H}_6\widehat{N}-{H}_7\widehat{K}$$
(9.A.23)

where

$$\left.\begin{array}{llll}&{H}_5=\left(\frac{{\overline{H}}_2}{{\overline{H}}_1}\right)<0; \\ &{H}_6=\left(\frac{{\overline{H}}_1+{H}_3}{{\overline{H}}_1}\right)>0 \ \mathrm{i}\mathrm{f} \ \ \left(\mathrm{i}\right) \ \left({W}^{*}- W\right){a}_{L2}\ge t{P}_2 \ \ \mathrm{and (ii) } \ \varepsilon_h \ \mathrm{is low; and} \\ &{H}_7=\frac{H_4}{{\overline{H}}_1}>\left(=\right)< \ \ \mathrm{according} \ \ \mathrm{to} \ \ \left({W}^{*}- W\right){a}_{L2}>\left(=\right)< t{P}_2 \end{array}\right\}$$
(9.A.24)

From (9.A.23) we find that

$$\left.\begin{array}{lll}&\left(\frac{{\widehat{P}}_G}{\widehat{K}}\right)=\left(-\right)\frac{H_7}{H_5}>0 \ \ \mathrm{i}\mathrm{ff} \ \ \left({W}^{*}- W\right){a}_{L2}> t{P}_2 \ \ \mathrm{and} \\ &\left(\frac{{\widehat{P}}_G}{\widehat{N}}\right)=\frac{H_6}{H_5}<0 \ \mathrm{i}\mathrm{f} \ \ \left(\mathrm{i}\right) \ \left({W}^{*}- W\right){a}_{L2}\ge t{P}_2 \ \ \mathrm{and} \\ & \quad\qquad\qquad \qquad\left(\mathrm{i}\mathrm{i}\right) \ {\varepsilon}_h \ \ \mathrm{i}\mathrm{s} \ \ \mathrm{low} \end{array}\right\}$$
(9.A.25)

From (9.A.1) and (9.A.22), we have

$$\left(\frac{{\widehat{X}}_G}{\widehat{K}}\right),\left(\frac{{\widehat{D}}_G}{\widehat{K}}\right)=0\kern0.5em \mathrm{and}$$
(9.A.26.1)
$$\left(\frac{{\widehat{X}}_G}{\widehat{N}}\right),\left(\frac{{\widehat{D}}_G}{\widehat{N}}\right)=1>0$$
(9.A.26.2)

9.1.2.1 Welfare Consequence of Capital of K Type

From (9.A.11) after using (9.A.26.1), one can write

$$\left(\frac{1}{V_1}\right)\frac{d V}{ d K}=- v\left[\left({W}^{*}- W\right){a}_{L1}\left(\frac{d{X}_1}{ d K}\right)+ t{P}_2\left(\frac{d{X}_2}{ d K}\right)\right]+ v{X}_G\left(\frac{d{P}_G}{ d K}\right)$$
(9.A.27)

The first term in (9.A.27) is the following:

$${T}_{1 K}=- v\left({W}^{*}- W\right){a}_{L1}\left(\frac{d{ X}_1}{ d K}\right)$$

Using (9.A.4) and simplifying, we obtain

$${T}_{1 K}=\left[\frac{v\left({W}^{*}- W\right){a}_{L1}{X}_1{\lambda}_{L2}}{\left|\lambda \right| K}\right]$$
(9.A.28)

Now the second term in (9.A.27) is

$${T}_{2 K}=- vt{P}_2\left(\frac{d{ X}_2}{ d K}\right)$$

Using (9.A.4) and simplifying, one gets

$${T}_{2 K}=-\left(\frac{vt{ P}_2{X}_2{\lambda}_{L1}}{\left|\lambda \right| K}\right)$$
(9.A.29)

Finally, the third term is given by

$${T}_{3 K}= v{X}_G\left(\frac{d{ P}_G}{ d K}\right)$$

Using (9.A.25), (9.A.24), (9.A.19) and (9.A.16) and simplifying, the above term can be reduced to the following:

$${T}_{3 K}=-\left[\left(\frac{v{ E}_Y^G{\lambda}_{L1}{X}_2}{Y\left|\lambda \right|{H}_2 K}\right)\left(1- s\right) v{P}_G{X}_G\left\{\left({W}^{*}- W\right){a}_{L2}- t{P}_2\right\}\right]$$
(9.A.30)

Using (9.A.28), (9.A.29) and (9.A.30) and simplifying from (9.A.27), one finally finds that

$$\left(\frac{1}{V_1}\right)\frac{dV}{dK}=\left(\frac{v{\lambda}_{L1}{X}_2}{\left|\lambda \right| K}\right)\left[\left({W}^{*}- W\right){a}_{L2}- t{P}_2\right]\left[1-\left(1- s\right)\left(\frac{v{ E}_Y^G{P}_G{X}_G}{Y{ H}_2}\right)\right]$$
(9.A.31)

From (9.A.31) we find that in the absence of both labour market distortion and tariff distortion, \(\left(\frac{1}{V_1}\right)\frac{dV}{dK}=0\). Therefore, welfare does not change.

Using (9.A.18) from (9.A.31), it leads to

$$\left.\begin{array}{lll}&\left(\frac{1}{V_1}\right)\frac{dV}{dK}>0 \ \mathrm{iff} \ \left({W}^{*}- W\right){a}_{L2}> t{P}_2 \ \ \mathrm{and} \\ &\left(\frac{1}{V_1}\right)\frac{dV}{dK}<0 \ \mathrm{iff} \ \left({W}^{*}- W\right){a}_{L2}< t{P}_2 \end{array}\right\}$$
(9.A.32)

Besides, from (9.A.32) the following results also follow.

When W* = W, that is, there is no labour market distortion,

$$\left(\frac{1}{V_1}\right)\frac{dV}{dK}<0$$
(9.A.33)

On the other hand, when t = 0, that is, there is no tariff distortion,

$$\left(\frac{1}{V_1}\right)\frac{dV}{dK}>0$$
(9.A.34)

9.1.2.2 Welfare Consequence of Capital of Type N

From (9.A.11) one can obtain

$$\begin{array}{lllll}\left(\frac{1}{V_1}\right)\frac{d V}{ d N}&=- v\left[\left({W}^{*}- W\right){a}_{L1}\left(\frac{d{X}_1}{ d N}\right)+ t{P}_2\left(\frac{d{X}_2}{ d N}\right)\right]\\& \ \quad + v{X}_G\left(\frac{d{P}_G}{ d N}\right)+\left[ v{W}^{*}{h}^{\prime}\left(\cdot \right) L\left(\frac{d{X}_G}{ d N}\right)- s{P}_G\left(\frac{d{ D}_G}{ d N}\right)\right]\end{array}$$
(9.A.35)

In (9.A.35) the first term is

$${T}_{1 N}=- v\left[\left({W}^{*}- W\right){a}_{L1}\left(\frac{d{ X}_1}{ d N}\right)+ t{P}_2\left(\frac{d{ X}_2}{ d N}\right)\right]$$

Using (9.A.4) and simplifying, we obtain

$$\begin{array}{llll}{T}_{1 N}&=-\left(\frac{v}{\left|\lambda \right| N}\right)\left[{\lambda}_{K G}{\lambda}_{L1}{X}_2\Big\{\left({W}^{*}- W\right){a}_{L2}- t{P}_2\Big\}\right.\\ & \ \quad \left.-\left({\lambda}_{LG}-{\varepsilon}_h\right)\left(\frac{a_{L1}{X}_1{\lambda}_{K2}}{a_{L2}}\right)\left\{\left({W}^{*}- W\right){a}_{L2}- t{P}_2\left(\frac{a_{L2}{a}_{K1}}{a_{K2}{a}_{L1}}\right)\right\}\right]\end{array}$$
(9.A.36)

Note that (λ LG − ε h) < 0 and that (a L2 a K1/a K2 a L1) < 1 (since sector 1 is labour-intensive relative to sector 2 with respect to capital of type K).

From (9.A.36) it now follows that

$${T}_{1 N}<0\kern1em \mathrm{if}\kern0.5em \left({W}^{*}- W\right){a}_{L2}\ge t{P}_2$$
(9.A.37)

We write the second term and the third term of (9.A.35) together as follows:

$${T}_{2 N+3 N}= v{X}_G\left(\frac{d{P}_G}{ d N}\right)+ v{W}^{*}{h}^{\prime}\left(\cdot \right) L\left(\frac{d{X}_G}{ d N}\right)- s{P}_G\left(\frac{d{ D}_G}{ d N}\right)$$

Using (9), (9.A.25), (9.A.24) and (9.A.26.2), we can write

$$\begin{array}{lll}{T}_{2 N+3 N}&= v\left[\left({X}_G\frac{P_G}{N}\right)\left(\frac{H_6}{H_5}\right)+{W}^{*}{h}^{\prime } L\left(\frac{d{X}_G}{ d N}\right)\right]-\left(\frac{z}{N}\right)\\ &= v\left[\left(\frac{P_G{X}_G}{N}\right)\left(\frac{{\overline{H}}_1}{{\overline{H}}_2}\right)+\left(\frac{P_G{X}_G}{N}\right)\left(\frac{H_3}{{\overline{H}}_2}\right)+\left(\frac{W^{*}{\varepsilon}_h hL}{N}\right)\right]-\left(\frac{z}{N}\right)\\ &= v\left[\left[\left(\frac{P_G{X}_G}{N}\right)\left(\frac{1- s- s{E}_{P_G^{*}}^G}{H_2}\right)-\left(\frac{P_G{X}_G}{{\overline{H}}_2 N}\right)\left(\frac{v{E}_Y^G{W}^{*}{\varepsilon}_h hL}{Y}\right)\right.\right.\\&\quad \left.\left.+\left(\frac{W^{*}{\varepsilon}_h hL}{N}\right)\right]\right. +\left(\frac{P_G{X}_G}{{\overline{H}}_2 N}\right)\left(\frac{v{E}_Y^G}{Y}\right)\left[\left({W}^{*}- W\right){a}_{L1}{X}_1\left\{{\lambda}_{K G}{\lambda}_{L2}\right.\right.\\ &\ \ \;\left.\left.\left.-{\lambda}_{K2}\big({\lambda}_{L G}-{\varepsilon}_h\big)\right\}+ t{P}_2{X}_2\left\{{\lambda}_{K1}\left({\lambda}_{L G}-{\varepsilon}_h\right)-{\lambda}_{K G}{\lambda}_{L1}\right\}\right]\right]-\left(\frac{z}{N}\right)\end{array}$$
(9.A.38)

Now

$$\begin{array}{llll}&\left(\frac{P_G{X}_G}{{\overline{H}}_2 N}\right)\left(\frac{v{ E}_Y^G}{Y}\right)\left[\left({W}^{*}- W\right){a}_{L1}{X}_1\left\{{\lambda}_{K G}{\lambda}_{L2}-{\lambda}_{K2}\left({\lambda}_{L G}-{\varepsilon}_h\right)\right\}\right.\\ & \ \quad\left. + t{P}_2{X}_2\left\{{\lambda}_{K1}\left({\lambda}_{L G}-{\varepsilon}_h\right)-{\lambda}_{K G}{\lambda}_{L1}\right\}\right]\ \\ &\quad=\left(\frac{P_G{X}_G}{{\overline{H}}_2 N}\right)\left(\frac{v{ E}_Y^G}{Y}\right)\left[{\lambda}_{K G}{\lambda}_{L1}{X}_2\left\{\left({W}^{*}- W\right){a}_{L2}- t{P}_2\right\}\right.\\ & \ \quad \quad \left. -\left({\lambda}_{L G}-{\varepsilon}_h\right)\left(\frac{a_{L1}{X}_1{\lambda}_{K2}}{a_{L2}}\right)\left\{\left({W}^{*}- W\right){a}_{L2}- t{P}_2\left(\frac{a_{L2}{a}_{K1}}{a_{K2}{a}_{L1}}\right)\right\}\right]\end{array}$$
(9.A.39)
$$<0\kern1em \mathrm{if}\kern0.5em \left({W}^{*}- W\right){a}_{L2}\ge t{P}_2$$
(9.A.39.1)

(Note that \({\overline{H}}_2<0\), (λ LG  − ε h ) < 0 and (a L2 a K1/a K2 a L1) < 1)

Besides,

$$\begin{array}{llll}&\left[\left(\frac{P_G{X}_G}{N}\right)\left(\frac{1- s- s{E}_{P_G^{*}}^G}{H_2}\right)-\left(\frac{P_G{X}_G}{{\overline{H}}_2 N}\right)\left(\frac{v{E}_Y^G{W}^{*}{\varepsilon}_h hL}{Y}\right)+\left(\frac{W^{*}{\varepsilon}_h hL}{N}\right)\right]\\ &\quad =\left[\left(\frac{P_G{X}_G}{N}\right)\left(\frac{1- s- s{E}_{P_G^{*}}^G}{H_2}\right)+\left(\frac{W^{*}{\varepsilon}_h hL}{N}\right)\left\{1-\left(\frac{P_G{X}_G}{{\overline{H}}_2}\right)\left(\frac{v{E}_Y^G}{Y}\right)\right\}\right]\\ &\quad =\left[\left(\frac{P_G{X}_G}{N}\right)\left(\frac{1- s- s{E}_{P_G^{*}}^G}{H_2}\right)+\left(\frac{W^{*}{\varepsilon}_h hL{E}_{P_G^{*}}^G}{N{ H}_2}\right)\right]\\ &\quad =\left(\frac{1}{N{ H}_2}\right)\left[\left(1- s\right){P}_G{X}_G-\left( s{P}_G{X}_G-{W}^{*}{\varepsilon}_h hL\right){E}_{P_G^{*}}^G\right]\\ &\quad =\left(\frac{1}{N{ H}_2}\right)\left[\left(1- s\right){P}_G{X}_G-\left( z-{W}^{*}{\varepsilon}_h hL\right){E}_{P_G^{*}}^G\right] \end{array}$$
(9.A.40)
$$<0\kern1em \mathrm{if}\kern0.5em z\ge {W}^{*}{\varepsilon}_h hL$$
(9.A.40.1)

(Note that H 2 < 0; \({E}_{P_G^{*}}^G<0\); and z = sP G X G .)

So, using (9.A.39), (9.A.39.1), (9.A.40) and (9.A.40.1) from (9.A.38), we find

$${T}_{2 N+3 N}<0\kern1em \mathrm{i}\mathrm{f}\kern0.5em \left(\mathrm{i}\right)\kern0.5em \left({W}^{*}- W\right){a}_{L2}\ge t{P}_2\kern0.5em \mathrm{and}\kern0.5em \left(\mathrm{i}\mathrm{i}\right)\kern0.5em z\ge {W}^{*}{\varepsilon}_h hL$$
(9.A.41)

It may be noted that the term T 2N + 3N measures the net effect of LEE and DVE (defined in the text) on social welfare.

Therefore, using (9.A.36), (9.A.37) and (9.A.38) and (9.A.41) from (9.A.35), it follows that

$$\left(\frac{1}{V_1}\right)\frac{dV}{dN}<0\kern1em \mathrm{i}\mathrm{f}\kern0.5em \left(\mathrm{i}\right)\kern0.5em \left({W}^{*}- W\right){a}_{L2}\ge t{P}_2\kern0.5em \mathrm{and}\kern0.5em \left(\mathrm{i}\mathrm{i}\right)\kern0.5em z\ge {W}^{*}{\varepsilon}_h hL$$
(9.A.42)

From Eqs. (9.A.38) and (9.A.40), it may be noted that the second sufficient condition (i.e. z ≥ W*ε h hL) can be replaced by a few other alternative sufficient conditions.

From (9.A.40) it may be noted that the second sufficient condition (i.e. z ≥ W*ε h hL) can be replaced by a few other alternative sufficient conditions.

From (9.A.42) one may note that in the absence of any tariff we have

$$\left(\frac{1}{V_1}\right)\frac{dV}{dN}<0\kern1em \mathrm{if}\kern0.5em z\ge {W}^{*}{\varepsilon}_h hL$$
(9.A.43)

9.1.2.3 Effect of \(\widehat{N}>0\) on Aggregate Labour Endowment in Efficiency Unit

Differentiating Eq. (9.16) with respect to N gives

$$\frac{d C}{ d N}={h}^{\prime } L\frac{d{ X}_G}{ d N}$$
(9.A.44)

Using (9.A.1) Eq. (9.A.44) may be rewritten as follows:

$$\frac{dC}{dN}=\left(\frac{\varepsilon_h hL}{N}\right)>0$$
(9.A.45)

So an inflow of foreign capital of type N always improves the human capital stock of the economy.

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Chaudhuri, S., Mukhopadhyay, U. (2014). FDI in Healthcare. In: Foreign Direct Investment in Developing Countries. Springer, New Delhi. https://doi.org/10.1007/978-81-322-1898-2_9

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