Relatively Inaccessible Abundance: Reflections on U.S. Health Care

Outsiders' views of American health care - and Canadian views in particular - contains this paradox: ready access to excellent high tech services for those who can pay but unfortunately too expensive for many Americans; in essence, inaccessible abundance. In this paper, I embellish upon this paradox with an initial examination of the rather complicated organization of American health care as viewed by an outside observer. I then highlight the key benefits and drawbacks seen of U.S. health care, grounded in empirical data, and how despite its drawbacks it is being spread to other countries. I conclude with a discussion of the values inherent in the provision of health care - that is, whether it should be viewed as a commodity or as a right of the citizens of a nation.U.S. health care, accessibility, external views

Brain Drain and Regain: The Migration Behaviour of South African Medical Professionals (Migration Policy Series No. 65)

Since the end of apartheid, South Africa has experienced a significant outflow of health professionals. The out-migration of health professionals from the country is part of a broader global trend of health professional migration from the Global South to the Global North. In the health sector, this “brain drain” has led to a significant decline in the quality of care in affected countries. The costs of health professional migration for countries of origin are usually measured in terms of lost investment in training and the gaps in medical care left by their departure. One recent study, for example, estimated that the cost to South Africa in lost investment in training from the emigration of health physicians to Australia, Canada, the United States and the United Kingdom amounts to USD1.4 billion. Previous studies have predicted that medical migration from South Africa is unlikely to subside in the short and medium term as health professionals and trainees exhibit very high emigration potential. This report provides an updated (2013) picture of the state of mind of South African health professionals. It also allows an assessment of whether professional attitudes and perceptions have changed between 2007 and 2013 including (a) whether levels of satisfaction with work and life in South Africa have improved or worsened; (b) whether emigration potential has declined or intensified amongst health professionals and (c) whether the “brain drain” from South Africa is likely to continue. These questions are of particular relevance given various changes in the health sector since 2007. Return migration has been advocated internationally as an antidote to the brain drain and an important downstream benefit for countries of origin in the South. This report therefore provides important new information about the implications of health professional return migration to South Africa. Another strategy adopted by some countries is to use immigration policy as a means of dealing with health professional shortages. South Africa is a destination country for health professionals from some countries although, with the exception of official schemes to temporarily import Cuban and Tunisian doctors, this is not official policy. Significantly, the medical professions have only just appeared on the government scarceskills lists that have been published for nearly a decade. This survey provided an opportunity to profile a sub-group of non-South African doctors to assess whether they are more inclined to remain in the country than their South African counterparts. The current survey was developed in collaboration with the Institute of Population Health at the University of Ottawa as part of a CIHR-funded global project on health professional migration from India, Jamaica, the Philippines and South Africa. The questionnaire was hosted on the MEDpages website and potential respondents were invited by email to complete the survey. A total of 1,383 completed questionnaires were received from physicians, dentists and pharmacists – a response rate of 7%

Professional Work in Health Care Organizations: The Structural Influences of Patients in French, Canadian and American Hospitals

Although there are several studies of the impact of employment of health professionals in large bureaucratic organizations, there has been significantly less research focused on the structural influence of patients on this relationship. In this paper we present comparative qualitative data gathered on the work experiences of health care professionals in Canadian, U.S. and French hospitals. We elaborate specifically on a typology of structural influence of clients on health care professionals work in hospitals in terms of open and closed units.health professions, health care organizations, patients, hospitals, physicians, nurses, comparative perspectives

No. 65: Brain Drain and Regain: The Migration Behaviour of South African Medical Professionals

Since the end of apartheid, South Africa has experienced a significant outflow of health professionals. The out-migration of health professionals from the country is part of a broader global trend of health professional migration from the Global South to the Global North. In the health sector, this “brain drain” has led to a significant decline in the quality of care in affected countries. The costs of health professional migration for countries of origin are usually measured in terms of lost investment in training and the gaps in medical care left by their departure. One recent study, for example, estimated that the cost to South Africa in lost investment in training from the emigration of health physicians to Australia, Canada, the United States and the United Kingdom amounts to USD1.4 billion. Previous studies have predicted that medical migration from South Africa is unlikely to subside in the short and medium term as health professionals and trainees exhibit very high emigration potential. This report provides an updated (2013) picture of the state of mind of South African health professionals. It also allows an assessment of whether professional attitudes and perceptions have changed between 2007 and 2013 including (a) whether levels of satisfaction with work and life in South Africa have improved or worsened; (b) whether emigration potential has declined or intensified amongst health professionals and (c) whether the “brain drain” from South Africa is likely to continue. These questions are of particular relevance given various changes in the health sector since 2007. Return migration has been advocated internationally as an antidote to the brain drain and an important downstream benefit for countries of origin in the South. This report therefore provides important new information about the implications of health professional return migration to South Africa. Another strategy adopted by some countries is to use immigration policy as a means of dealing with health professional shortages. South Africa is a destination country for health professionals from some countries although, with the exception of official schemes to temporarily import Cuban and Tunisian doctors, this is not official policy. Significantly, the medical professions have only just appeared on the government scarceskills lists that have been published for nearly a decade. This survey provided an opportunity to profile a sub-group of non-South African doctors to assess whether they are more inclined to remain in the country than their South African counterparts. The current survey was developed in collaboration with the Institute of Population Health at the University of Ottawa as part of a CIHR-funded global project on health professional migration from India, Jamaica, the Philippines and South Africa. The questionnaire was hosted on the MEDpages website and potential respondents were invited by email to complete the survey. A total of 1,383 completed questionnaires were received from physicians, dentists and pharmacists – a response rate of 7%

Perceptions de partialité dans la sélection des diplômés internationaux en médecine aux programmes de résidence au Canada

Background: In Canada, international medical graduates (IMG) consist of immigrant-IMG and previous Canadian citizens/permanent residents who attended medical school abroad (CSA). CSA are more likely to obtain a post-graduate residency position than immigrant-IMG and previous studies have suggested that the residency selection process favours CSA over immigrant-IMG. This study explored potential sources of bias in the residency program selection process. Methods: We conducted semi-structured interviews with senior administrators of clinical assessment and post-graduate programs across Canada. We asked about perceptions of the background and preparation of CSA and immigrant-IMG, methods applicants use to improve likelihood of obtaining residency positions, and practices that may favour/discourage applicants. Interviews were transcribed and a constant comparative method was employed to identify recurring themes.  Results: Of a potential 22 administrators, 12 (54.5%) completed interviews. Five key factors that may provide CSA with an advantage were: reputation of the applicant’s medical school, recency of graduation, ability to complete undergraduate clinical placement in Canada, familiarity with Canadian culture, and interview performance.  Conclusions: Although residency programs prioritize equitable selection, they may be constrained by policies designed to promote efficiencies and mitigate medico-legal risks that inadvertently advantage CSA. Identifying the factors behind these potential biases is needed to promote an equitable selection process.Contexte :Parmi les diplômés internationaux en médecine (DIM) au Canada, il y a des diplômés immigrants et des citoyens ou des résidents canadiens qui ont fait leurs études de médecine à l’étranger (CEE). Ces derniers ont plus de chances d’obtenir un poste de résidence postdoctorale que les DIM immigrants. Des études montrent que le processus de sélection des résidents favorise les CEE au détriment des DIM immigrants. La présente étude explore les sources potentielles de biais dans le processus d’attribution des postes de résidence. Méthodes : Nous avons mené des entrevues semi-structurées avec des gestionnaires principaux de programmes d’évaluation clinique et de programmes de formation postdoctorale de tout le Canada. Nous les avons interrogés sur leurs perceptions quant au parcours et au niveau de préparation des CEE et des DIM immigrants, quant aux méthodes utilisées par les candidats pour augmenter leurs chances d’obtenir un poste de résidence et quant aux pratiques qui peuvent encourager ou décourager les candidats. Les entretiens ont été transcrits et une méthode comparative constante a été employée pour identifier les thèmes récurrents. Résultats : Douze (54,5 %) des 22 gestionnaires sollicités ont participé aux entrevues. Les cinq facteurs clés susceptibles de procurer un avantage aux CEE sont : la réputation de la faculté de médecine où le candidat a obtenu son diplôme, la date récente d’obtention de ce dernier, la possibilité d’effectuer un stage clinique de premier cycle au Canada, la familiarité avec la culture canadienne et la performance à l’entrevue. Conclusions : Bien que la sélection équitable soit une priorité pour les programmes de résidence, ils doivent également respecter des politiques visant l’efficacité et l’atténuation des risques médico-légaux qui avantagent involontairement les CEE. Il faut déceler les facteurs qui sous-tendent ces biais potentiels pour renforcer le caractère équitable du processus de sélection

Scoping review about the professional integration of internationally educated health professionals

Sources retained for data extraction and charting. (PDF 352 kb

The Role of Migrant Care Workers in Ageing Societies: Report on Research Findings in the U.K., Ireland, Canada and the U.S.

Migrants play an increasingly significant role in caring for the elderly due to a growing number of older people and declining domestic labour supplies, according to this report in the IOM Migration Research Series. It examines the demand for migrant care workers; compares the experiences of migrants, employers and older people; and presents recommendations for addressing the increasing significance of elder care and its implications for migrant labour

No. 65: Brain Drain and Regain: The Migration Behaviour of South African Medical Professionals

Since the end of apartheid, South Africa has experienced a significant outflow of health professionals. The out-migration of health professionals from the country is part of a broader global trend of health professional migration from the Global South to the Global North. In the health sector, this “brain drain” has led to a significant decline in the quality of care in affected countries. The costs of health professional migration for countries of origin are usually measured in terms of lost investment in training and the gaps in medical care left by their departure. One recent study, for example, estimated that the cost to South Africa in lost investment in training from the emigration of health physicians to Australia, Canada, the United States and the United Kingdom amounts to USD1.4 billion. Previous studies have predicted that medical migration from South Africa is unlikely to subside in the short and medium term as health professionals and trainees exhibit very high emigration potential. This report provides an updated (2013) picture of the state of mind of South African health professionals. It also allows an assessment of whether professional attitudes and perceptions have changed between 2007 and 2013 including (a) whether levels of satisfaction with work and life in South Africa have improved or worsened; (b) whether emigration potential has declined or intensified amongst health professionals and (c) whether the “brain drain” from South Africa is likely to continue. These questions are of particular relevance given various changes in the health sector since 2007. Return migration has been advocated internationally as an antidote to the brain drain and an important downstream benefit for countries of origin in the South. This report therefore provides important new information about the implications of health professional return migration to South Africa. Another strategy adopted by some countries is to use immigration policy as a means of dealing with health professional shortages. South Africa is a destination country for health professionals from some countries although, with the exception of official schemes to temporarily import Cuban and Tunisian doctors, this is not official policy. Significantly, the medical professions have only just appeared on the government scarceskills lists that have been published for nearly a decade. This survey provided an opportunity to profile a sub-group of non-South African doctors to assess whether they are more inclined to remain in the country than their South African counterparts. The current survey was developed in collaboration with the Institute of Population Health at the University of Ottawa as part of a CIHR-funded global project on health professional migration from India, Jamaica, the Philippines and South Africa. The questionnaire was hosted on the MEDpages website and potential respondents were invited by email to complete the survey. A total of 1,383 completed questionnaires were received from physicians, dentists and pharmacists – a response rate of 7%

Causes, Consequences, and Policy Responses to the Migration of Health Workers: Key Findings from India

Background: This study sought to better understand the drivers of skilled health professional migration, its consequences, and the various strategies countries have employed to mitigate its negative impacts. The study was conducted in four countries—Jamaica, India, the Philippines, and South Africa—that have historically been “sources” of health workers migrating to other countries. The aim of this paper is to present the findings from the Indian portion of the study. Methods: Data were collected using surveys of Indian generalist and specialist physicians, nurses, midwives, dentists, pharmacists, dieticians, and other allied health therapists. We also conducted structured interviews with key stakeholders representing government ministries, professional associations, regional health authorities, health care facilities, and educational institutions. Quantitative data were analyzed using descriptive statistics and regression models. Qualitative data were analyzed thematically. Results: Shortages of health workers are evident in certain parts of India and in certain specialty areas, but the degree and nature of such shortages are difficult to determine due to the lack of evidence and health information. The relationship of such shortages to international migration is not clear. Policy responses to health worker migration are also similarly embedded in wider processes aimed at health workforce management, but overall, there is no clear policy agenda to manage health worker migration. Decision-makers in India present conflicting options about the need or desirability of curtailing migration. Conclusions: Consequences of health work migration on the Indian health care system are not easily discernable from other compounding factors. Research suggests that shortages of skilled health workers in India must be examined in relation to domestic policies on training, recruitment, and retention rather than viewed as a direct consequence of the international migration of health workers

"I don't see gender": Conceptualizing a gendered system of academic publishing.

Academic experts share their ideas, as well as contribute to advancing health science by participating in publishing as an author, reviewer and editor. The academy shapes and is shaped by knowledge produced within it. As such, the production of scientific knowledge can be described as part of a socially constructed system. Like all socially constructed systems, scientific knowledge production is influenced by gender. This study investigated one layer of this system through an analysis of journal editors' understanding of if and how gender influences editorial practices in peer reviewed health science journals. The study involved two stages: 1) exploratory in-depth qualitative interviews with editors at health science journals; and 2) a nominal group technique (NGT) with experts working on gender in research, academia and the journal peer review process. Our findings indicate that some editors had not considered the impact of gender on their editorial work. Many described how they actively strive to be 'gender blind,' as this was seen as a means to be objective. This view fails to recognize how broader social structures operate to produce systemic inequities. None of the editors or publishers in this study were collecting gender or other social indicators as part of the article submission process. These findings suggest that there is room for editors and publishers to play a more active role in addressing structural inequities in academic publishing to ensure a diversity of knowledge and ideas are reflected