Monash Institute for the Study of Global Movements

Programme:

The Effects of Global Movement upon Health and Well Being

Chief Investigators:

Jeff Richardson, Bruce Hollingsworth – Faculty of Business and Economics
Chandra Shah, Michael Long – Faculty of Education
Robert Birrell – Faculty of Arts

Programme Director: Jeff Richardson

Programme Summary

The two year $200,000 program will document the global movements of doctors and nurses and the effects of these upon health in net recipient and donor countries (positive and possibly negative respectively). It will create a data bank for subsequent analyses which will be used initially to examine causal paths between the workforce GDP and health, health and GDP.

Challenges and reform options for global social policy will be analysed. Future work will focus upon the impact on social institutions, individual subjective wellbeing (SWB) and health related social objectives.

The general aim is to determine the effects of global movements upon health, individual wellbeing, social (fairness related) welfare, health system organisation, social relationships, economic costs and benefits. The programme CIs meet once a month, with Jeff Richardson as programme leader co-ordinating progress. Specific project information and project contacts can be seen further down this page

In addition to the following projects we have organised a series of seminars, by Dr Graham Lister (Nuffield Trust), Dr Pippa Gough (Kings Fund), Dr Richard Smith and Professor James Buchan (Queen Margaret University College ).

For further information on this programme contact:

Professor Jeff Richardson
Centre for Health Economics
Faculty of Business and Economics
Monash University
PO Box 477, West Heidelberg
Melbourne , Victoria 3081
Australia

Tel: +61 (0)3 9496 4441 Fax: +61 (0)3 9496 4424
Email: jeff.richardson@buseco.monash.edu.au

Project One: Health, Workforce, and GDP

Leader: Bruce Hollingsworth

This project focuses on the determinants of population health outcome in different countries, with outcomes measured by mortality, life expectancy, and disability adjusted life expectancy. Cross national data sets will be used to model the impact of technological, labour force and other movements on lifestyle and consequently health. Careful attention will be paid to how economic factors are determinants of health, and which factors may be modifiable through interventions by policy making bodies, in order to inform policy makers at national and global level.

We hypothesise that effects of global movements on health will be significantly greater in developing, as opposed to developed countries. In particular shortages of doctors and nurses in developing countries may mean any net addition, or, perhaps more likely, loss to the medical workforce may have significant health effects. By contrast specific medical care interventions may have only a small impact on populations in the developed world, and other factors such as lifestyle, education and income may have larger effects.

The project consists of an extensive literature review to establish the background and issues to be concentrated upon, this is what is being undertaken now, initial findings are attached. The second phase of the project involves data gathering. We know that several large data sets from the WHO (191 countries), OECD (30 countries), and World Bank are available and these will allow us to undertake the analysis necessary. Collation, synthesis and investigation of these large data sets will be undertaken. These data are available over time, this is a great advantage, and essential when mapping the impact of movements.

The next stage will involve modelling. State of the art non-parametric and parametric techniques will be made use of to model and simulate the effects of movements on health. We will be able to focus on specific countries which have experienced either net losses or gains in medical workforce terms and estimate the impact of this over time on the health of their population. This will be the main part of the study and will consequently will take the most time, in terms of establishing, and testing of models, and variables on large data sets over time. This is an important phase for interaction with the other projects in terms of workforce movements.

Following the establishment of initial results, we will outline a policy framework for future analysis of movements, laying out an agenda for future research, and highlighting potential policy implications of initial results. Also, a grant application is being written and submitted to a major funding body (ARC/NHMRC) to continue, and further extend this work on a national and international level.

Finally, the dissemination of results and findings will take place, there will be a report written, and other dissemination will take place via the usual means (national and international conference presentation, submission of high impact journal papers etc).

To summarise, the outcomes main outcomes from the project will be: the most comprehensive economic analysis to date of the relationship between health and global movements; a description of the relative importance of global movements compared to other factors on health outcomes, and; a framework for monitoring these effects over time.

Contact: Bruce Hollingsworth
Centre for Health Economics
Faculty of Business and Economics
Monash University
PO Box 477, West Heidelberg
Melbourne , Victoria 3081
Australia

Tel: +61 (0)3 9496 4421 Fax: +61 (0)3 9496 4424
Email: bruce.hollingsworth@buseco.monash.edu.au

Dr Bruce Hollingsworth

Publications:

Hollingsworth, B. Who wins and loses when medical professionals migrate? Around the Globe; 2004: 1(2) 32-35.

Hollingsworth, B. Global Public Goods For Health: health economic and public health perspectives. Health Economics; 2004: 13(5) 501.

Hollingsworth, B., Shah, C., Long, M., Richardson, J. Modelling the economic impact of GATS. In: Blouin C., Drager N., Mattoo B, Smith R. Trade in health services and GATS handbook . Geneva: WHO. Forthcoming.

Hollingsworth, B., Shah, C., Long, M., Richardson, J. Economics modelling of international movements in the health labour force. Centre for Health Economics Working Paper Series. Forthcoming.

Spinks J. and Hollingsworth, B. Health production and the socioeconomic determinants of health in OECD countries: the use of efficiency models. Centre for Health Economics Working Paper Series. Forthcoming.

Project Two: Globalisation and the movement of nursing workers

Leader: Chandra Shah, Michael Long and Jeff Richardson

The project builds on work undertaken by Chandra Shah, Michael Long and Gerald Burke for the 2002 National Review of Nursing Education. The following program indicates the issues we intend to research. Given that there will be resource and data constraints, the final outcomes may not cover all the issues discussed below.

Proposed program

• Develop a model for the nursing labour market.
• Use the model to explain the cyclical imbalances in the market.
• Policy tools used to redress imbalances.
• Conduct a review of the literature on the pattern of international migration of nurses and related workers.
• Map the flows of nursing workers between different countries.
• Investigate the causes of the international flows of nursing workers.
• Investigate the effects of nursing worker movements at several levels:
  • the individual;
  • the recipient country;
  • the donor country; and
  • global.

Individual level

• Examine the factors (political, social and economic) that motivate nursing workers to migrate.
• Compare those who migrate permanently with those who move only for a fixed time.

Recipient country level

• Examine the causes of movements of nursing workers to recipient countries.
• Are the movements due to shortages of nursing workers in these countries, and if so what are causes of shortages?
• Are shortages the result of the incapacity of the training system to meet demand?
• Has demand increased because of growth or replacement needs or both? What are its causes - ageing of the population, ageing of the nursing workforce (increases replacement needs), the net effect of new technologies?
• Is migration used as a substitute for training new nurses?
• Why can't the training system cope with the demand for nursing workers? Is it because training capacity has been run down through market reforms in the training sector?
• Is it because there is a lack of demand for training (alternative career options for women, poor relative wages and work conditions) or is it because of poor workforce planning?
• Are the costs of recruitment borne equitably by the public and private components of the health sector.
• Examine other social and economic implications of inflows of nursing workers (certification, working conditions, wage rates, quality).

Donor country level

• Examine the economic effects on the donor countries, including the net loss of investment in human resources and talent to the donor country.
• How significant are remittances to the home country in offsetting some or all such losses?
• Does emigration result in shortages in the donor countries and does that cause rise in nurse wages?
• Investigate instances of overseas investment in the preparation of nurses.
• Examine the impact on the training system. Does it create a two-tier training market for nursing workers, one to serve domestic demand and the other to serve overseas demand? Does it improve the overall quality of nurse training?

Global level

• Examine responses to the global movement of health workers at the supra national level, for example by international bodies such as the World Health Organisation, the International Labour Organisation and the World Trade Organisation.

International collaboration

We intend to use the outline of this project as the basis for inviting researchers from other countries to contribute to the project through parallel research from the perspective of their own countries. The result of this collaboration will be a compilation of research papers on the global movement of nursing and related health workers.

Contact: Dr Chandra Shah

Centre for the Economics of Education and Training
Faculty of Education
Monash University
Building 6
Clayton Campus
Wellington Road
Melbourne , Victoria 3800
Australia

Tel: +61 (0)3 9905 2787 Fax: +61 (0)3 9905 5400
Email: chandra.shah@education.monash.edu.au

Dr Chandra Shah

Publications:

Shah, C. & Long, M 2003 ‘Employment changes and job openings for new entrants in nursing and caring occupations in Australia', Australian Journal of Labour Economics, 6 (3), 453-471 .

Shah, C & Long, M 2004 Global labour mobility and mutual recognition of skills and qualifications: European Union and Australia/New Zealand perspectives, CEET Working Paper No. 56.

Technical Consultation on Mobility of Skills in Asia organised by Korean Research Institute for Vocational Education and Training (KRIVET), the International Labour Organization (ILO) and the Asia Pacific Skills Development Programme (APSDEP), Seoul, South Korea, Global labour mobility and mutual recognition of skills and qualifications: European Union and Australia/New Zealand perspectives.

5th Path to Full Employment Conference and the 10th National Conference on Unemployment, Newcastle, Employment changes and job openings for new entrants in nursing and caring occupations in Australia.

Project Three: Doctor Movements

Leader: Bob Birrell

This component is based on a study of medical doctor movement between Western Europe , North America and Oceana and other western countries. It will comprise a detailed case study of Australia (currently underway) and an evaluation of movements in other Western countries which will be conducted in the context of what has been learned about the Australian experience.

Current work involves the following;

Purchase and preparation of data sets which make possible a description of the movement of doctors into and out of Australia , by visa category, birthplace, country of origin, age and sex. This data includes arrivals and departures data up to and including the year 2002-2003 and visa issued data (in order to identify visas issued to doctors on-shore). This data is being evaluated in the context of theory about the alleged ‘push' and ‘pull' factors shaping international movements of overseas trained doctors (OTDs).

Purchase of 2001 Census matrixes which identify the employment status of doctors by birthplace, place of training, and time of arrival in Australia . These matrixes (in hand) were designed to indicate the extent of reliance on overseas trained doctors (OTDs) in Australia as well as the extent of underutilisation of OTDs as practicing doctors. Comparisons with 1996 and 1991 census results (held by the CPUR) are underway.

Evaluation of evidence concerning the role of OTDs in the Australian medical workforce includes statistical analysis and field work (currently being conducted in Victoria under the auspices of the Rural Workforce Agency of Victoria). This is being supplemented by work on the surgical workforce conducted on behalf of the Royal Australasian College of Surgeons.

An analytical study built upon previous work on the changing role of OTDs (including that of Birrell and Hawthorne) in Australia is being prepared. This will review the political and administrative responses to the increasing use of OTDs in the context of the changing demand and supply situation for doctors in Australia .

Contact: Dr Robert Birrell
Centre of Population & Urban Research
School of Political and Social Inquiry
Faculty of Arts
Monash University
Building 11
Clayton Campus

Tel: +61 (0)3 9905 2967
Email: Bob.Birrell@arts.monash.edu.au

Dr Robert Birrell

Publications:

B. Birrell and L. Hawthorne, ‘Medicare plus and overseas-trained medical doctors', People and Place, vol 12 no. 2, 2004, pp. 84-100.

B. Birrell, ‘Australian policy on overseas trained doctors', Medial Journal of Australia, (in press) December 2004.

B. Birrell, ‘The regulation of medical practice in Australia , Canada , United States and Britain ', People and Place, vol. 12, no. 3, 2004, pp. 40-51.

Further information on the Monash Institute for the Study of Global Movements is available on their www site at:
http://www.globalmovements.monash.edu.au/