Medical migration : what can we learn from the UK's perspective ?

This paper seeks to determine the macro-economic impacts of migration of skilled medical personnel from a receiving country's perspective. The resource allocation issues are explored in theory, by developing an extension of the Rybczynski theorem in a low-dimension Heckscher-Ohlin framework, and empirically, by developing a static computable general equilibrium model for the United Kingdom with an extended health sector component. Using simple diagrams, an expansion of the health sector by recruiting immigrant skilled workers in certain cases is shown to compare favorably to the (short-term) long-term alternative of using domestic (unskilled) workers. From a formal analysis, changes in non-health outputs are shown to depend on factor-bias and scale effects. The net effects generally are indeterminate. The main finding from the applied model is that importing foreign doctors and nurses into the United Kingdom yields higher overall welfare gains than a generic increase in the National Health Service budget. Welfare gains rise in case of wage protection.Health Monitoring&Evaluation,Health Systems Development&Reform,Labor Markets,Population Policies,Health Economics&Finance

The Economic Impact of Medical Migration: an Overview of the Literature

Despite rapid economic and social development of the Maldives, the vulnerability of the island population in terms of poverty remains high. Using household panel data for the period 1997/98 Ð 2004 we show that, although the majority of the poor manages to escape from poverty, a substantial part of the non-poor falls back into poverty at the same time. Using Logit regression analysis, the most influential determinants of escaping household poverty are shown to be: the level of education, participation in community activities, and the proportion of adults employed. Factors that have the largest impact on impeding a poverty escape are: the proportion of household members not working due to bad health, living in the North, and the proportion of female household members. The former two factors, in addition to household size, are also most influential on the odds of falling into poverty. Working in tourism, or the public sector, and taking out a loan to invest are important factors that prevent households from falling into poverty. Policy implications of these results are not only relevant at government level but also at household level. The government may consider paying more attention to the development of the two Northern regions, improve access to good quality education and health care, and further develop (private sector) tourism across the country. Household coping strategies involve investing in education, entering the labour market (especially in tourism and the public sector) and family planning.medical migration, brain drain, doctor migration, nurse migration

VULNERABILITY AND POVERTY DYNAMICS IN THE MALDIVES

Despite rapid economic and social development of the Maldives, the vulnerability of the island population in terms of poverty remains high. Using household panel data for the period 1997/98 Ð 2004 we show that, although the majority of the poor manages to escape from poverty, a substantial part of the non-poor falls back into poverty at the same time. Using Logit regression analysis, the most influential determinants of escaping household poverty are shown to be: the level of education, participation in community activities, and the proportion of adults employed. Factors that have the largest impact on impeding a poverty escape are: the proportion of household members not working due to bad health, living in the North, and the proportion of female household members. The former two factors, in addition to household size, are also most influential on the odds of falling into poverty. Working in tourism, or the public sector, and taking out a loan to invest are important factors that prevent households from falling into poverty. Policy implications of these results are not only relevant at government level but also at household level. The government may consider paying more attention to the development of the two Northern regions, improve access to good quality education and health care, and further develop (private sector) tourism across the country. Household coping strategies involve investing in education, entering the labour market (especially in tourism and the public sector) and family planning.vulnerability, income poverty dynamics, Maldives, Logit regression, probability of escaping from or falling into poverty

WEIGHTING DIMENSIONS OF POVERTY BASED ON PEOPLES PRIORITIES: Constructing a Composite Poverty Index for the Maldives

We work with a panel of bilateral trade flows from 1988 to 2002, exploring the influence of infrastructure, institutional quality, colonial and geographic context, and trade preferences on the pattern of bilateral trade. We are interested in threshold effects, and so emphasize those cases where bilateral country pairs do not actually trade. We depart from the institutions and infrastructure literature in this respect, using Heckman selection model-based gravity estimators of trade flows. We also depart from this literature by mixing principal components (to condense our institutional and infrastructure measures) with a focus on deviations from expected values for given income cohorts to control for multicollinearity. Infrastructure, and institutional quality, are significant determinants not only of export levels, but also of the likelihood exports will take place at all. Our results support the notion that export performance, and the propensity to take part in the trading system at all, depends on institutional quality and access to well developed transport and communications infrastructure. Indeed, this dependence is far more important, empirically, than variations in tariffs in explaining sample variations in North-South trade. This implies that policy emphasis on developing country market access, instead of support for trade facilitation, may be misplaced.poverty measures, living standard dimensions, aggregation, composite index, Maldives

The Economic Impact of Medical Migration: a Receiving CountryÕs Perspective

This paper seeks to determine the macro-economic impacts of migration of skilled medical personnel from a receiving countryÕs perspective, taking the UK as an archetype OECD economy that imports medical services. The resource allocation issues have been explored in theory, by further developing the Rybczynski theorem and empirically, using a Computable General Equilibrium (CGE) model with an extended health component. The main finding is that importing foreign doctors and nurses into the UK yields higher overall welfare gains compared to a generic increase in the NHS budget. Welfare gains rise in the case of wage protection.medical migration, immigrant health care workers, migrant nurses, migrant doctors

Sit down at the ball game: how trade barriers make the world less food secure

This paper analyses the impacts of trade policy responses to rising world food prices by carrying out a series of stylised experiments in the wheat market using a world trade model, GTAP. The sequence of events that is modelled comprises a negative wheat supply shock and subsequent implementation of an export tax by a major net exporter and a reduction in import tariffs by a small importer. The effects of trade policy responses are contrasted with those of full liberalisation of the wheat market. At the core are the (opposite) effects on producers and consumers, as well as the terms-of-trade and trade tax revenue effects. Food security is shown to depend crucially on changes in prices but also in incomes that are associated with changes in factor returns. The results reveal that major net exporters are generally better off when implementing export taxes for food security purposes. Large exporting countries export price instability causing world food prices to rise further. Net importing countries lose out and have limited leeway to reduce tariffs or subsidise imports. Liberalising wheat trade mitigates rising prices and contributes to food security, but to the detriment of production in Africa and Asia, making them more dependent on and vulnerable to changes in the world market. Concerted action at the WTO forum is required, notably clarifying and sharpening the rules regarding export measures.food security; world food crisis; international grain trade; trade measures; trade liberalisation; CGE modelling

The economic impact of health care provision: a CGE assessment for the UK

This thesis seeks to determine the macro-economic impacts of changes in health care provision, whilst recognising the simultaneous effects of consequent changes in health on effective labour supplies and the resource claims made by the health care sector. The resource allocation issues have been explored in theory, by developing an extension of the standard Rybczynski theorem from a low-dimension Heckscher-Ohlin framework, and empirically, by developing a Computable General Equilibrium model, calibrated to a purpose-built dataset for the UK. The theory predicts that, if the government is solely concerned with improving per capita income, a morally questionable policy of targeting health care provision towards skilled workers performs best. Furthermore, the impact of an expanding health sector on the outputs of non-health sectors is shown to depend on the sign and magnitude of a scale effect of increased effective labour supplies and a factor-bias effect of changes in the ratio of skilled to unskilled labour, although the latter effect dominates if effective labour supplies are relatively inelastic with respect to health care provision. The theoretical predictions are not generally validated by the applied model due to added real-life complexities. The main findings are that a rise in NHS expenditures, the employment of foreign health care-specific skilled workers, and costless factor-neutral and skill-biased technical change in the UK health sector have a positive impact upon overall welfare via direct improvements in population well-being and indirect benefits from increased worker incomes. The study indicates that if an expansion of the health sector is financed from a reduction in state benefits, the non-working households and pensioners may require some compensation since they rely relatively heavily on these as a source of income. The presence of health care-specific factors and rising pharmaceutical prices impact negatively upon the health sector and overall welfare, suggesting the importance of tackling rising input costs and structural rigidities. This may be achieved by the immigration policy, although since effects on domestic workers if their wages are not sustained, and on countries of origin faced by a 'brain-drain', are negative, in the long-term increasing the number of medical school places may be more desirable. Another suitable policy response is to purchase a more effective pharmaceutical product. Fairly small productivity gains in health care were shown to generate overall welfare gains. Finally, factor-neutral and skill-biased technical improvements yield significant welfare gains and cost-savings in the health sector. Such technical improvements may come in the form of improved medical procedures, which have been developed abroad yet are freely available or have been funded by charitable institutions, but also may reflect domestic policy which aims at reducing administrative overheads so that more resources can be devoted to front-line staff. The sensitivity of the results to the elasticity of the waiting lists with respect to health care indicates the importance of ensuring that additional resources are effectively employed, attainable by the technical and administrative improvements in health care

Trade openness and investment in North Africa: A CGE application to deep and comprehensive free trade areas (DCFTAs) between the EU and respectively Egypt, Morocco and Tunisia

The aim of this paper is to provide an impact analysis of deep and comprehensive free trade areas (DCFTAs) between the European Union (EU) and most of the North-African (NAF) countries – namely Egypt, Morocco and Tunisia. Scenarios are modelled with MAGNET, a general equilibrium model, and focus on trade liberalisation including non-tariff measures (NTMs) on the one hand, increases in foreign direct investments (FDIs) and capital flows on the other. They assume either broad productivity gains in all sectors of NAF countries, or targeted productivity gains in the agricultural sector aiming to reduce losses (waste) in NAF countries' agricultural production, post-harvest handling and storage. Results suggest that economic growth is stimulated mostly by widespread productivity gains, and boosted by trade liberalisation. Positive impacts on economic growth could thus be intensified by combining pro-investment policies with comprehensive trade liberalisation, especially the removal of NTMs. The effects on jobs and food security remain ambiguous.JRC.J.4-Agriculture and Life Sciences in the Econom

Consumers discard a lot more food than widely believed : Estimates of global food waste using an energy gap approach and affluence elasticity of food waste

This work provides an internationally comparable consumer food waste dataset based on food availability, energy gap and consumer affluence. Such data can be used for constructing meaningful and internationally comparable metrics on food waste, such as those for Sustainable Development Goal 12. The data suggests that consumer food waste follows a linear-log relationship with consumer affluence and starts to emerge when consumers reach a threshold of approximately $6.70/day/capita level of expenditure. These findings also imply that most empirical models overestimate consumption by not accounting for the possibility of food waste in their analysis. The results also show that the most widely cited global estimate of food waste is underestimated by a factor greater than 2 (214 Kcal/day/capita versus 527 Kcal/day/capita). Comparison with estimates of US consumer food waste based on national survey data shows this approach can reasonably reproduce the results without needing extensive data from national surveys.</p

Association between lung function and exacerbation frequency in patients with COPD

To quantify the relationship between severity of chronic obstructive pulmonary disease (COPD) as expressed by Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage and the annual exacerbation frequency in patients with COPD. We performed a systematic literature review to identify randomized controlled trials and cohort studies reporting the exacerbation frequency in COPD patients receiving usual care or placebo. Annual frequencies were determined for total exacerbations defined by an increased use of health care (event-based), total exacerbations defined by an increase of symptoms, and severe exacerbations defined by a hospitalization. The association between the mean forced expiratory volume in one second (FEV(1))% predicted of study populations and the exacerbation frequencies was estimated using weighted log linear regression with random effects. The regression equations were applied to the mean FEV(1)% predicted for each GOLD stage to estimate the frequency per stage. Thirty-seven relevant studies were found, with 43 reports of total exacerbation frequency (event-based, n = 19; symptom-based, n = 24) and 14 reports of frequency of severe exacerbations. Annual event-based exacerbation frequencies per GOLD stage were estimated at 0.82 (95% confidence interval 0.46-1.49) for mild, 1.17 (0.93-1.50) for moderate, 1.61 (1.51-1.74) for severe, and 2.10 (1.51-2.94) for very severe COPD. Annual symptom-based frequencies were 1.15 (95% confidence interval 0.67-2.07), 1.44 (1.14-1.87), 1.76 (1.70-1.88), and 2.09 (1.57-2.82), respectively. For severe exacerbations, annual frequencies were 0.11 (95% confidence interval 0.02-0.56), 0.16 (0.07-0.33), 0.22 (0.20-0.23), and 0.28 (0.14-0.63), respectively. Study duration or type of study (cohort versus trial) did not significantly affect the outcomes. This study provides an estimate of the exacerbation frequency per GOLD stage, which can be used for health economic and modeling purposes