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The publication of the World Health Report (WHO, 2006) “Working together for Health” has brought attention to the global human resources required to produce health. This report estimates that 57 countries, particularly in Sub-Saharan Africa and South East Asia, have an absolute shortage of 2.3 millions of doctors, nurses and midwifes (WHO, 2006, p.13). This implies that many countries do not have enough health care professionals to deliver essential health interventions. Recent estimates also how that there will be dramatic shortages in Africa by 2015 (Scheffler et al., 2008). In 2004, the Europe region has over 35% of the world’s supply of physicians along with about 32% world’s health expenditure. In contrast, countries in South East Asia suffer the highest proportion of the Global Burden of Disease with only 11% of the world’s supply of physicians and 1 % of world’s health expenditures. Similarly, Africa experiences 24 % global burden of disease while having only 2% of the global physician supply and spending that is less than 1% global expenditures. This shows clearly huge disparities in the global distribution of medical doctors around the world (Sheffler et al., 2008). Planning for health human resources has become a priority at the European level. The European Commission published on 10 December 2008 the “Green Paper on the European Workforce of Health” (EU, 2008) with the aim of describing the challenges faced by health professionals in all member states, such as ageing of the general population and of the health workforce, the migration of health professionals in and out of the EU, as well as the brain drain from third countries 63 . Recently, a bigger European project, the PROMeTHEUS has been launched in 2009 for a 3 year period. The research project cover all EU member States and selected neighborhood countries in order to understand the mobility impact on health services and system in countries importing and exporting staff 64 . The main idea is that mobility of health professionals can influence the performance of national health systems, and these impacts are increasing in light of increasing mobility in Europe. The main argument is that the mobility of health professionals changes the composition of the health workforce in the source and receiving country which in turn influences on health systems performance. 63 http://europa.eu/legislation_summaries/public_health/european_health_strategy/sp0005_en.htm 64 See http://www.euro.who.int/en/home/projects/observatory/activities/research-studies-and- projects/prometheus ! &%!
The aim of this sub-part is to provide a description of the stock and flows of medical doctors within and outside the EU. Besides that, a discussion of national regulations, medical education and provision of future projections are planned. A major focus is placed on the characterization of the health systems in Europe. It addresses the levels of stocks, flows besides the needs and shortages in medical doctors. The impacts of the enlargement of the European Union in relation to the above parameters are also introduced. The factors behind migration as they have been reported in the literature are also discussed. This is followed by a description of the regulatory framework governing the access to the medical practice. But, as education is an important component for both satisfying the needs of the destination countries and ensuring indirect benefits to the countries of origin, medical education is also introduced. All these elements are then re- discussed in relation to the new economics of skilled labor migration. I.3.1 Method pursued The overall method used is that of literature survey where different pieces of knowledge about the subject are consolidated for the purpose of the current study. It is based on the existing information in medical and economics literature. A relevant search of the formal literature is through EconLit, and PubMed search engines. Data are collected from several sources. In particular, information is extracted from the databases of international organizations such as the OECD and World Health Organization (WHO). A study conducted by the World Health Organization (WHO) provides an overview of 53 European countries. The report is published in 2009 and contains data for the latest year 2005. Other OECD reports provide relevant information. The first one is that of Dussault et al. (2009). They report a substantial increase in mobility of health workers between 1995 and 2005 in 12 selected OECD countries, including 8 European countries (Denmark, Finland, Ireland, the Netherlands, Norway, Sweden, Switzerland, and the United Kingdom). This study also indicates that migratory flows of health workers are generally poorly documented. Another report deals with the crisis in the health workforce, and includes analysis of flows data and reliance of foreign health professionals (OECD, 2008). The third one examines how the financial crisis has influenced mobility trends (OECD, 2010). It ! &&!
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F E M I S E R E S E A R C H P R O G
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What Can Be Learnt from the New Eco
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AMGA: American Medical Group Associ
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USA: United State of America WB: Wo
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medical doctors are then free to en
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elate to quality research and educa
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This may concern also EU countries
Page 15 and 16: discussed both in theory and practi
Page 17 and 18: EU are then described and discussed
Page 19 and 20: specialties. This study shows that
Page 21 and 22: with this trade. Special arrangemen
Page 23 and 24: into the developed countries; where
Page 25 and 26: them as follow: Cross-border delive
Page 27 and 28: In this regard, the EU is suggestin
Page 29 and 30: Given the importance of health care
Page 31 and 32: Serbia. Low wages, poor working con
Page 33 and 34: • How does tertiary education wit
Page 35 and 36: Driouchi & Kadiri (2010) are promis
Page 37 and 38: annual living costs per student. Th
Page 39 and 40: Lithuania 4.12 4.15 4.01 4.03 3.97
Page 41 and 42: Egypt 67.57 68.86 70.17 71.52 72.89
Page 43 and 44: observed externally from developing
Page 45 and 46: Relative Wages : MIN MENA / By comp
Page 47 and 48: No future, Heavy workload, to save
Page 49 and 50: one-year qualification apprenticesh
Page 51 and 52: Other European Countries Austria 4
Page 53 and 54: one medical university and studies
Page 55 and 56: includes a three-year vocational tr
Page 57 and 58: has 18 medical universities and stu
Page 59 and 60: général du Gouvernement to gradua
Page 61 and 62: of Medical Science, Bachelor of Med
Page 63 and 64: Egypt Iran 29463 31445 32134 25990
Page 65: major policies and strategies relat
Page 69 and 70: • What is the role of mobility of
Page 71 and 72: Commonwealth of Independent states
Page 73 and 74: Dodani and LaPorte (2005) suggest t
Page 75 and 76: In regards to the mobility of Europ
Page 77 and 78: The general conclusions of these th
Page 79 and 80: Specific factors Impact of HIV/AIDS
Page 81 and 82: Portugal X X Romania X X X Russian
Page 83 and 84: Germany Italy Spain Lithuania Slova
Page 85 and 86: Italy (2%) and Russia (4) in 2008 (
Page 87 and 88: theory assumes perfect transferabil
Page 89 and 90: The data available suggest potentia
Page 91 and 92: This chapter deals with the migrati
Page 93 and 94: networks and on the major channels
Page 95 and 96: assumed here that emigration decisi
Page 97 and 98: Increases (respectively decreases)
Page 99 and 100: Figure II.1.2: The shape of H as a
Page 101 and 102: The optimal emigration rate that ca
Page 103 and 104: Figure II.1.4: Effects of the Level
Page 105 and 106: empirical investigation focuses on
Page 107 and 108: Table II.1.3.1: Country annual tren
Page 109 and 110: Table II.1.3.2: Country annual tren
Page 111 and 112: ! ! C/D>)! 01::! 0103! 5881::7! E#%
Page 113 and 114: "#$%&'!()*)+!Eurostat Database Abou
Page 115 and 116: Using these parameter estimates, co
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different websites for different co
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the theoretical values of the relat
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p-value 0.33 0.03 t test 0.99 2.25
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The following set of graphs are the
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The countries with higher number of
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Turkey (m*=0.41, m**=0.77) Yemen (m
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periods but should be concerned abo
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health report “Comptes Nationaux
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In accordance with the health insur
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95 adults >15 years old per 100000
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To achieve progress in the health s
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The external problems comprise (1)
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first four hospital universities ex
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monitoring trends and economic fact
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Other support staff 6300 2.11 2004
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areas, the case of doctors who reti
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areas of Morocco. It is computed ye
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political instability, economic dep
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1. Gender VS Intention to Migrate A
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salaries differs according to the w
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Results The results are given below
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These results suggest that the numb
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Finally, the questionnaire records
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The past decades have witnessed an
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changed the notion of space, where
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implications on health, Huynen et a
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Figure III.1.3: Social stratificati
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Lee et al., (2007) primarily focus
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However, Collins (203) does recogni
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America. In Africa, where there are
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physicians from Liberia practice in
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Figure III.1.7: Migrant care worker
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espectively. An interesting particu
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Table III.1.5: Supply of foreign (-
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Table III.1.6: Health care wages in
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Figure II.1.11: Factors affecting h
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Figure III.1.12: Factors contributi
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Table III.1.10: International Quali
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health as integral to wellbeing thr
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III.2.1 Need for A cooperative Fram
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graduate spends of certain number o
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III.2.2 Migration of Medical Doctor
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The convexity condition is simply a
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• A payoff vector (ai)i S is said
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III.2.2.2 Discussion and Public Pol
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Europe. Second, in the North Africa
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In the short run, the country of or
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great incentive for medical student
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system, and therefore to the rest o
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MENA countries could be moving to p
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of their medical school. The other
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Beine, M., Docquier, F. & Rapoport,
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German Medical Association.(2011).
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World Bank Database, 2007. World Ba
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http://gse.buffalo.edu/org/inthighe
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Berland, Y. (2002). Demographie des
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Gericke, C.A. (2006). Finance healt
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Salehi-Isfahani, D., Tunali, I., As
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Beine, M., Docquier, F. & Rapoport,
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Docquier, F., Lohest, O. & Marfouk,
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Labdelaoui, H. (2010). Les dimensio
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Stark, O. (1991), The Migration of
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WHO - World Health Organization (20
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Linacre, S. (2007). “Migration: p
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Challenging Inequities in Health: F
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Mullan, F. (2007). Doctors and Socc
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Vujicic M, Zurn P, Diallo K, Dal Po
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Collins, T. (2003). Globalization,
Page 253 and 254:
Kana, M.A., (2009). From Brain Drai
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Sagoe, K. (2004). Using the Diaspor
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Sub-part II.1: Appendix I Appendice
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means that So if , then: > which is
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A, B,C>0 and , , Then Demo 5: Sign
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t test 3.21788138 1.86856175 3.1713
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Lithuania Years m Relative wage H/H
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Romania Years m Relative wage H/H0
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MENA Countries Risk Neutral Model C
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Tunisia Turkey 1993 0.1781 2.50 1.9
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Syria Tunisia Turkey Yemen Stand.de
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Morocco Syria Tunisia t-stat (theor
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Risk aversion model summary table C
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Table II-2-1.2: Projections of the
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Observations 5 Coefficients Erreur-
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Figure 4: Age distribution within r
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Figure 11: Migration conditions dis
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! "(&!
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! "((!
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! ")+!
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