Pardee-CFLP-Remittances-TF-Report

young; most fled the war as children and were sent for a medical education bythe government in exile of John Garang.A Modest, Innovative ProposalWe propose one measure that may help to overcome some of these barriers toencourage the return of locally trained health workers from the more fortunatenations where many of them now reside. Some refugee clinicians might beencouraged to return to their natal country if the return does not create a seriouseconomic burden for them in the long term. This would involve tacklingthe golden chain that ties him or her to the developed country’s health system.The professional and his employer contribute significant amounts into pensionfunds, either private or governmental. These pension systems will not beginpaying a benefit until the member reaches a defined retirement age, which iscurrently 66 in both the U.S. and the UK. Depending on employment history andpension fund rules, the amount of the retirement benefit generally continues togrow with each annual contribution. We trace the impact of two hypotheticalexamples; a nurse from Sierra Leone and a doctor from Liberia. Even if she findsan attractive job back home and no longer has family ties binding her to thedeveloped country, the nurse from Sierra Leone working in the UK or the Liberiandoctor in the U.S. will be reluctant to reduce her pension income by leavingdeveloped country employment prematurely. The economics literature confirmsthat employees in such “defined benefit” pension plans are less likely to changejobs, particularly as they near retirement age (Hurd 1996; Gale et al. 2004).What if the developed country government continued contributions to the pensionplan for health professionals returning to strengthen the health systemsof their home country? The expense would not be great. In the U.S., the costin 2013 would be $14,099 per year 3 if development funds covered both theemployer and employee contribution to Social Security for the Liberian doctor.In the UK in 2013, it would cost about £5,355 (US$8,140) per year to maintainthe contribution funds to the National Health Service pension scheme for thenurse returning to Sierra Leone.The total cost for continued contributions to pension plans as an incentive forrefugee health professionals to return would be modest. To cover the pensionfund contributions of 100 Liberian doctors practicing in the U.S. costs $1.41 millionper year. But the return of even one-third of the 107 Liberian-born physi-3 Assumes the doctor is earning more than the Social Security maximum salary base of $113,700.http://tinyurl.com/SSA-taxrates.130 A Pardee Center Task Force Report | October 2013