The impact of physician migration on mortality in low and middle-income countries: an economic modelling study

Published on Jan 1, 2020in BMJ Global Health
路 DOI :10.1136/bmjgh-2019-001535
Saurabh Saluja9
Estimated H-index: 9
Niclas Rudolfson2
Estimated H-index: 2
+ 2 AuthorsMark G. Shrime41
Estimated H-index: 41
Background The WHO estimates a global shortage of 2.8 million physicians, with severe deficiencies especially in low and middle-income countries (LMIC). The unequitable distribution of physicians worldwide is further exacerbated by the migration of physicians from LMICs to high-income countries (HIC). This large-scale migration has numerous economic consequences which include increased mortality associated with inadequate physician supply in LMICs. Methods We estimate the economic cost for LMICs due to excess mortality associated with physician migration. To do so, we use the concept of a value of statistical life and marginal mortality benefit provided by physicians. Uncertainty of our estimates is evaluated with Monte Carlo analysis. Results We estimate that LMICs lose US15.86 billion (95% CI .4 to $38.2) annually due to physician migration to HICs. The greatest total costs are incurred by India, Nigeria, Pakistan and South Africa. When these costs are considered as a per cent of gross national income, the cost is greatest in the WHO African region and in low-income countries. Conclusion The movement of physicians from lower to higher income settings has substantial economic consequences. These are not simply the result of the movement of human capital, but also due to excess mortality associated with loss of physicians. Valuing these costs can inform international and domestic policy discussions that are meant to address this issue.
  • References (29)
  • Citations (0)
馃摉 Papers frequently viewed together
6 Authors (David E. Bloom, ..., Andrea B Feigl)
138 Citations
18 Authors (Rifat Atun, ..., Mary Gospodarowicz)
211 Citations
7 Citations
78% of Scinapse members use related papers. After signing in, all features are FREE.
14 CitationsSource
#1Clayton J. Masterman (Vandy: Vanderbilt University)H-Index: 4
#2W KipviscusiH-Index: 69
Examination of estimates of the income elasticity of the value of a statistical life based on international stated preference studies yields an average between 0.94 and 1.05 overall and 0.65 and 0.80 after controlling for covariates. Quantile regression estimates indicate that the income elasticity is about 0.55 for more affluent countries and 1.0 for lower income nations, i.e., those countries that have estimates of the value of a statistical life below $2 million or per capita income levels be...
6 CitationsSource
#1Yusuke Tsugawa (Harvard University)H-Index: 22
#2Anupam B. Jena (Harvard University)H-Index: 32
Last. Chantal WorzalaH-Index: 76
view all 4 authors...
Objective To determine whether patient outcomes differ between general internists who graduated from a medical school outside the United States and those who graduated from a US medical school. Design Observational study. Setting Medicare, USA. Participants 20% national sample of data for Medicare fee-for-service beneficiaries aged 65 years or older admitted to hospital with a medical condition in 2011-14 and treated by international or US medical graduates who were general internists. The study...
32 CitationsSource
This paper investigates the effect of changes in the physician coverage ratio on infant and disease mortality, utilizing historical data from Germany. The results indicate substantial health effects. One additional physician per 1,000 of population reduces infant mortality by 23%. We find similar negative effects for a variety of common diseases and stillbirths. Using a semiparametric control function approach, we demonstrate that the marginal returns to coverage are nonlinear and decreasing.
#1W KipviscusiH-Index: 69
#2Clayton J. Masterman (Vandy: Vanderbilt University)H-Index: 4
23 CitationsSource
#1Rie Sakai (Harvard University)H-Index: 4
#2G眉nther Fink (Harvard University)H-Index: 28
Last. Ichiro Kawachi (Harvard University)H-Index: 127
view all 4 authors...
Objective To investigate the effect of pediatrician supply on under-5 mortality over the period 2000鈥2010. Data Sources Multiple publicly available data sources were used. Study Design Japan's 366 鈥淪econdary Tier of Medical Care Units鈥 (STMCU) were used as study units. To evaluate the association between under-5 mortality and pediatrician supply, we explored time and area fixed-effects Poisson regression model. The following factors were introduced into the models as time-varying controls: (1) n...
6 CitationsSource
#1Ronald Labont茅 (U of O: University of Ottawa)H-Index: 37
#2David Sanders Mrcp (UWC: University of the Western Cape)H-Index: 40
Last. Ivy Lynn Bourgeault (U of O: University of Ottawa)H-Index: 26
view all 11 authors...
Background This paper arises from a four-country study that sought to better understand the drivers of skilled health worker migration, its consequences, and the strategies countries have employed to mitigate negative impacts. The four countries鈥擩amaica, India, the Philippines, and South Africa鈥攈ave historically been 鈥渟ources鈥 of skilled health workers (SHWs) migrating to other countries. This paper presents the findings from South Africa.
18 CitationsSource
#1Jung鈥怘ua Shao (CGU: Chang Gung University)H-Index: 6
#2Anne M. Chang (QUT: Queensland University of Technology)H-Index: 31
Last. Su-Hui Chen (CGUST: Chang Gung University of Science and Technology)H-Index: 6
view all 5 authors...
Aims This paper is a report on the effectiveness of a self-management programme based on the self-efficacy construct, in older people with heart failure. Background Heart failure is a major health problem worldwide, with high mortality and morbidity, making it a leading cause of hospitalization. Heart failure is associated with a complex set of symptoms that arise from problems in fluid and sodium retention. Hence, managing salt and fluid intake is important and can be enhanced by improving pati...
27 CitationsSource
Aims To re-examine the form of the relationships between the global distribution of health professionals (physicians and nurses), gross national product per capita, female literacy, and infant and under-5 mortality rates reported in three papers by Robinson and Wharrad using more recent data. The secondary aim was to explore prior assumptions about the quality of the data, the homogeneity of the sample, and the form of the relationship. Background The analyses by Robinson and Wharrad did not tak...
8 CitationsSource
#1Jonathan Crush (Balsillie School of International Affairs)H-Index: 34
#2Abel Chikanda (Queen's University)H-Index: 11
Last. Wade Pendleton (UCT: University of Cape Town)H-Index: 8
view all 3 authors...
Conventional wisdom holds that the 鈥榖rain drain鈥 of health professionals from Africa is deeply damaging to the continent. Recently, a group of North American and European neoliberal economists has challenged this view, variously arguing that the negative consequences are highly exaggerated and the compensating benefits many. The benefits include various forms of diaspora engagement in which those who have left then engage in a variety of activities and actions that bring substantial benefits to ...
12 CitationsSource
Cited By0