Chapter 4: The Scope for Migration
A substantial part of the international migration of skilled health workers is from relatively poor countries to relatively rich countries. While migration is only partially demand driven, as many migrants (including health workers) migrate irrespective of any certainties of job acquisition in the destination, increased demand for health workers in developed countries has influenced and directed migration flows, and suggested the greater probability of employment for skilled migrants. This chapter examines why that should be so, and where demand is concentrated. Since employment in health services accounts for about 10 per cent of the total employment in high-income economies, about 6 per cent in the transition economies of Eastern Europe, and rather less in developing countries, social, economic and political changes in the most developed countries have a significant influence on global labour markets. DEVELOPED-WORLD DEMAND Growing demand for health workers in relatively rich countries has resulted from ageing populations, high attrition rates (for reasons ranging from patient violence to discontent with wages and working conditions etc.), growing demand for health care, greater specialisation and a rising ability to pay. In most developed countries national policies have increased day-care treatment and encouraged shorter, more intensive hospital stays, discharging patients to residential homes, and significantly increasing the demand for care workers, especially in the private sector. Effective demand is most concentrated in those countries where domestic output of SHWs is inadequate and/or attrition rates are high, but where, seemingly paradoxically, wages are highest. Needs are particularly concentrated in rural areas, and...
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