Impact, regulation and health policy implications of physician migration in OECD countries

BACKGROUND: In the face of rising demand for medical services due to ageing populations, physician migration flows are increasingly affecting the supply of physicians in Organisation for Economic Co-operation and development (OECD) countries. This paper offers an integrated perspective on the impact of physician migration on home and host countries and discusses international regulation and policy approaches governing physician migration. METHODS: Information about migration flows, international regulation and policies governing physician migration were derived from two questionnaires sent to OECD countries, a secondary analysis of EUROSTAT Labour Force Surveys, a literature review and official policy documents of OECD countries. RESULTS: OECD countries increasingly perceive immigration of foreign physicians as a way of sustaining their physician workforce. As a result, countries have entered into international agreements regulating physician migration, although their success has been limited due to the imposition of licensing requirements and the protection of vested interests by domestic physicians. OECD countries have therefore adopted specific policies designed to stimulate the immigration of foreign physicians, whilst minimising its negative impact on the home country. Measures promoting immigration have included international recruitment campaigns, less strict immigration requirements and arrangements that foster shared learning between health care systems. Policies restricting the societal costs of physician emigration from developing countries such as good practice guidelines and taxes on host countries have not yet produced their expected effect or in some cases have not been established at all. CONCLUSIONS: Although OECD countries generally favour long-term policies of national self-sufficiency to sustain their physician workforce, such policies usually co-exist with short-term or medium-term policies to attract foreign physicians. As this is likely to continue, there is a need to create a global framework that enforces physician migration policies that confer benefits on home and host countries. In the long term, OECD countries need to put in place appropriate education and training policies rather than rely on physician migration to address their future needs

Differential Employment Patterns for Citizens and Non-Citizens in Science and Engineering in the United States: Minting and Competitive Effects

The consequences of the heavy inflow of foreign talent for U.S. scientists and engineers over the period 1973-1997 are examined using data from the Survey of Doctorate Recipients. Of particular interest is whether non-citizens trained in the United States have displaced citizens from jobs in science and engineering (S&E). Using a novel adaptation of the shift-share technique, it is shown that citizen S&E doctorates have fewer jobs in S&E and fewer academic jobs than their non-citizen counterparts for two reasons: the citizen doctoral population has experienced slower growth than the non-citizen doctoral population, and citizen S&E doctorates have been displaced. Whether the displacement observed was a voluntary response of citizens to the lure of better opportunities elsewhere or an involuntary response indicative of having been pushed out by foreign talent remains to be determined. Copyright 2004 Gatton College of Business and Economics, University of Kentucky..

Informing UK Policy Development on the Regulation of CAM Practitioners: Lessons from Hong Kong?

Public policy discussions on how to regulate acupuncture and herbal medical practitioners have reached a stalemate in the United Kingdom. After considerable activity in the first half of the current decade a wider review of professional regulation has re-opened the discussion as to the most appropriate way to regulate the practice of all health-care practitioners. In the meantime, the public continues to consult complementary and alternative medicine (CAM) practitioners in large numbers and self-medicate with herbal products and other natural remedies, posing challenges for policy-makers as to how to ensure public safety. In the NHS, providers and purchasers struggle to reconcile demands for access to CAM services with their clinical governance requirements. Hong Kong implemented new arrangements for the statutory regulation of traditional Chinese medical practitioners in the 1990s and has experienced the challenges of regulating a large established private market as well as integrating Chinese medicine further into the public health system. This experience is analysed in order to see whether the approach adopted there could address the public policy challenges faced in the UK. The article finds that, despite key cultural and historical differences related to the provision and use of CAM services, the similarities between the health-care systems and the reasons for moves to professional regulation in Hong Kong and the UK provide useful insights into what is happening in the UK in relation to service provision and the relationship with the NHS and the medical profession. These are discussed in the light of current health policy developments in the UK

Rethinking governmental licensing of higher education institutions

Accreditation, Certification, Higher education, Licensing, Quality assurance, D18, D45, H11, I28, K20,