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Introduction to health professional mobility in a changing Europe 5
their country of practice (European Federation of Nurses Associations, 2012).
However, the financial crisis, while stimulating some workers to consider
migration, has also led some countries to raise barriers to migrant workers. In
response to economic decline and rising unemployment rates, these countries
are tightening their immigration policies (OECD, 2012b), which is reducing
the opportunities for mobile health workers to enter some countries and in
some cases may be displacing “traditional” pre-crisis migration flows into and
within Europe, creating new migratory patterns to other countries or regions
that have been less affected by the financial crisis.
The overall impact of the economic crisis on EU health systems has been variable
(Fahy, 2012), and the health sector may have been impacted less negatively than
other areas of the economy in many OECD countries (OECD, 2011). The
assessment of trends in overall migration (i.e. not just health worker movements)
in OECD countries suggests that the slowdown in migration caused by the
economic crisis was short term (OECD, 2012b). Mobility of health professionals
in EU Member States continues to be a central issue for most countries, but the
patterns of mobility have changed, and for some individuals it is the impact of the
crisis that has been the motivation to move. Some countries have been affected
more than others by the impact of the economic crisis. Health professional
mobility has not “stopped” because of this crisis, but at the aggregate level its
magnitude, directions and impact have changed and will be changing further,
and the experiences and motivations of individual mobile health professionals
may also differ in the new economic reality.
1.3 The policy conundrum: ethics versus efficiency?
The challenges of health professional mobility are not new: they have been
identified and observed across decades (for example, Mejia, Pizurki & Royston,
1979; Pang, Lansang & Haines, 2002; Wright, Flis & Gupta, 2008; Connell,
2010). What has changed in Europe is the creation of a border-free labour
market, and its expansion with the EU enlargements of 2004, 2007 and 2013,
which endows health professionals with the right to provide services and to
establish themselves in another EU Member State. This provided new mobility
opportunities for health professionals and reduced options for Member States to
limit or selectively contain these cross-border flows. In parallel, since 2008 the
financial crisis has contributed to redefining opportunities for individual health
professionals, the health systems in which they practise and the priorities of
health professional regulators. Shifting opportunities and widening inequalities
present a context where the ethical and efficiency implications of policy options
are being redefined.