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

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

Cristina Boboc (Bucharest Academy of Economic Studies, Romania) and Emilia Ţiţan (Bucharest Academy of Economic Studies, Romania)
DOI: 10.4018/978-1-4666-4723-7.ch007
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Abstract

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.
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Introduction

In the context of globalization in general and of EU enlargement in particular, migration is one of the most important and sensitive aspect with a lot of implications on social, economical and demographical changes.

In ECE countries, workers in health systems are facing increasing pressure and insecurity as long as they have to respond to a complex range of health threats: financing policies, technological advances and consumer expectations. Many workers face discouraging working environments, poverty-level wages, unsupportive management, insufficient social recognition, and weak career development. Moreover, the skills of some professionals in health system are not well matched to the local profile of health needs. These two reasons accelerated international migration of physicians from the Eastern to the Western Europe and intensified the gaps in health service coverage.

This chapter is mainly descriptive and deals with current issues regarding the diagnosis of medical system trying to identify the main reasons for migration. The focus is on ECE countries, members of EU: Bulgaria, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Slovakia and Slovenia after the accession to EU.

It begins with a literature review of the main papers about physician’s emigration between EU countries. Some push and pull factors are identified and studied in detail during the rest of the paper. Among push factors we mention: low pay, poor working conditions, lack of resources, limited career opportunities etc. Despite the Europeans are not so willing to move to another country, varying profiles in migration appears between European countries: some as strong importers and other as strong exporters of physicians.

As the migration of health workers is very often a symptom of the difficulties faced by the health system and the society as a whole in the country of origin, this chapter lays out a diagnosis of health sector. The focus is on ECE countries with the following questions:

  • 1.

    What is the overall health status of ECE countries?

  • 2.

    What are the main indicators of domestic health policy efforts?

  • 3.

    How does tertiary education in health vary among the countries composing the ECE region in relation to the needs of countries of destination in the EU?

  • 4.

    What are the major trends affecting the flows and stocks of medical doctors?

  • 5.

    What are the trends in the migration of physicians?

  • 6.

    What are the challenges in health system?

In dealing with these questions we have used descriptive techniques (tables, graphs, mean and variance indicators), factorial analysis methods (Principal Component Analysis and Canonical Analysis) besides regression methods. In order to assure the comparability between countries, we have used mainly data from EUROSTAT.

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Literature Review

Despite the increasing pressure of globalization and of the knowledge economy which promote labor migration, Fouarge and Ester (2008) find out that Europeans are not so willing to move to another country. Based on Eurobarometer Mobility Survey data (2005), only 5.4 per cent of the working-age population intends to move to another country within the next five years. Anyway, there are great disparities between countries, mostly between Eastern and Western countries. While family and other social relationships, as well as housing and local environment conditions, are important, Fouarge and Ester (2007a) besides Fouarge and Ester (2007b) in addition to Bonin, Eichhorst, Florman, Hansen, Skiöld, Stuhler, Tatsiramos, Thomasen and Zimmermann (2008) show that employment-related factors, such as higher income, better working conditions, and opportunities of finding a suitable job are key migration motivators in Europe, and in the new members states in particular. Furthermore, Bonin et al. (2008) show that language and cultural barriers also play an important role.

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