Trade in Services, Intellectual Property and Investment

Introduction and Context

International business increasingly depends on transactions that are not ordinary cross-border sales of goods. A software platform may be delivered digitally, a foreign bank may establish a local subsidiary, a consultant may travel temporarily to advise a client, and a pharmaceutical firm may license a patent to a manufacturer abroad. These transactions are governed by three connected but distinct areas of international economic law:

1. Trade in services, principally governed multilaterally by the General Agreement on Trade in Services (GATS).
2. Intellectual property (IP), governed at the World Trade Organization (WTO) level mainly by the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), together with domestic and regional regimes.
3. International investment, governed through domestic investment laws, investment chapters in trade agreements, bilateral investment treaties (BITs), and investor–state dispute settlement (ISDS) mechanisms.

These regimes seek to balance liberalization with legitimate public objectives such as consumer protection, financial stability, public health, privacy, national security, environmental protection and cultural policy. Their practical significance is considerable: a firm entering a foreign market must determine not only whether it may sell, but also how it may supply, whether it may own local assets, how its technology will be protected, and what legal risks arise if government policy changes.

Learning Objectives

By the end of this chapter, students should be able to:

• Explain the scope and architecture of the GATS.
• Distinguish the four GATS modes of supply and apply them to transactions.
• Analyze market-access, national-treatment and domestic-regulation issues.
• Explain TRIPS standards for patents, copyright, trademarks, trade secrets and enforcement.
• Evaluate licensing, technology transfer and border-enforcement risks.
• Explain investment screening, expropriation, fair and equitable treatment, performance requirements and ISDS risk.
• Integrate services, IP and investment analysis in an international business decision.

1. The GATS Framework

1.1 Scope and institutional structure

The GATS applies to measures by members affecting trade in services, including measures adopted by central, regional or local governments and by bodies exercising delegated governmental authority. “Measures” include laws, regulations, rules, procedures, decisions and administrative actions.

The GATS does not apply to services supplied in the exercise of governmental authority. This exclusion is narrower than a general public-service exemption. A service falls within the exclusion only when it is supplied neither on a commercial basis nor in competition with one or more service suppliers. A publicly funded service may therefore remain within GATS coverage if private suppliers compete with it or if it is supplied commercially.

The GATS also contains a general security exception and general exceptions, including measures necessary to protect public morals or public order, human, animal or plant life or health, and measures relating to compliance with laws. Such exceptions are subject to conditions designed to prevent arbitrary or unjustifiable discrimination and disguised restrictions on trade.

The agreement has three important layers:

• General obligations, some applying across the agreement, such as most-favoured-nation treatment (MFN), transparency and certain administrative disciplines.
• Specific commitments, recorded in each member’s schedule, especially market access and national treatment.
• Annexes and sectoral instruments, addressing areas such as telecommunications, financial services, air transport and movement of natural persons.

MFN treatment generally requires a member to treat services and service suppliers of all WTO members no less favourably than those of any other member. Unlike market access and national treatment, MFN applies broadly unless a permitted exemption exists.

1.2 The four modes of supply

The GATS classifies services according to the location of the supplier and consumer.

Modes may occur in combination. For example, a foreign hospital may establish a local clinic (Mode 3), receive foreign patients (Mode 2), and obtain remote diagnostic support from specialists abroad (Mode 1). A temporary movement of employees may also involve Mode 4, but Mode 4 does not cover permanent migration or access to the general employment market.

1.3 Market access and national treatment

A member’s schedule determines the extent of its commitments by sector and mode. A commitment may be “none,” meaning no listed limitation, or may contain limitations. “Unbound” means the member undertakes no commitment for that sector or mode, subject to other obligations.

Under GATS Article XVI, market-access limitations include, unless otherwise specified:

• limits on the number of service suppliers;
• limits on the total value of service transactions or assets;
• limits on the total number of service operations or quantity of output;
• limits on the number of natural persons employed;
• measures requiring particular types of legal entity or joint venture; and
• limits on foreign capital participation.

The legal classification depends on the measure’s design and effect, not merely on the label used by government. A numerical quota on foreign-owned clinics, for example, may be a market-access limitation even if described as an investment-planning rule.

National treatment under Article XVII requires treatment no less favourable to like foreign services and service suppliers than that accorded to domestic services and suppliers, but only in sectors and modes included in the schedule. A formally identical rule can still be less favourable in practice if it modifies competitive conditions to the detriment of foreign suppliers. Conversely, different treatment is not necessarily inconsistent if it does not disadvantage the foreign service or supplier in competitive terms.

1.4 Domestic regulation

Article VI addresses measures such as licensing requirements, qualification requirements, technical standards and procedures. These measures often pursue legitimate objectives and are not automatically prohibited. The key distinction is between:

• quantitative or structural restrictions that may fall under scheduled market-access disciplines; and
• regulatory requirements applied to suppliers, which may raise Article VI concerns.

The frequently cited idea that regulation should be “not more burdensome than necessary” must not be presented as a free-standing, universally applicable GATS test. Its application depends on the relevant legal provision, the member’s commitments, and applicable additional disciplines or interpretations. Article VI:4 contemplates disciplines concerning qualification requirements, technical standards and licensing requirements, while Article VI:5 limits certain measures in committed sectors where they nullify or impair commitments in specified circumstances. Additional disciplines may also apply in particular sectors or under later legal instruments.

Accordingly, analysis should proceed in stages:

1. Identify the service and mode of supply.
2. Determine whether the measure affects trade in services.
3. Check the member’s schedule and any applicable annex or additional discipline.
4. Characterize the measure as market access, national treatment, domestic regulation or another obligation.
5. Examine legitimate regulatory objectives, procedural fairness, transparency and any applicable exception.
6. Avoid assuming that every burdensome regulation violates a general necessity test.

Licensing systems should be transparent, impartial and administered within a reasonable period. Professional qualification rules may legitimately protect consumers, but opaque, discriminatory or unnecessarily duplicative procedures create legal and commercial risk.

2. Applying GATS to Business Decisions

A services firm should prepare a regulatory map identifying each mode used in its business model. Consider a digital education company that:

• supplies online courses from its home country to foreign students: Mode 1;
• opens a locally incorporated subsidiary: Mode 3; and
• sends instructors temporarily to conduct workshops: Mode 4.

The facts identify Modes 1, 3 and 4—not Mode 2. Mode 2 would arise only if students travelled abroad to consume the service. The company must therefore inspect commitments for each relevant mode separately. A country may permit Mode 1 but restrict Mode 3 through foreign-equity caps, or permit Mode 3 while imposing qualification rules on Mode 4 personnel.

Worked application: scheduled commitments

Suppose a country’s schedule for management consulting states:

• Mode 1 market access: “none”;
• Mode 3 market access: foreign equity limited to 49%;
• Mode 4: unbound except for executives and specialists for 90 days;
• national treatment: no limitation for Mode 1, but a local licensing condition for Mode 3.

A foreign firm may provide remote consulting without a listed market-access restriction, but it cannot assume that it may establish a wholly owned subsidiary. Its executives may enter only within the stated personnel category and duration. The local licensing condition must be assessed under the applicable national-treatment and domestic-regulation rules.

3. Intellectual Property and TRIPS

3.1 Purpose and principles

TRIPS establishes minimum standards of IP protection and enforcement while allowing members policy space to pursue public objectives. It incorporates important principles from earlier intellectual-property conventions and requires national treatment and MFN treatment, subject to specified exceptions.

TRIPS does not create a single global patent or trademark registration. Rights remain territorial, and businesses generally need protection in each relevant jurisdiction. International filing systems may simplify procedures, but they do not eliminate national legal requirements.

3.2 Principal rights

Copyright and related rights. Copyright protects original expression, not ideas, methods or facts as such. Protected subject matter commonly includes software code, written works, music, audiovisual works and databases meeting applicable originality standards. Authors receive economic rights, while moral rights may arise under other international instruments or national law.

Trademarks. A trademark distinguishes goods or services. Protection may cover words, logos, shapes, sounds or other signs, subject to national law. Registration usually strengthens enforcement, but use, distinctiveness and classification remain important.

Geographical indications. A geographical indication identifies a product as originating in a territory where a quality, reputation or characteristic is essentially attributable to geographical origin. TRIPS gives special protection to wines and spirits and requires broader protection against misleading use.

Patents. TRIPS requires patents to be available for inventions, whether products or processes, in all fields of technology, provided they are new, involve an inventive step and are capable of industrial application, subject to permitted exclusions. Patent terms must generally be at least 20 years from the filing date. Patent rights are territorial and can be limited by exceptions such as regulatory review and, under conditions, compulsory licensing.

Trade secrets. Undisclosed information is protected when it is secret, has commercial value because it is secret, and has been subject to reasonable steps to keep it secret. Protection is particularly important for algorithms, formulas, customer lists, manufacturing processes and pricing data.

3.3 Licensing and technology transfer

Licensing grants another party defined rights to use IP while ownership remains with the licensor. A licence should specify:

• the protected asset and technical materials;
• territory and field of use;
• duration and renewal;
• exclusivity;
• royalties and payment audit rights;
• quality-control obligations;
• confidentiality and cybersecurity safeguards;
• improvements and grant-back arrangements;
• sublicensing;
• compliance with export controls and sanctions; and
• termination and post-termination treatment.

International licensing presents risks beyond contract drafting. A licensee may face restrictions on importing components, local competition rules, data-localization requirements or compulsory-licensing provisions. A licensor must also consider whether technology transfer could weaken its competitive position or expose trade secrets.

3.4 Enforcement and border measures

TRIPS requires civil and administrative procedures, provisional measures and criminal procedures in specified circumstances. Effective enforcement depends heavily on national institutions. Rights holders should preserve evidence, register rights where useful, conduct supply-chain due diligence and use customs-recordation systems where available.

Border measures can suspend the release of suspected counterfeit or pirated goods. They are particularly valuable for trademarks and copyright, but procedures, eligible rights and evidentiary standards differ by jurisdiction. Enforcement must also respect due process and avoid blocking legitimate parallel trade where national law permits it.

Public-health controversies demonstrate the balance between patent protection and access to medicines. TRIPS permits members to adopt measures protecting public health, and the Doha Declaration confirms members’ right to interpret and implement TRIPS in support of access to medicines, subject to the agreement’s conditions.

4. International Investment Law

4.1 Investment entry and screening

Investment law commonly distinguishes between:

• admission and establishment, governed largely by domestic law and treaty commitments; and
• post-establishment treatment, governed by domestic law and applicable treaty standards.

Investment screening may examine national security, critical infrastructure, sensitive data, defence technology, media influence, land ownership or supply-chain resilience. Screening is not automatically protectionist or unlawful, but fair systems should use clear criteria, consistent procedures, reasoned decisions and review mechanisms. Companies should conduct ownership and control analysis, identify beneficial owners, map data and technology assets, and seek approval before closing where required.

4.2 Core investment protections

National treatment and MFN. These standards may require treatment comparable to domestic or third-country investors, depending on treaty wording and the relevant comparator.

Fair and equitable treatment (FET). FET clauses vary. They may protect against arbitrary or manifestly unfair conduct, denial of justice, fundamental procedural unfairness and, in some treaties, frustration of specific representations. FET does not normally guarantee that laws will never change. A sophisticated investor should assess the host state’s regulatory framework, representations, permits and foreseeable policy evolution.

Full protection and security. This commonly concerns physical security and, depending on treaty language, legal protection, but its scope is treaty-specific.

Expropriation. Direct expropriation involves formal seizure or transfer of title. Indirect expropriation may arise where government measures substantially deprive an investor of the use, value or control of an investment without formal seizure. Police-power regulation adopted in a non-discriminatory manner for legitimate public purposes may not constitute compensable expropriation, especially under modern treaty language. The analysis is fact-specific and considers economic impact, duration, interference with reasonable expectations, the character of the measure and the public purpose.

A lawful expropriation generally requires a public purpose, non-discrimination, due process and compensation under the applicable treaty. Compensation formulas vary; no universal single formula governs every dispute.

Transfers. Many treaties protect transfers relating to investments, subject to exceptions for insolvency, criminal enforcement, financial regulation or balance-of-payments crises.

4.3 Performance requirements and the TRIMs Agreement

Performance requirements condition investment approval or benefits on conduct such as local purchasing, export targets, technology transfer, local employment or domestic production. They may conflict with investment treaties, trade agreements or the WTO Agreement on Trade-Related Investment Measures (TRIMs).

TRIMs prohibits certain investment measures inconsistent with GATT Article III (national treatment) or Article XI (quantitative restrictions), especially local-content and trade-balancing requirements illustrated by the agreement’s examples. The legal characterization does not depend solely on whether the measure is called a “requirement,” “condition” or “incentive.”

For example, suppose a government offers a tax credit only to an electronics investor that uses at least 40% domestically produced hardware. Although the measure is framed as an incentive rather than a mandatory purchase rule, the condition may encourage or require substitution of domestic products for imported products and therefore raise TRIMs concerns. The conclusion requires examination of the measure’s exact legal design, availability of the benefit, competitive effects and relevant exceptions, but the incentive label is not decisive.

Investment treaties may separately restrict performance requirements, sometimes extending beyond TRIMs to technology transfer, exclusive sourcing, research location or local management conditions. A transaction should therefore be assessed under both WTO law and the applicable investment instrument.

4.4 Investor–state dispute settlement

ISDS permits a qualifying investor to bring a claim directly against a host state under a treaty, investment chapter or contract containing consent to arbitration. Typical steps include consultation, a cooling-off period, notice of dispute, tribunal constitution, jurisdictional objections, merits, damages and enforcement.

Risk analysis should address:

• whether the claimant is an eligible investor;
• whether the asset is a protected investment;
• treaty nationality and corporate restructuring;
• timing and limitation periods;
• fork-in-the-road or exhaustion requirements;
• applicable substantive standards;
• transparency and third-party participation; and
• costs, duration and enforceability.

ISDS does not guarantee recovery. Tribunals may reject claims for lack of jurisdiction, abuse of process, failure to satisfy procedural conditions or insufficient evidence. States increasingly revise treaties to clarify FET, exceptions, taxation, public health and environmental regulation.

5. Integrated Case Study: Aurora Mobility’s Foreign Expansion

The following is an illustrative fictional case.

Background

Aurora Mobility, a company headquartered in State A, develops electric-vehicle fleet software, owns a patented battery-management system and plans to enter State B. It intends to sell cloud services remotely, establish a wholly owned subsidiary, send engineers for six-month installations and license its patent to a local manufacturer.

State B requires cybersecurity certification, limits foreign ownership in critical transport infrastructure to 60%, screens investments involving sensitive mobility data, and offers a tax credit to manufacturers using at least 40% domestic hardware. Its customs authority has a recordation system for trademarks and patents.

Problem

Aurora must determine whether its business model is legally feasible and how to reduce regulatory and dispute risk.

Analysis

Remote software delivery is Mode 1. The subsidiary is Mode 3. Temporary engineer travel is Mode 4. No facts indicate Mode 2. Aurora must inspect State B’s GATS schedule for each mode, especially foreign-equity limits, licensing and temporary-entry commitments. Cybersecurity certification may be a domestic-regulation issue, but its legality depends on the applicable commitments and disciplines; it is not automatically invalid merely because compliance is costly.

The patent licence should define territory, field of use, confidentiality, improvements, quality control and audit rights. Aurora should register relevant trademarks and use customs recordation to address counterfeit products. Trade secrets should be protected through access controls, employee obligations and technical safeguards.

The 60% foreign-ownership ceiling may be a market-access limitation if covered by State B’s Mode 3 commitments, but it may also be permitted if State B scheduled the limitation or reserved the sector. Investment screening should be completed before closing. The tax credit’s 40% domestic-hardware condition raises a TRIMs issue because an incentive conditioned on domestic sourcing can operate as a local-content measure. State B must also examine any investment-treaty prohibition on performance requirements.

Aurora should assess whether State B made specific commitments on permits or approvals. A sudden cancellation after reliance could raise FET or expropriation arguments, but ordinary, non-discriminatory cybersecurity regulation adopted for a legitimate public purpose may be defensible. The investment contract should include stabilization, dispute-resolution and compliance provisions only where legally and commercially appropriate.

Approach and outcome

Aurora restructures the project so that non-sensitive data is processed locally while sensitive data is segregated; obtains preliminary screening approval; uses a 40%-owned local joint venture only if commercially acceptable; negotiates a patent licence with strong confidentiality and audit provisions; and seeks clarification of the tax-credit condition from State B’s authorities. It also creates a treaty-risk register and preserves evidence of government representations.

Learning points

• One transaction can involve several GATS modes, but each mode must be identified from the facts.
• Market access depends on scheduled commitments, not on a general assumption of openness.
• Domestic regulation analysis requires attention to Article VI, applicable disciplines and commitments.
• IP protection is territorial and must be supported by contracts, registration and enforcement planning.
• Incentives may raise TRIMs and investment-treaty concerns even when they are not expressed as mandatory purchase rules.
• ISDS risk is reduced by careful structuring, but cannot be eliminated through contractual drafting alone.

6. Managerial, Ethical and Contemporary Considerations

Managers should treat legal compliance as part of market-entry strategy rather than as a post-investment administrative task. A cross-functional review should include legal, tax, cybersecurity, engineering, human-resources, public-policy and supply-chain personnel.

Ethical issues include abusive use of IP rights, exploitation of weak enforcement institutions, discriminatory licensing, excessive data extraction and strategic treaty restructuring solely to manufacture jurisdiction. Responsible firms should respect human rights, privacy, labour standards and environmental obligations even where formal legal enforcement is weak.

Digital trade creates continuing uncertainty. Cloud computing may involve several locations for users, servers, payment processing and personnel. Artificial-intelligence systems raise questions about copyright training data, confidential information, algorithmic transparency and cross-border data governance. Businesses should not assume that an AI model’s outputs are protected by copyright or that training data may be used without authorization; results depend on applicable law and facts.

Best practice is to maintain a country-by-country matrix covering service modes, scheduled commitments, licences, ownership caps, IP registrations, customs procedures, data rules, screening approvals, performance requirements, treaty protections and dispute deadlines.

Challenges and Limitations

International economic law remains difficult because obligations are fragmented across treaties and domestic regimes. Classification disputes can arise over whether a measure concerns goods, services, investment or IP. Schedules may contain complex limitations and reservations. Tribunal decisions are not always uniform, and treaty wording controls outcomes. Public-interest regulation may be legally defensible but commercially disruptive. Finally, enforcement costs can exceed the value of a claim, especially for small firms.

Chapter Summary

The GATS regulates measures affecting trade in services through general obligations, scheduled commitments and sectoral disciplines. Services may be supplied through four modes: cross-border supply, consumption abroad, commercial presence and presence of natural persons. Market access and national treatment are primarily schedule-based. Domestic regulation must be analyzed under the relevant GATS Article VI provisions, commitments and applicable additional disciplines; a universal necessity test should not be assumed.

TRIPS establishes minimum standards for copyright, trademarks, geographical indications, patents and undisclosed information, but rights remain substantially territorial. Licensing, confidentiality, registration, customs cooperation and civil enforcement are central to commercial protection.

Investment law addresses admission, screening and post-establishment treatment. Key issues include FET, expropriation, national treatment, transfers, performance requirements and ISDS. The TRIMs Agreement is essential when local-content or trade-balancing measures affect goods, and an incentive may raise the same concern even when it is not framed as a compulsory purchase rule. Effective international-business analysis integrates treaty text, schedules, domestic regulation, transaction structure and public-policy risk.

Key Terms

GATS: WTO agreement governing trade in services.

TRIPS: WTO Agreement on Trade-Related Aspects of Intellectual Property Rights.

Mode 1: Cross-border supply of a service.

Mode 2: Consumption of a service abroad.

Mode 3: Supply through commercial presence.

Mode 4: Temporary presence of natural persons.

Market access: Conditions governing entry and operation of service suppliers under GATS Article XVI.

National treatment: Treatment no less favourable than that accorded to domestic like services or suppliers.

Domestic regulation: Licensing, qualification and technical rules affecting service suppliers.

MFN treatment: Treatment no less favourable than that given to any other WTO member.

Patent: Exclusive territorial right protecting a qualifying invention for a limited period.

Trademark: Sign distinguishing goods or services.

Trade secret: Confidential commercially valuable information protected by reasonable secrecy measures.

Licence: Contractual authorization to use an intellectual-property right.

Expropriation: Government taking or substantial deprivation of an investment.

Fair and equitable treatment: Treaty standard concerning fairness of host-state conduct.

Performance requirement: Condition imposed on an investment’s establishment, operation or benefit.

TRIMs: WTO agreement addressing certain investment measures affecting trade in goods.

ISDS: Investor–state dispute settlement.

Investment screening: Government review of proposed investments, often for national-security or strategic reasons.

Review Questions

Short Answer Questions

1. What conditions must be satisfied for the GATS governmental-authority exclusion to apply?
2. Distinguish GATS Modes 1, 2, 3 and 4.
3. Why are market-access commitments schedule-specific?
4. What are the principal requirements for protecting a trade secret?
5. Why can a tax incentive create a TRIMs issue?

Long Answer Questions

1. Explain the relationship among GATS market access, national treatment and domestic regulation.
2. Discuss the principal categories of IP protected by TRIPS and their commercial significance.
3. Analyze the legal and strategic issues involved in international technology licensing.
4. Explain direct and indirect expropriation and the relevance of legitimate public regulation.
5. Evaluate the advantages and limitations of ISDS for international investors and host states.

Analytical / Application Questions

1. A foreign online university supplies courses remotely, opens a local branch and sends lecturers for three months. Identify the GATS modes and the principal legal questions that should be investigated.
2. A government grants a tax rebate only to an automobile investor that purchases 50% of its components domestically. Analyze possible TRIMs and investment-treaty concerns.
3. A host state introduces non-discriminatory cybersecurity rules after a foreign data-services investment is established. Using FET, expropriation and domestic-regulation concepts, assess the investor’s potential arguments and the state’s defences.

Multiple Choice Questions with Answers

Question 1

Which fact is required for the GATS governmental-authority exclusion?

A. The service must be supplied by a government ministry.

B. The service must be supplied neither commercially nor in competition with other suppliers.

C. The service must involve no foreign consumer.

D. The service must be listed as unregulated in the member’s schedule.

Correct Answer: B. The service must be supplied neither commercially nor in competition with other suppliers.

Question 2

A consultant provides advice online from State A to a client in State B. Which GATS mode is most directly involved?

A. Mode 1

B. Mode 2

C. Mode 3

D. Mode 4

Correct Answer: A. Mode 1

Question 3

A foreign bank establishes a subsidiary in the host country. This is primarily:

A. Mode 1

B. Mode 2

C. Mode 3

D. Mode 4

Correct Answer: C. Mode 3

Question 4

Which statement about GATS domestic regulation is most accurate?

A. Every costly regulation automatically violates GATS.

B. A universal necessity test applies regardless of commitments.

C. Analysis depends on Article VI, applicable disciplines and the member’s commitments.

D. Domestic regulation is outside GATS because it is not a tariff.

Correct Answer: C. Analysis depends on Article VI, applicable disciplines and the member’s commitments.

Question 5

Which right protects confidential information that has commercial value because it is secret and is subject to reasonable secrecy measures?

A. Patent

B. Trademark

C. Trade secret protection

D. Geographical indication

Correct Answer: C. Trade secret protection

Question 6

What is a central feature of a patent under TRIPS?

A. It is automatically global upon filing in one country.

B. It protects every business idea regardless of technical content.

C. It protects qualifying inventions for a limited territorial term.

D. It cannot be subject to any public-interest limitation.

Correct Answer: C. It protects qualifying inventions for a limited territorial term.

Question 7

Why may a 40% domestic-hardware condition attached to a tax credit raise TRIMs concerns?

A. Because every tax credit is prohibited by WTO law.

B. Because an incentive can encourage domestic sourcing and affect competitive conditions even if not labelled mandatory.

C. Because TRIMs applies only to services.

D. Because patents cannot be used in manufacturing.

Correct Answer: B. Because an incentive can encourage domestic sourcing and affect competitive conditions even if not labelled mandatory.

Question 8

Which issue is most directly associated with investment screening?

A. Classification of a trademark’s visual design

B. Review of a proposed investment for national-security or strategic concerns

C. Calculation of a service supplier’s royalty rate

D. Determination of whether a consumer travelled abroad

Correct Answer: B. Review of a proposed investment for national-security or strategic concerns

Question 9

Which statement best describes indirect expropriation?

A. Only formal transfer of title qualifies.

B. It may involve substantial deprivation of use, value or control without formal seizure.

C. It occurs whenever a regulation reduces profits by any amount.

D. It is identical to a breach of a private contract.

Correct Answer: B. It may involve substantial deprivation of use, value or control without formal seizure.

Question 10

Which fact most clearly indicates GATS Mode 2?

A. A patient travels abroad for medical treatment.

B. A foreign company opens a local clinic.

C. A doctor gives advice by video from abroad.

D. A specialist temporarily enters to install equipment.

Correct Answer: A. A patient travels abroad for medical treatment.