Cover_WHO_Health Professional Mobility_DRAFT_Mise en page 1 22/04/14 19:47 Page 1 32 HEALTH PROFESSIONAL MOBILITY HEALTH IN A CHANGING EUROPE Health professional mobility in Europe has become a fast moving target for policy AND DIVERSE RESPONSES MOBILE INDIVIDUALS NEW DYNAMICS, makers. It is evolving rapidly in direction and magnitude as a consequence of funda- Health Professional 32 mental change caused by EU enlargement and the financial and economic crisis. Health professional mobility changes the numbers of health professionals in countries and the skill-mix of the workforce, with consequences for health system performance. Mobility in Countries must factor-in mobility if they are forecasting and planning their workforce requirements. To this end they need clarity on mobility trends and the mobile Observatory workforce, and effective interventions for retaining domestic and integrating foreign- Studies Series trained health workers. Health professional mobility remains an unfinished agenda in a Changing Europe Europe, at a time when the repercussions of the financial crisis continue to impact on the European health workforce and its patterns of mobility. This book sheds new light on health professional mobility in this changing Europe. New dynamics, mobile individuals It is the second volume of the PROMeTHEUS project, following the previously published country case study volume. The 14 thematic chapters in this book are grouped in and diverse responses three parts: • The changing dynamics of health professional mobility Edited by James Buchan • The mobile individual Matthias Wismar • Policy responses in a changing Europe Irene A. Glinos Jeni Bremner The book goes well beyond situation analysis as it presents practical tools such as a yardstick for registry methodology, a typology of mobile individuals, qualitative tools for studying the motivation of the workforce and a set of concrete policy responses at EU-, national and organizational level including bi-lateral agreements, codes and workplace responses. The editors James Buchan, Professor, School of Health, Queen Margaret University, Scotland. Irene A. Glinos, Jeni Bremner Glinos, Irene A. Matthias Wismar, James Buchan, by Edited Matthias Wismar, Senior Health Policy Analyst, European Observatory on Health Systems and Policies, Belgium. Irene A. Glinos, Senior Researcher, European Observatory on Health Systems and Policies, Belgium. Jeni Bremner, Director, European Health Management Association, Belgium. Observatory Studies Series No. 32 8 5 2 0 5 0 9 8 2 9 ISBN 9289050258 8 7 9 Health professional mobility in a changing Europe The European Observatory on Health Systems and Policies supports and promotes evidence- based health policy-making through comprehensive and rigorous analysis of health systems in Europe. It brings together a wide range of policy-makers, academics and practitioners to analyse trends in health reform, drawing on experience from across Europe to illuminate policy issues. The European Observatory on Health Systems and Policies is a partnership between the World Health Organization Regional Office for Europe, the Governments of Austria, Belgium, Finland, Ireland, the Netherlands, Norway, Slovenia, Spain, Sweden and the United Kingdom; and the Veneto Region of Italy, the European Commission, the European Investment Bank, the World Bank, UNCAM (French National Union of Health Insurance Funds), the London School of Economics and Political Science, and the London School of Hygiene & Tropical Medicine. Health professional mobility in a changing Europe New dynamics, mobile individuals and diverse responses Edited by James Buchan, Matthias Wismar, Irene A. Glinos, Jeni Bremner European on Health Systems and Policies a partnership hosted by WHO Keywords: CAREER MOBILITY HEALTH PERSONNEL HEALTH POLICY HEALTHCARE PROVIDERS PERSONNEL MANAGEMENT PUBLIC HEALTH © World Health Organization 2014 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies) All rights reserved. The European Observatory on Health Systems and Policies welcomes requests for permission to reproduce or translate its publications, in part or in full. Address requests about publications to: Publications, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark. Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the European Observatory on Health Systems and Policies concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the European Observatory on Health Systems and Policies in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the European Observatory on Health Systems and Policies to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the European Observatory on Health Systems and Policies be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the European Observatory on Health Systems and Policies or any of its partners. This volume is part of the PROMeTHEUS research projecy which received funding from the European Community’s Seventh Framework Programme (FP7/2007–2013) under grant agreement 223383. ISBN 978 92 890 5025 8 Printed in the United Kingdom Cover design by Dimitri Culot Contents Acknowledgements vii List of tables, figures and boxes xi List of abbreviations xv List of contributors xvii Part I Setting the scene, key findings and lessons 1 Chapter 1 Introduction to health professional mobility in a changing Europe 3 James Buchan, Irene A. Glinos and Matthias Wismar Chapter 2 Health professional mobility in a changing Europe: lessons and 17 findings Irene A. Glinos, James Buchan and Matthias Wismar Part II The changing dynamics of health professional mobility 33 Chapter 3 The economic crisis in the EU: impact on health workforce mobility 35 Gilles Dussault and James Buchan Chapter 4 Mobility of health professionals before and after the 2004 and 65 2007 EU enlargements: evidence from the EU PROMeTHEUS project Diana Ognyanova, Claudia B. Maier, Matthias Wismar, Edmond Girasek and Reinhard Busse Chapter 5 Monitoring health professional mobility in Europe 95 Claudia B. Maier, James Buchan, Matthias Wismar, Diana Ognyanova, Edmond Girasek, Eszter Kovacs and Reinhard Busse Chapter 6 Health professionals crossing the EU’s internal and external 129 borders: a typology of health professional mobility and migration Irene A. Glinos and James Buchan Part III The mobile individual 153 Chapter 7 Health professional migration in Lithuania: why they leave and 155 what makes them stay Žilvinas Padaiga, Martynas Pukas and Liudvika Starkienė vi Health professional mobility in a changing Europe Chapter 8 Motivations and experience of health professionals who migrate 177 to the United Kingdom from other EU countries Ruth Young, Charlotte Humphrey and Anne Marie Rafferty Chapter 9 Why do health professionals leave Germany and what attracts 203 foreigners? A qualitative study Diana Ognyanova, Ruth Young, Claudia B. Maier and Reinhard Busse Chapter 10 “I am kind of in stalemate”. The experiences of non-EU migrant 233 doctors in Ireland Niamh Humphries, Posy Bidwell, Ella Tyrrell, Ruairi Brugha, Steve Thomas and Charles Normand Chapter 11 A multi-country perspective on nurses’ tasks below their skill 251 level: reports from domestically trained nurses and foreign-trained nurses from developing countries Luk Bruyneel, Baoyue Li, Linda Aiken, Emmanuel Lesaffre, Koen Van den Heede and Walter Sermeus Part IV Policy responses in a changing Europe 267 Chapter 12 The unfinished workforce agenda: Europe as a test-bed for 269 policy effectiveness Diana Ognyanova, Evgeniya Plotnikova and Reinhard Busse Chapter 13 Policy responses facilitating mobility or mitigating its negative 301 effects: national, EU and international instruments Sherry Merkur Chapter 14 The role of bilateral agreements in the regulation of health worker 325 migration Evgeniya Plotnikova Chapter 15 Creating good workplaces: retention strategies in health-care 345 organizations Elisabeth Jelfs, Moritz Knapp, Paul Giepmans and Peter Wijga Chapter 16 Lessons from retention strategies outside Europe 367 Carmen Mihaela Dolea Acknowledgements This book, the second volume of the PROMeTHEUS project, could not have been written without the ground-laying work delivered by our colleagues from all over Europe contributing to the first volume as country informants, country correspondents and authors. As authors and editors of the second volume we are deeply indebted