Medical and health care services represent large proportions of Gross National Product (GDP) in most countries yet remain protected and, hence, little traded. This suggests that large gains from trade are likely to exist from opening medical and health care services to international competition. The pent up demand for cross border services is underlined by the growth in medical tourism – a very inefficient method of organizing international trade – and the rapid expansion of international transfers of medical data, analysis and professional skills as electronic communications technology and co-requisite programing advance. The General Agreement on Trade in Services (GATS) has had little success in garnering commitments in these areas of services. The article examines the GATS to determine the reasons for its lack of success. The GATS suffers from institutional rigidities and difficulties in identifying opportunities for reciprocity. These constraints combined with the typically strong protectionist lobbying has meant opportunities for gains from trade remain largely unexploited.