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Costs and Benefits of Healthcare Worker Mobility

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Zivilgesellschaftliche Initiativen für sichere Fluchtwege – ein Überblick Migrantenorganisationen – vielfältige Akteurinnen gesamtgesellschaftlicher Integration (Flucht-)Migration und Gesundheit Medizinische Versorgung Interview David Zimmermann Definition von Migration Gesundheitszustand von Migranten Barrieren/ Prävention Erklärungsmodelle Schlussfolgerungen Literatur Das Jahr 2015: Ein Rückblick Fluchtmigration: Hintergründe Verwaltungs- und Infrastrukturkrise EU: Reaktionen auf die Fluchtzuwanderung Flüchtlingszahlen weltweit Internationale Studierende Einleitung Bildungsmigration Internationale Studierende Internationale Studierende in Deutschland Übergang in den Arbeitsmarkt Literatur Migration und Pflege Einführung Altern in der Migrationsgesellschaft Interview mit Helma Lutz Deutsche Asylpolitik und EU-Flüchtlingsschutz Einleitung Flüchtlingsrecht Asylrecht, Flüchtlingspolitik, humanitäre Zuwanderung Flucht und Asyl als europäisiertes Politikfeld Asyl und Asylpolitik Ausblick Literatur Integration in der postmigrantischen Gesellschaft Einleitung Die postmigrantische Gesellschaft Paradigmenwandel Brauchen wir den Integrationsbegriff noch? Integration als Metanarrativ Notwendigkeit eines neuen Leitbildes Literatur Lifestyle Migration Was ist Lifestyle Migration? Briten in Spanien Einen neuen Lebensstil entdecken Folgen des Residenztourismus Zusammenfassung Literatur Wahlrecht und Partizipation von Migranten Einleitung Politische Rechte und Kommunalwahlrecht Wahlrecht für Drittstaatsangehörige Einbürgerung Aktuelle Entwicklungen Schlussbemerkungen Literatur Frontex und das Grenzregime der EU Einleitung Frontex – Fragen und Antworten Die Entwicklung des europäischen Grenzregimes Externalisierung Technologisierung Grenzwirtschaft/border economies Auf der anderen Seite des Grenzzauns Ist Einwanderung ein Risiko? Literatur Demografischer Wandel und Migration Einleitung Demografischer Übergang Deutschland und Europa Internationale Wanderung Integration und Reproduktionsverhalten Wanderungspolitik Regionale Muster Literatur Glossar English Version: Policy Briefs "Having a nationality is not a given, it is a privilege" Sanctuary and Anti-Sanctuary Immigration Law in the United States Migrant Smugglers Urbanizing Skilled Female Migrants in the EU Self-Organization of Women* Refugees Impact of Migration Revisited Child and Youth Migration Human Rights Protections Migration from the United Kingdom Adoption and Child Migration Third Culture Kids Trafficking in Children Actors in National and International (Flight)Migration Regimes UNHCR UNRWA International Organization for Migration The International Organization for Migration (IOM) German Asylum Policy and EU Refugee Protection Introduction Refugee Law Asylum Law, Refugee Policy, Humanitarian Migration Flight and Asylum Current Developments Current and Future Challenges References Integration in a Post-Migrant Society Introduction Post-Migrant Society Paradigm Shift Do We Still Need the Concept of Integration? Integration as a Metanarrative Need for a New Concept References Lifestyle Migration What Is Lifestyle Migration? British in Spain Realizing a New Style of Life Outcomes of Lifestyle Migration Conclusion References Voting rights and political participation Introduction Political and Municipal Voting Rights Voting Rights for Nationals of Non-EU States Naturalization Recent Developments Conclusions References Frontex and the EU Border Regime Introduction Frontex — Questions and Answers The Development of a European Border Regime Externalization Technologization Border Economies On the Other Side of the Border Fence Is Migration a Risk? References Demographic Change and Migration in Europe Introduction Demographic Transition Germany and Europe International Migration Reproductive Behavior Migration Policy Regional Patterns Glossary Further Reading Global Migration in the Future Introduction Increase of the World Population Growth of Cities Environmental Changes Conclusion: Political Migration References Germans Abroad Introduction Germans Abroad Expatriates in Hong Kong and Thailand Human Security Concerns of German Expatriates Conclusions References Migrant Organizations What Are Migrant Organizations? Number and Structure Their Role in Social Participation Multidimensionality and the Dynamic Character Interaction with their Environments Between the Countries of Origin and Arrival Conclusion References EU Internal Migration EU Internal Migration East-West Migration after the EU Enlargement Ireland United Kingdom Spain Portugal Greece Italy Germany Assessment of Qualifications Acquired Abroad Introduction Evolution of the Accreditation Debate The Importance of Accreditation Basic Principles Thus Far of the Accreditation of Qualifications Acquired Abroad Actors in the Accreditation Practice Reasons for Establishing a New Legal Framework The Professional Qualifications Assessment Act What Is Being Criticized? The Accreditation System in Transition Conclusion References From Home country to Home country? Context Motives Immigration and Integration in Turkey Identification Emigration or Return? References Integration in Figures Approaches Development Six Approaches Conclusion References Climate Change Introduction Estimates Affected areas Environmental migration Conclusion References Dual citizenship Discourse Classic objections Current debate Rule of law Conclusion References Female Labour Migration The labour market Dominant perceptions Skilled female migration Issues Conclusion References How Healthy are Migrants? Definition The Health Status Prevention/Barriers Migration and Health Conclusions References Networks Spain Migrant networks Effects of networks Romanian networks Conclusion References Integration Policy Introduction Demographic situation Economic conditions Labour market The case in Stuttgart Integration measures Evaluation Outlook References Irregular Migration Introduction The phenomenon Political approaches Controlling Sanctions Proposed directive Conclusions References Integration Courses Introduction The Netherlands France Germany United Kingdom Conclusions References Recruitment of Healthcare Professionals Introduction The Situation Health Worker Migration Costs and Benefits Perspectives and Conclusion References Triggering Skilled Migration Introduction Talking about mobility Legal framework Coming to Germany Mobility of scientists Other factors Conclusions References Remittances Introduction The Term Remittance Figures and Trends Effects Conclusion References EU Expansion and Free Movement Introduction Transitional Arrangements Economic Theory The Scale The Results Continued Restrictions Conclusion References The German "Green Card" Introduction Background Green Card regulation Success? Conclusion References Does Germany Need Labour Migration? Introduction Labour shortages Labourmarket Conclusion Labourmigration References Dutch Integration Model The "Dutch model"? The end? Intention and reality A new view Where next? References Impressum

Costs and Benefits of Healthcare Worker Mobility

James Stewart Darlene Clark Paul F. Clark

/ 6 Minuten zu lesen

Sending countries

The major costs of the migration of healthcare professionals are borne by the developing countries that lose significant numbers of nurses, physicians and other healthcare professionals.

Geldscheine und Stethoskop (© dpa/ZB)

Healthcare systems in these countries range from barely adequate to completely dysfunctional. They suffer from a host of problems - inadequate funding, inferior technology, epidemics, war and political instability, a lack of infrastructure, insufficient training capacity, and a long-standing shortage of healthcare professionals. The further loss of nurses and physicians to developed countries renders poor healthcare systems even less capable of providing care for their patients.

Thus, one of the most significant cost factors is the source country's diminished ability to provide care for its citizens. The impact is particularly significant when such personnel cannot be replaced because of a shortage. Not only does the healthcare system lose the services of healthcare professionals, but the inability to replace them puts added pressure on the remaining employees. Such pressure further strains the system, creating additional push factors that then contribute to the loss of more healthcare professionals.

Source countries also incur another significant cost when RNs and MDs migrate: their investment in training. The training of healthcare professionals in most developing countries is either entirely sponsored, or heavily subsidised, by the government. This substantial investment in training is lost when a nurse or a physician permanently emigrates to a developed country. The United Nations estimates that each migrating African healthcare professional represents a loss to the source country of US$184,000 .

One of the major policy issues complicating efforts to develop an international consensus regarding the employment of migrating healthcare workers is how to compensate countries for lost services and investments. If healthcare workers paid all of the costs of training then there would be little question regarding their right to capture all of the benefits of that training by working in any setting they choose. However, in cases where governments have provided substantial subsidies that enabled future healthcare workers to enrol in educational institutions, the case is not so clear-cut.

The benefits accruing to source countries from the emigration of healthcare workers are twofold: remittances sent home to families and services of migrants who return with enhanced skills and experience. Remittances can have a significant influence on the living standards of the populace in source countries. Collectively, remittances play a crucial role in the economies of many developing nations since these funds represent one of the most important sources of foreign revenue . In the case of the Philippine government, encouragement of the emigration of nurses is a deliberate policy. In support of this policy, nursing schools train many more nurses than their country needs, and those who emigrate become part of a "labour outsourcing industry" driving the Philippine economy. In 2001, expatriate contract workers, including nurses, sent home US$6.2 billion in remittances. The countries employing the greatest number of Filipino nurses are the United States, Ireland, Saudi Arabia and the United Kingdom . In general, however, the Philippine experience appears to be unique and there is scant evidence that remittances compensate for the damage done to healthcare systems in source countries, particularly since remittances go to families, not directly to the healthcare systems.

Source countries can potentially benefit from emigration of healthcare workers in the case of temporary migration. When nurses and physicians leave to work in the healthcare system of a developed country, they gain experience and training in a more advanced setting. In this scenario, migration can be a positive arrangement for a developing country: the source country temporarily gives up its training investment, as well as the healthcare professionals' services; in exchange, upon the nurses' or doctors' return, it recoups its initial investment, as well as the added qualifications and experience gained during the professionals´ time away. Unfortunately for developing countries, there is little evidence that more than a small percentage of emigrants actually return. Even in cases where healthcare workers do return, healthcare systems in developing countries may not be able to take advantage of the skills and expertise acquired abroad. The technologies available in developing countries may be much less sophisticated than those in developed countries, reducing the utility of qualifications and experience obtained overseas.

Receiving countries

While the available evidence suggests that the costs exceed benefits for source countries, benefits tend to exceed costs for receiving countries. There are, in fact, several types of costs incurred by countries hosting immigrant healthcare workers. First, there are costs associated with worker recruitment. The extent to which these costs are shared by employers and government varies from country to country. Such costs are likely to be passed on to consumers and taxpayers. The same can be said for resettlement costs, i.e. temporary support enabling workers to assimilate into a new society such as housing subsidies and public assistance. The UK probably has the most systematic and coordinated recruitment programme of any country in the world. The British National Health Service (NHS) has its own recruitment programme to identify healthcare professionals interested in immigrating to the UK. It operates different recruitment strategies for the various professions. It usually recruits physicians on an individual basis, but tends to recruit nurses in groups of ten, twenty, or more from a specific country. As part of its recruitment process, the NHS provides information on job locations, living arrangements and immigration procedures .

Some critics argue that the immigration of highly trained healthcare workers is linked to the erosion of employment conditions among domestic healthcare workers. For example, if immigrant workers are more willing to accept part-time and contractual positions than domestic workers, the wages and employment conditions of domestic workers are adversely affected. One negative outcome is lower tax receipts from domestic workers than would otherwise be the case. Although diminished worker commitment and associated negative effects on productivity would have the greatest impact at the firm level, the macro-economic implications should not be overlooked. As a final example, it is important to recognise that there may also be adverse effects on the quality of healthcare provided to citizens in the receiving country if immigrant workers are imperfect substitutes for domestic workers.

The benefits accruing to receiving countries from the inflow of healthcare workers are manifold. The most direct benefit is the reduction in the shortage of skilled healthcare workers plaguing developed countries. Given that the healthcare systems in these countries still face a shortage, the situation would clearly be even worse without these foreign workers. The quality of healthcare available to consumers will be improved compared to a scenario in which shortages are greater, and public health risks will be reduced as well. If the employment of immigrant healthcare professionals depresses wages of workers in the healthcare sector, consumers could conceivably benefit financially if any of the reductions in labour costs are passed through in the form of lower prices (or taxes). Receiving countries will also benefit from taxes paid by immigrant healthcare workers. In addition, the recruitment of immigrant healthcare workers can allow local communities with a shortage of domestic healthcare workers to remain competitive in efforts to attract new employers, with the potential positive impact of increased local tax revenues.

 
Costs and Benefits in Sending and Receiving Countries
 
Sending countriesReceiving countries
Costs
  • Reduction in domestic health care delivery capacity

  • Loss of training investments in emigration professionals

  • Loss of consumption and tax receipts

  • Decline in morale and commitment among remaining workers

  • Recruitment costs

  • Resettlement costs

  • Decline in compensation and working conditions of domestic workers

  • Decline in morale and commitment among domestic workers

  • Reduction in tax receipts from domestic workers

Benefits
  • Remittances received from expatriates

  • Improvements in skills of returners

  • Relief of supply shortages

  • Improved quality of health care

  • Tax receipts from foreign workers

  • Enhanced local competitiveness

Source:Author's summary

Fussnoten

Fußnoten

  1. See Oyowe (1996).

  2. See Forcier, Simoens and Giuffrida (2004). For more information on remittances, see "Remittances – A Bridge between Migration and Development?" focus Migration Policy Brief No. 5).

  3. See Diamond, D. (2002): "One nation, overseas." Wired Magazine, June, online edition.

  4. See Buchan and Dovlo (2004); Buchan, Jobanputra and Gough (2004).

James Stewart is Professor of Labor Studies and Employment Relations, and of Management and Organization, Pennsylvania State University.

Darlene Clark is Senior Lecturer in the School of Nursing, Pennsylvania State University, and Clinical Assistant Professor, College of Nursing, University of Arizona.

Paul F. Clark is Professor and Head, Department of Labor Studies and Employment Relations, Pennsylvania State University.