Medical Knowledge, North-South Cooperation, and Mobility of Medical Doctors

This chapter introduces the overall context of the Millennium Development Goals (MDGs), the on-going cooperative frameworks and the triple helix approach with the support of Information and Communication Technologies (ICTs). These are devoted to accelerate the implementation of further collaboration between medical schools in both North and South of the Mediterranean area. Three important players are identified in each region. These include the medical school, the public authority, and the business related to healthcare. These players from North and South can engage in specific areas that are education, research, and development, before the identification of means and incentives to be further devoted to attract medical doctors. These collaborations follow the trends developed by international organizations, mainly the WHO. The most important conclusions attained in the previous chapters of the present book are also summarized in the present chapter.

Inputs from the New Economics of Migration of Medical Doctors in Eastern and Central Europe

This is a contribution to the new economics of skilled labor emigration that focuses on the mobility of physicians inside European Union from ECE countries. Economic models under risk neutrality and aversion are used. The findings show that the education could change significantly the results on the emigration benefices. Comparisons of theoretical and observed relative human capital per country averages are conducted and ensured the statistical validity of the model used. The empirical results based on the available data on emigration by Docquier and Marfouk (2008) but also by Bhargava, Docquier, and Moullan (2010) allowed further use of the model to understand the current trends in the emigration of physicians and the border between brain gain and brain drain. The countries included in the study all exhibited brain gain between 1991-2004. Each country is encouraged to anticipate the likely effects of this emigration on the economy with the increase of health demand, the domestic wages, and the increase in education capacity for medical doctors.

Skilled Human Resources in the Health Sectors and Impacts of New Health Technologies on Health Workforce in Developing Economies

This chapter focuses on the importance of human health resources in relation to current and future trends in health. It is based on a syntheses of reports, publications, and economic development processes related to the increasing needs for skilled human resources in health systems that are under both high demand and also under the requirements of new health technologies. A special emphasis is placed on developing countries where a series of constraints could lead to limits in providing access to health care and a shortage of skilled labor. The human resources related risks at both levels of developed and developing economies are also discussed even though emergent and developed countries have generated new instruments to limit the negative effects of these constraints. Finally, if the expansion of access to new health technologies could be achieved within the world global health system framework, requirements of increasingly needed human resources and skills are shown.

The Theoretical Model of the New Economics of Migration of Medical Doctors

The focus of this chapter is on the selection of the theoretical model to be used to capture the main features related to the migration decisions of medical doctors in the selected groups of countries (ECE, MENA, and EU). The selected model is consequently submitted to empirical tests, and this is shown in the following chapters of this section.

Introduction to Labor and Health Economics

This chapter introduces the main components of the book and focuses on the shortage in medical doctors, its causes, and its consequences. The implications on migration of medical doctors is also introduced. The role of the new economics of migration is identified as a promising research angle. A series of issues need to be analyzed in order to better understand the global health system and feed economic and social policies. These elements are discussed in relation to the outcomes of the new economics of migration of medical doctors in the context of the Middle East and North Africa (MENA), Eastern and Central Europe (ECE), and the European Union (EU).

Perception by Moroccan Physicians of Factors Affecting their Migration Decisions

The variety of factors affecting migration decisions of medical doctors are confronted with the opinions of medical doctors operating in Morocco. The major objective of this exercise is to see how individual and environmental factors are perceived by each medical doctor who has selected to stay or to return to the country of origin after his or her medical studies. The method used in this research is based on the analysis of the information and data from a survey of physicians. This survey is based on the inputs from 117 medical doctors operating in different cities of Morocco. The results reveal that those with lower age and higher difficulties in medical practice constitute most of the medical doctors to relocate overseas. The migration conditions are also found to have a significant negative effect on respondents’ intention to migrate. The study reveals as well that labor wages, gender, the status of the hospital (private or public), and the situations prevailing in hospitals do not significantly affect the attitude of respondents about migration. These results confirm that the surveyed doctors have selected to not migrate but to operate in Morocco while those that migrate could have opposite assessments for the same factors. All the surveyed doctors have confirmed the importance of intensifying cooperation between hospitals and medical schools on both sides of the Mediterranean region. This cooperative framework creates new incentives for the promotion of exchanges of medical doctors, knowledge, and experiences between the South and the North. The intensification of this collaboration allows medical doctors to be more mobile, creating a new win-win process that is far from the brain-drain type of vision.

A Descriptive Overview of the Emigration of Medical Doctors from MENA to EU

This chapter focuses on a descriptive analysis of physician’s migrants from MENA to the European Union (EU). It assesses the determinants of this migration with its effects on sending and receiving economies. The relationship of the migration of medical doctors to health, medical education, and employment in MENA and EU is also discussed. Both descriptive and analytical approaches are used. The attained results show that the main factors for migration are income, work, and living conditions.

Beyond Brain Drain

The past decades have witnessed an increase in the pace and a consolidation of immigration of medical doctors and the globalization of the health system. If properly managed, globalization of the health workforce could lead to perceptible gains in health status for all parties involved. In a world economy shaped by strong institutions, globalization could benefit those countries with a strong and human and physical capital. This chapter reviews the importance of immigration and aims at presenting different views on immigration of medical doctors. While the traditional view has been dominated by the rhetoric on “brain-drain,” a new and more promising thread of research has centered on the relatively new concept of “brain-circulation.” Mobility for medical workers and health workers, in general, can be a significant contributor to the formation of scientific and technical human capital, which has been an important driver in economic expansion and social development in many regions of the world. To illustrate the point, the authors use a cooperative framework to elucidate the relationship between immigration of medical doctors and economic development in the long-run using the potential agreement between North Africa and the European Union as an example. The finding could have implications for the capacity of developing countries to turn around and use “circular immigration” as a means to integrate into the emerging knowledge economy.

The New Economics of Skilled Labor Migration

This is a contribution to the new economics of skilled labor emigration that focuses on the mobility of medical doctors from Middle East and North African countries. The theoretical model under risk neutrality and aversion as suggested in chapter 9 is applied. The findings show that the relative expected benefits and the emigration rate have major effects on the net relative human medical capital that remains in the source country. The effects of relative wages in the destination and sending countries besides the yield of education are likely to change the emigration patterns. Comparisons of theoretical and observed relative human capital per country averages are conducted and the statistical validity of the model is ensured. The empirical results based on the available data by Docquier and Marfouk (2006) and Bhargava, Docquier, and Moullan (2010) allow further use of the model to understand the current trends in the emigration of medical doctors. These trends confirm the magnitude of relative wages besides the level of education and the attitude towards risk as determinants of the emigration of skilled labor. The countries included in the study all exhibited brain gain from 1991-2004, but two distinct groups of countries are identified. Each country is encouraged to anticipate the likely effects of this emigration on the economy with the increase of health demand, domestic wages, and the increase in education capacity for medical doctors.

Migration of Medical Doctors, Health, Medical Education, and Employment in Eastern and Central Europe

This chapter is mainly descriptive and deals with current issues including economic and legal matters besides the prevailing wages and other benefits for medical doctors by country. The focus is on ECE countries, members of EU: Bulgaria, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Slovakia, and Slovenia. A key factor in providing medical care is the availability of qualified and motivated health care professionals. The emigration of physicians is an important constraint that limits the satisfaction of the local needs in health care in the origin countries, with poorer performing healthcare systems. The empirical evidence suggests that medical doctor emigration in the European Union happens because of poor distribution of physicians, low internal mobility, and inappropriate skill mix. In the case of migration from ECE countries to Western EU countries, the main reasons are differences in working conditions, remuneration level, and career opportunities. Substantial improvements in health and the conversion of the brain drain in brain gain in ECE countries should be obtained by some not very expensive measures: motivation of doctors, increase of competences, and convergence between needs and physician specialization.