Working together to Address Healthcare Workforce Mobility in Europe

The overall objective is to convene a series of high-level political dialogues to codify the role of all EU member states in combatting health workforce shortages resulting from mass migration of health professionals from newer member States of Central and Eastern Europe to those in Western Europe.

Trends of Health Workforce Migration in the European Union

 The First  Webinar of 2021

 02 February  2021

15.00-16.30 CET

Supported by the grant from the Open Society Foundations

Teams environment

Scope and purpose

Background

In all European Nations life and health is one of the most important pillars of wellbeing. Value of health is the cultural backbone of our civilization.

EU citizens, even being cautious about high tax burden, are asking for more health services of higher quality and agree to finance higher health bills by general taxes or health insurance contributions.  For decades’ demand for health services grew faster than the total economy, pushing up the share of health care expenditure in GDP. Relative role of the health sector was growing in the 20th century and continues to grow in the 21st century. The latest available Eurostat figures on Eurozone (2017) show that employment in health exceeded 9720 thousand and is almost twice bigger than in economic sectors of agriculture, forestry, fisheries, mining, and manufacturing of basic metals that dominated European policy at the start of European integration combined that is 5850 thousand (see a chart).

Source: Eurostat

The impressive dynamics of health sector most likely will continue at least until 2030 in most of OECD countries according to majority of recent forecasts. The dynamics creates opportunities but at the same time is related to risks. For example, the free movement of people is a cornerstone of an open and integrated Europe. Yet the mass migration of Europeans, particularly from East to West, creates a source of anxiety for both sending and receiving Member States. Europe leads the World according to main characteristic of public health, yet COVID-19 clearly indicated limited resilience of all European health systems.

The webinar has a purpose to reflect on healthcare labour market development in Europe with the emphasis on labour migration, to look at evidence on push and pull factors leading to migration of labour force in healthcare sector.

The webinar is an integral part of a 3-year project Working Together to Address Health Workforce Mobility in Europe.  The start of the project was publicly announced on European Health Forum Gastein 2020. Up to 12 webinars to address the unequal distribution of the health workforce in Europe, to participate in designing of policies to support regions that have difficulties in attracting health workers as well as promoting training and education of health professionals to common standards, coupled with measures to safeguard the rights of health workers from the rest of the world. are foreseen by the project.

A background paper for the webinar is developed and displayed on a website of European Institute of Health and Sustainable Development (www.eihsd.eu).

Conclusions of the webinar are going to be developed and disseminated in 2 weeks after the webinar.

 Format

Moderated by a professional moderator Joe Lynam from BBC and chaired by Dr Vytenis Andriukaitis.

Panel of 4 speakers representing the following perspectives:

  1. Jean-Christophe Dumont, Head of the International Migration Division. “Recent trends in international mobility of health workers across Europe and the OECD”.
  2. Markus Schneider, BASYS, Germany. “System of health accounts as a tool for healthcare labour force management”.
  3. Corinne Hinlopen, Wemos, The Netherlands. “Suboptimal allocation of healthcare work force in Member states: Medical deserts in Europe”.
  4. Gediminas Cerniauskas, European Institute for Health and Sustainable Development, Lithuania. “Trends that may change international migration patterns in European Union: case study on Lithuania”.

Speakers and Moderator

Vytenis Povilas Andriukaitis served as European Commissioner for Health and Food Safety in 2014-2019. Vytenis Andriukaitis has been practicing surgeon for more than 20 years.  In 1990 he was one of the co-authors of Constitution of the Republic of Lithuania adopted in 1992. A Member of Parliament of the Republic of Lithuania for six mandates. He led the Lithuanian delegation to the Convention on the Future of Europe. Minister for Health of Republic of Lithuania (2012-2014).

 Jean-Christophe Dumont, PhD, Head of the International Migration Division in the Directorate for Employment, Labour and Social Affairs, OECD since 2011. He joined the OECD Secretariat in 2000 to work on international migration issues. He oversees the OECD annual flagship publication on migration, the International Migration Outlook, and numerous publications on the economic impact of international migration, as well as on migration management and the labour market integration of immigrants and their children in OECD countries. He has also worked on migration and development issues and on the international mobility of health workers. He holds a PhD in development economics from the University Paris IX-Dauphine and was a research fellow at Laval University, Quebec, Canada.

 Markus Schneider, Ph.D., Director of German Consulting Company BASYS, with proven record on research and modelling healthcare systems of Western Europe and consultancy in most countries of Central and Eastern Europe – 35-years’ experience in the fields of health, social and economic systems on a national and international level. Through BASYS he provides knowledge to the Commission of the European Union, The World Bank, OECD, WHO, Ministries and other organisations. BASYS is committed to quality, competence, and entrepreneurship of consultancy.

Corinne  Hinlopen, Wemos, studied Sociology and Development Studies at Wageningen University (The Netherlands) with specialisations in health education and public health. In 2001, she earned her Master’s in Public Health at the Netherlands School of Public Health, after which she worked with various public health organizations in the Netherlands, in the fields of infectious diseases, food and nutrition, non-communicable diseases, health promotion and disease prevention. Realizing once again that lasting improvements in (public) “Health for all” require intersectoral, systemic changes as well as international collaboration, Corinne set her mind to working in international advocacy and joined Wemos in 2014. As the Policy Researcher for Global Health, she focuses on human resources for health, health systems, the Sustainable Development Goals and on ‘leaving no one behind’ and likes to challenge institutions on their contributions to global public goods for health.

Gediminas Cerniauskas, PhD in health economics, has more than 20 years record of working in Lithuanian Government (Deputy Minister of Health, Minister of Health, advisor to Prime-Minister), Academy (Professor of health economics in Mykolas Romeris University, Vilnius) and consultancy (projects in East Europe, Caucasus, Central Asia). Graduated from Vilnius University, studied in London School of Economics.

Moderator, Joe Lynam: is a respected broadcaster and moderator who was the BBC’s senior Business Correspondent for a decade. He now presents the current affairs show ‘The Newsroom’ on BBC Radio 4 and the World Service. Joe has won many awards for his original journalism. He has presented and been a senior correspondent on the Today programme, Newsnight, BBC One Breakfast as well as Five Live and the BBC News Channel.

Webinar Outline

time in total: 90 min.

 

Time Activity Who is leading and/or speaking? What’s on screen for event participants?
2 min Introduction and opening

Presenting speakers 

Moderator Moderator
3 min Short video on UHC
 10 min European values and mobility of healthcare work force: how to strike a balance between free movement of labour, universal health coverage, equal accessibility to health services to all residents of the EU? Vytenis Andriukaitis Chair Moderator and chair

 

 

Q1: 1st Intervention of panellists 25 min

 

Moderator and panel
15 min Recent trends in international mobility of health workers across Europe and the OECD, Jean-Christophe Dumont Moderator and speaker
10 min System of health accounts as a tool for healthcare labour force management, Markus Schneider Moderator and speaker
5 min Q&A Moderator and speakers
Q2 – The 2nd intervention of panellists 20 min  

 

Moderator and panel

 

 

10 min Suboptimal allocation of healthcare work force in Member states: Medical deserts in Europe, Corinne Hinlopen Moderator and speaker
10 min Trends that may change international migration patterns in European Union: case study on Lithuania, Gediminas Cerniauskas Moderator and speaker
20 min Q3 – Questions from the audience and panel responses  Chair, moderator, panel,

 

Chair, Moderator, panel
5 min Wrap up  Chair, moderator Chair, moderator

 

 

For additional information or questions on the content, logistics or technical issues pls. address to EIHSD staff: accordingly: Gediminas Cerniauskas (gcerniauskas57@gmail.com); Romas Buivydas (rbuyvidas@sec.lt) Tamar Gabrielashvili-Cerniauskiene (tngabriel@eihsd.eu)

Background paper for a webinar Trends of Health Workforce Migration in the European Union

 02 February  2021

Source: for figures 1-11 OECD data base. For figures 12-14 Eurostat.

Figure 1.Foreign trained doctors are becoming more important for European national health systems.

Figure 2. Especially in Scandinavia.

Figure 3. But Southern Europe and MS from 2004 relies on locally trained doctors.

Figure 4. Dynamics of Migration is not even. Multifactorial analysis is needed to understand the causes and it is not easy to predict the future.

It is likely that push and pull factors related to economic crisis of 2008-2009 played a substantial role.

Figure 5. The EU enlargement has increased role of migration from the East to the West of Europe

Figure 6. The EU enlargement has increased role of migration from the East to the West of Europe

Figure 7. Countries main donors of doctors (according to origin of training) to Germany

Civil war in Syria, German policies to welcome refugees from Syria or to  repatriate nationals from Romania and Russia, Romania and Poland becoming places to train foreign born (in our case German born) students  may played a role.

Figure 8. No migrant doctor inflow from a New Europe were recorded by OECD in Germany before enlargement

Figure 9. Measuring migration according to birthplace provides additional information on migration of doctors.

Figure 10. For some countries (Israel, Norway, Sweden) training of nationals abroad is important.

Figure 11. Registered migration of nurses is relatively less important for national health systems.

Figure 12. Dynamics of migration of nurses may have patterns that differs from these of doctors.

Statistics for nurses is relatively limited in time and the scope of information.

1 table. Foreign-trained nurses stock. Germany

Figure 13. Training is a main avenue to develop healthcare workforce.

Figure 14. Dynamics of training. Training of doctors had contracted in nineties and recovered around 2010.

Figure 15. Some countries have adjusted medical universities for export of graduates from medical professions.

Recent Trends in International Migration of Doctors, Nurses and Medical Students

OECD, 2019

Gaétan Lafortune, OECD Health Division, Karolina Socha-Dietrich, OECD Health Division Erik Vickstrom formerly from the OECD International Migration Division

1. Recent trends in international mobility of doctors and nurses

The number of foreign-trained doctors working in OECD countries increased by 50% between 2006 and 2016 (to reach nearly 500 000 in 2016), while the number of foreign-trained nurses increased by 20% over the five-year period from 2011 to 2016 (to reach nearly 550 000). The United States is still the main country of destination of foreign-trained doctors and nurses, followed by the United Kingdom and Germany. The number of foreign-trained doctors has also increased rapidly over the past decade in some European countries like Ireland, France, Switzerland, Norway and Sweden. However, it is important to bear in mind that not all foreign-trained doctors are foreigners as a large number in countries such as Norway, Sweden and the United States are people born in the country who obtained their first medical degree abroad before coming back. In these cases, it is not appropriate to refer to this phenomenon as a “brain drain”, particularly as these people usually pay the full cost of their education while studying abroad.

Concerns about shortages of health professionals are not new in OECD countries, and these concerns have grown in many countries with the prospect of the retirement of the ‘baby-boom’ generation of doctors and nurses. These concerns prompted many OECD countries to increase over the past decade the number of students in medical and nursing education programmes to train more new doctors and nurses in order to replace those who will be retiring and avoid a “looming crisis” in the health workforce.1

Because of these education and training policies, but also because of greater retention rates of current doctors and nurses and greater immigration of doctors and nurses in some countries, the number of doctors and nurses has continued to increase in most OECD countries since 2000, both in absolute number and on a per capita basis

Methodology of measurement

Migration patterns can be measured based on nationality, place of birth, or place of education/training. The first approach, based on nationality, faces a number of shortcomings. Firstly, foreigners disappear from the statistics when they are naturalised. Secondly, in several OECD countries, many people who were born and raised in the country hold a different nationality, so there is therefore no systematic link between migration and nationality.

The second approach, based on the place of birth, is more meaningful because when the country of birth differs from the country of residence, it implies that the person did cross a border at some point in time. However, the main question that arises to evaluate the impact of highly skilled migration on origin countries is where the education took place. Some foreign-born people arrived at younger ages, most probably accompanying their family, while others came to the country to pursue their tertiary education and have stayed after completing their studies. In these cases, most of the cost of education will have been supported by the receiving country, and/or by migrants themselves, not by the country of origin.

The third approach, based on the place of education/training, is the most relevant from a policy perspective, although it does raise a number of measurement issues. One of these issues is that nursing and medical education and training can be very long and go through different stages. The definition used in the annual OECD/Eurostat/WHO-Europe Joint Questionnaire is based on where people have received their first medical or nursing degree. Another issue has to do with the internationalisation of medical education, which means that a certain number of foreign-trained doctors or nurses may be people who were born in a country and decided to pursue their studies in another country before returning to their home country. The Joint Questionnaire seeks to collect data on the number of such native-born but foreign-trained doctors and nurses.

2. Recent trends in internationalisation of medical education

Gaétan Lafortune OECD Health Division, Karolina Socha-Dietrich OECD Health Division

The number of international students pursuing medical education away from their home country has increased significantly over the past decade, with some countries becoming popular destinations. For example, around half of all medical students in Ireland, nearly a third in Romania and a quarter in Poland are international students. This mobility of students is driven by demand and supply factors, including admission limits in medicine in the home countries of these students and active recruitment strategies of some medical schools. The mobility has been supported by the mutual recognition of qualifications, particularly across EU member states. Most international students from OECD countries studying medicine abroad intend to return to their home country to complete their postgraduate training and work as doctors.

3. International students in Polish medical schools

Anna Jaroń Researcher, Institute of Public Affairs, Agnieszka Łada, Director of the European Programme, Institute of Public Affairs Karolina Socha-Dietrich, OECD Health Division

Since 1993, most Polish medical schools have opened full-cycle study programmes in English for international students seeking education outside their home country either due to high tuition fees or limits on student intake. The schools continually adapt their international offer and promote recognition of their degrees also outside the European Union. Initially, the schools attracted students mainly from the United States; later also from Middle Eastern and South-East Asian countries; more recently from Norway, Sweden and Canada, and increasingly also from India. International students bring additional income for the schools; this helps to increase the attractiveness of faculty jobs, thereby addressing the emigration of medical educators from Poland.

4. Romania: A growing international medical education hub.

Marius Ungureanu, Babeș-Bolyai University, Karolina Socha-Dietrich, OECD Health Division

For international medical students, the attractiveness of Romanian medical

schools has increased since the country’s accession to the European Union in 2007, as they offer diplomas with EU-wide recognition for relatively low tuition fees and living costs. At present, nearly all medical schools offer programmes in English and/or French, taking up around 30% of the total teaching capacity. The internationalisation of medical education in Romania has taken place in the absence of any formal national strategy. Rather, medical schools have developed their own strategies to attract international students as a way to generate additional income, to be able to recruit and retain academic staff and to develop their infrastructure.

5. Brain gain and waste in Canada: Physicians and nurses by place of birth and training.

Alexia Olaizola, Arthur Sweetman, Department of Economics, McMaster University

The number of practicing physicians and PNs grew at double the rate of the total workforce, whereas practicing RNs only grew at one-third that rate. The high physician growth rate was a result of education and immigration policies intended to address perceptions of increasing physician shortages. In contrast, the low RN and high PN growth rates likely reflect a shift to lower cost PNs with no growth in total nursing relative to the workforce. The growth rate of foreign-born, foreign-trained professionals working in all three professions was larger than the relevant occupation’s average growth rate. Despite this, the percentage of foreign-born, foreign-trained individuals not working in their trained profession also increased for physicians and RNs. The net effect is that the percentage of foreign-born, foreign-trained potential physicians and RNs working in their profession declined. This “brain waste” reflects mismatches between health and immigration policies.

Statistical documentation of “brain waste” by Canadian health system

Health professional mobility in the WHO European Region and the WHO Global Code of Practice: data from the joint OECD/EUROSTAT/WHO-Europe questionnaire 

Gemma A Williams, Gabrielle Jacob, Ivo Rakovac, Cris Scotter, Matthias Wismar

European Journal of Public Health, Volume 30, Issue Supplement_4, September 2020,

In 2018, foreign-trained doctors and nurses comprised over a quarter of the physician workforce and 5% of the nursing workforce in five of eight and four of five case study countries, respectively. Since 2010, the proportion of foreign-trained nurses and doctors has risen faster than domestically trained professionals, with increased mobility driven by rising East-West and South-North intra-European migration, especially within the European Union. The number of nurses trained in developing countries but practising in case study countries declined by 26%. Although the number of doctors increased by 27%, this was driven by arrivals from countries experiencing conflict and volatility, suggesting countries generally are increasingly adhering to the Code’s principles on ethical recruitment.

WHO Global Code of Practice on the International Recruitment of Health Personnel Sixty-third World Health Assembly – WHA63.16 May 2010

Migration of health workers: the WHO code of practice and the global economic crisis.

© World Health Organization 2014

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