Mobility of Health Professionals: Health Systems, Work Conditions, Patterns of Health Workers' Mobility and Implications for Policy Makers

182 Pages·2013·2.33 MB·English

by  Frits Tjadens, Caren Weilandt, Josef Eckert (auth.)

Mobility of Health Professionals
Frits Tjadens
Caren Weilandt
Josef Eckert
Mobility of Health
Professionals
Health Systems, Work Conditions, Patterns of Health
Workers‘ Mobility and Implications for Policy Makers
1  C
Frits Tjadens† Dr. Josef Eckert
Health and Care Associates (HASCA), Alphen Aan WIAD – Scientific Institute of the Medical Association
den Rijn, CA, Netherlands of German Doctors (Wissenschaftliches Institut der
Ärzte Deutschlands gem. e. V.)
Dr. Caren Weilandt Bonn, Germany
WIAD – Scientific Institute of the Medical Association
of German Doctors (Wissenschaftliches Institut der
Ärzte Deutschlands gem. e. V.)
Bonn, Germany
ISBN 978-3-642-34052-9 ISBN 978-3-642-34053-6 (eBook)
DOI 10.1007/978-3-642-34053-6
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V
We dedicate this book to the memory of Frits Tjadens (1957–2012) who
contributed so much to its making but tragically died before its publication.
VII
Foreword
In this book on mobility of health professionals we reviewed, analysed and summarised
published information and data as well as collected interview data from stake holders, in-
cluding politicians, policy makers, health service managers and migrant health workers. The
aim of the project was an in-depth analysis including assessment of all available statistical
data and analyses as well as of qualitative data collected in 25 countries around the world.
The partners involved in the MoHProf project gathered evidence around basic questions
and knowledge gaps relating to the international migration of health professionals, which
involved an analysis of migration flows, evaluation of policies addressing migration and the
development of recommendations concerning these policies.
The country specific issues are elaborated in specific volumes of 25 national reports and na-
tional profiles, which summarise these findings. This comprehensive background material
is available on the project website, www.mohprof.eu. In this book we draw attention to some
European wide and global issues raised by our research results.
Certain countries both within the European Union and outside do not produce a domestic
supply of health professionals sufficient to satisfy demands. They have through many years
relied on an inflow of health workers from abroad. Often these workers are educated and
even received specialty training in their home countries, which are frequently low- or mid-
dle- income countries.
Do policy makers consider this an issue that should be addressed, and if so, in what way?
Ethical codes for international recruitment, increased intake of health/medical education
institutions, exchange of relevant information regarding migration of health professionals
within and between EU countries as well as with other relevant nations?
Another important issue is the way migrant health workers are received in the destination
countries. We note that lead times for assessing their credentials and qualifications, in par-
ticular for those coming from non-EU countries, sometimes take as long as 5–10 years – in-
cluding even processes of deskilling.
Again, is this an issue for European policy makers? Is there a need for an EU-wide, or even
global data bank on country specific information on health/medical education and training?
Regarding the latter, some data suggests that content and level of education in some Mem-
ber States, in particular new members in the Eastern part of the European Union, are lower
than the standard applied in receiving countries and that discrimination of these workers
exists in receiving countries. We can observe that migrant health workers may not reach
the career levels for which they are qualified, for example, qualified nurses working as care
givers in the homes of the elderly, or physicians not reaching advanced career positions be-
cause their qualifications are not fully recognised. We need more evidence on possible dis-
crimination and the variation in standards of education between countries.
VIII F oreword
Not all receiving countries take full responsibility for ensuring that migrant health profes-
sionals fully master the language, understand the regulations to be respected and know their
rights and entitlements in the receiving country. This is an issue not only for policy makers
but also for further research. But already at the present state of knowledge, policy makers
may consider taking actions that facilitate the further and quicker integration of migrant
health workers in the receiving countries.
Finally, we would like to draw attention to the global impact of the shortage of employed
health professionals. According to forecasts, the competition for qualified health profession-
als will continue, and even increase, in the coming ten years – in particular recruitment to
the USA as a driving force. EU Member States – partly already sending countries – may
then lose significant numbers of health professionals and need to replace them by recruits
from countries within and increasingly outside the European Union – in a demanding com-
petition with the USA.
This book provides a comprehensive description and analysis of the mobility streams of
health professionals, the motives and driving forces behind them and the impact on and
challenges for health systems. Finally, the book draws conclusions and provides recommen-
dations for future strategic planning, monitoring and the management of mobility of health
professionals as well as further research and policy development needs.
We invite the European Commission, Member States, the European Parliament and other
concerned parties to seriously consider the implications of our findings in policy formula-
tion at local, national and regional levels as well as the ethical aspects relevant within and
outside the EU regarding the particular topic area of mobility of health professionals.
The
International Council of Nurses (ICN), Switzerland
International Hospital Federation (IHF), Switzerland
International Organization for Migration (IOM) Brussels, Belgium
World Medical Association (WMA), France
and the MoHProf Research Team
Scientific Institute of the Medical Association of German Doctors (WIAD), Germany
Centre of Migration Research of the Warsaw University (CMR), Poland
Medical University of Varna (MUV), Bulgaria
Institute of Health Policy and Development Studies of the University of the Philippines
(IHPDS)
Public Health Institute (PHI), USA
International Organization for Migration (IOM), Mission with Regional Functions South
Africa
IX
A Note to Readers
This report was written in the period 1 December 2011 and 25 March 2012.
Sole responsibility lies with the authors. Neither the European Commission nor any person
acting on behalf of the Commission is responsible for the use which might be made of the
following information.
XI
Contents
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 Mobility of health workers, an introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.2 The MoHProf project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.3 Mobility of health professionals: conceptualisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.4 This report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.5 Research questions and structure of the report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2 International mobility as a process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2.1 Mobility of health workers: who, what, how? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
2.2 Entering the country . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
2.3 After entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
2.4 Moving on? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
3 Factors contributing to mobility of health workers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
3.1 A discussion about factors contributing to mobility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
3.2 Push factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
3.3 Pull factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
3.4 Stick factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
3.5 Stay factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
3.6 Concluding remarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
4 Countries, structures and systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
4.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
4.2 Demography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
4.3 General context in MoHProf countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
4.4 Economic parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
4.5 Health system indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
4.6 Health workers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
4.7 Income, life expectancy and health workers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
4.8 Earnings in health care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
5 Some notions about the European dimension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
5.1 Europe in the world: stocks and flows of health workers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
5.2 Recognition of qualifications of health workers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
5.3 Working time: impact in or on the medical workforce? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
5.4 Other issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
5.5 Provisional conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
6 Managing mobile health workforces? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
6.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
6.2 Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
6.3 Receiving countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
6.4 Sending countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
6.5 Codes and agreements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
6.6 Economies in turmoil: shrinking pulls, increasing pushes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
XII C ontents
6.7 Health workforce management in a post-crisis era . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
6.8 Rural and remote areas: an old challenge for a new century . . . . . . . . . . . . . . . . . . . . . . . . . . 120
6.9 Nurses’ mobility: wider focus required . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
7 Conclusions, challenges and recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
7.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
7.2 Conclusions and challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
7.3 Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Annexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
A 1 World Bank indicators in MoHProf countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
A 2 Data sources and their peculiarities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
A 3 Overview of stocks and flows in MoHProf countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
A 4 Indicators and methodology related to health education . . . . . . . . . . . . . . . . . . . . . . . . . 157
A 5 Agreements, Conventions and Memoranda of Understanding . . . . . . . . . . . . . . . . . . . . 159
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
XIII
Authors and Contributors
Contributors to the MoHProf project and the MoHProf summary report
This report provides an overview of the outcomes of the MoHProf project, carried out un-
der the 7th Framework Programme for Research and Development of the European Union.
While this report was written by a small team, the efforts of all other parties involved in this
project have become the foundation upon which this team could fulfil its purpose.
The summary report was written by
5 Frits Tjadens
5 Caren Weilandt
5 Josef Eckert
With assistance of WIAD scientific staff
And the MoHProf consortium:
5 Scientific Institute of the Medical Association of German Doctors (WIAD), Germany
5 Centre of Migration Research of the Warsaw University (CMR), Poland
5 Medical University of Varna (MUV), Bulgaria
5 Institute of Health Policy and Development Studies of the University of the Philippines
(IHPDS)
5 Public Health Institute (PHI), USA
5 International Hospital Federation (IHF), Switzerland
5 International Organization for Migration (IOM) Brussels, Belgium
5 International Council of Nurses (ICN), SwitzerlandWorld Medical Association (WMA),
France
5 European Medical Association (EMA), Belgium
5 Global Health Workforce Alliance (GHWA), Switzerland
We would like to thank all of the teams involved in the project, authoring the national profiles
as well as the national reports. In particular we would like to thank the main partners and
consultants participating during the whole duration of the project in the research steering
group and contributing significantly to its final outcome:
5 Per Gunnar Svensson (WIAD)
5 Eric de Roodenbeke (IHF)
5 Roumyana Petrova-Benedict and Mariya Samuilova (IOM)
5 Paweł Kaczmarczyk and Agnieszka Makulec (CMR)
5 Todorka Kostadinova (MUV)
5 Fely Marilyn Lorenzo and Jennifer dela Rosa (IHPDS)
5 Mary A. Pittman and Christine Brown-Mahoney (PHI)
5 Julia Seyer (WMA)
5 Mireille Kingma (ICN)
Since this summary report is based mainly on the national reports and national profiles we
would like to thank all contributors to these documents and this report: