Insourced: How Importing Jobs Impacts the Healthcare Crisis Here and Abroad

241 Pages·2012·3.27 MB·English

by  Kate Tulenko

I N S O U R C E D
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Dr. Kate Tulenko
I N S O U R C E D
How Importing Jobs
Impacts the Healthcare Crisis
Here and Abroad
Dartmouth College Press
Hanover, New Hampshire
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dartmouth college press
An imprint of University Press of New England
www.upne.com
© 2012 Trustees of Dartmouth College
All rights reserved
Manufactured in the United States of America
Designed by Eric M. Brooks
Typeset in Fresco Plus Pro and Officina Sans
by Passumpsic Publishing
University Press of New England is a member of the
Green Press Initiative. The paper used in this book meets
their minimum requirement for recycled paper.
For permission to reproduce any of the material
in this book, contact Permissions, University Press of
New England, One Court Street, Suite 250, Lebanon NH
03766; or visit www.upne.com
Library of Congress Cataloging-in-Publication Data
Tulenko, Kate.
Insourced: how importing jobs impacts the healthcare
crisis here and abroad / Kate Tulenko.
p.; cm.
Includes bibliographical references.
isbn 978-1-61168-227-4 (cloth: alk. paper)—
isbn 978-1-61168-268-7 (ebook)
I. Title. [dnlm: 1. Foreign Professional
Personnel—supply & distribution—United States.
2. Developing Countries—United States.
3. Health Manpower—trends—United States.
4. Health Personnel—education—United States.
5. Medically Underserved Area—United States. w 76]
610.73'7069091724—dc23 2011047068
5 4 3 2 1
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To my husband, Ken Heyman,
and my daughters, Helena and Freya,
for all their love, support, and lonely Saturdays,
which made this book possible.
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Contents
Foreword by Laurie Garrett / ix
Preface / xiii
Acknowledgments / xxv
Introduction / 1
1 Shortage in the Land of Abundance / 10
2 How the United States Created Its
Healthcare-Workforce Problem / 40
3 The Path to America / 66
4 The Damage Done / 91
5 The Fox and the Hydra
Failed Attempts to Address Insourcing / 116
6 Successful Efforts to Curb Insourcing / 138
7 The Way Forward / 150
Notes / 181
Index / 197
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Foreword
It’s hard to imagine any realistic conversation about global health
that doesn’t begin with the question: “Where are the health-
care workers?” In 2004 Lincoln Chen and Tim Evans told us1
that the world was facing a profound deficit of some 4.3 mil-
lion health professionals; for sub-Saharan Africa alone, the def-
icit was 1 million.
Since then the pressures on the global health labor force have
only increased, and training of doctors, nurses, dentists, phar-
macists, lab technicians, midwives, medical supplies experts,
hospital administrators, optometrists, and every other type of
health professional remains woefully inadequate.
The most acute shortages of skilled health personnel are in
countries facing the gravest public health challenges. For exam-
ple, in rural Mozambique, where hiv rates exceed 10% of the
adult population and famine shadows the people with shock-
ing regularity, the few physicians available have a patient load of
6,496 patients per md, about twenty times the burden doctors
face in the capital city of Maputo.2 Any initiative to improve the
well-being of Mozambique’s largely rural population must begin
by asking who will actually implement programs of mass immu-
nization, hiv testing, prenatal care, safe drinking water, or ma-
laria prevention.
The spectacular boom in global health financing between
2002 and 2009, jumping from roughly $5.6 billion to more than
$20 billion, allowed the world to dream big: Eradicate malaria,
provide universal access to hiv treatment, stop the spread of
drug-resistant tuberculosis, and bring maternal mortality rates
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