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HEALTH PROFESSIONAL MOBILITY and HEALTH SYSTEMS 23 EVIDENCE from 17 EUROPEAN COUNTRIES Edited by Matthias Wismar, Claudia B

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HEALTH PROFESSIONAL MOBILITY and HEALTH SYSTEMS 23 EVIDENCE from 17 EUROPEAN COUNTRIES Edited by Matthias Wismar, Claudia B Cover_WHO_nr23_Mise en page 1 6/10/11 17:59 Page1 23 HEALTH PROFESSIONAL MOBILITY AND HEALTH SYSTEMS PROFESSIONAL MOBILITY AND HEALTH HEALTH Health professional mobility affects the performance of health systems and these EVIDENCE FROM 17 EUROPEAN COUNTRIES impacts are assuming greater significance given increasing mobility in Europe, a Health Professional 23 process fuelled by the European Union (EU) enlargements in 2004 and 2007. This volume presents research conducted within the framework of the European Commission’s Health PROMeTHEUS project. This research was undertaken in order to address gaps in the knowledge of the numbers, trends and impacts and of the policy Mobility and Health responses to this dynamic situation. Observatory Observatory The following questions were used to provide analytical guidance for the 17 country Studies Series case studies reported here: from Austria, Belgium, Estonia, Finland, France, Germany, Systems Hungary, Italy, Lithuania, Poland, Romania, Serbia, Slovakia, Slovenia, Spain, Turkey and the United Kingdom. • What are the scale and characteristics of health professional mobility in the EU? Evidence from • What have been the effects of EU enlargement? 17 European countries • What are the motivations of the mobile workforce? • What are the resulting impacts on health system performance? Edited by Matthias Wismar • What is the policy relevance of those impacts? Claudia B. Maier • What are the policy options to address health professional mobility issues? Irene A. Glinos Gilles Dussault Josep Figueras The editors Matthias Wismar is Senior Health Policy Analyst at the European Observatory on Health Systems and Policies. Irene A. Glinos, Gilles Dussault, Josep Figueras Josep Gilles Dussault, Glinos, Irene A. Maier, Claudia B. Matthias Wismar, by Edited Claudia B. Maier is a Technical Officer at the European Observatory on Health Systems and Policies. Irene A. Glinos is a Researcher at the European Observatory on Health Systems and Policies. Gilles Dussault is a Professor at the Instituto de Higiene e Medicina Tropical, Universidade Nova De Lisboa. Josep Figueras is Director of the European Observatory on Health Systems and Policies and Head of the WHO European Centre for Health Policy. Observatory Studies Series No. 23 Health Professional Mobility and Health Systems 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 Belgium, Finland, Ireland, the Netherlands, Norway, Slovenia, Spain, Sweden 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 and Health Systems Evidence from 17 European countries Edited by Matthias Wismar, Claudia B. Maier, Irene A. Glinos, Gilles Dussault, Josep Figueras Keywords: DELIVERY OF HEALTH CARE – organization and administration HEALTH PERSONNEL – trends EMIGRATION AND IMMIGRATION EUROPE © World Health Organization 2011, on behalf 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, Scherfigsvej 8, 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. ISBN 978 92 890 0247 9 Printed in the United Kingdom Cover design by M2M Contents Foreword by Paola Testori Coggi, Director-General, Directorate-General for Health and Consumers ix Foreword by Zsuzsanna Jakab, Regional Director, WHO Regional Office for Europe xi Acknowledgements xiii List of tables, figures and boxes xv List of abbreviations xxvii List of contributors xxix Part I Setting the scene, results and conclusions 1 Chapter 1 Health professional mobility and health systems in Europe: 3 an introduction Matthias Wismar, Claudia B Maier, Irene A Glinos, Jeni Bremner, Gilles Dussault, Josep Figueras Chapter 2 Cross-country analysis of health professional mobility in Europe: 23 the results Claudia B Maier, Irene A Glinos, Matthias Wismar, Jeni Bremner, Gilles Dussault, Josep Figueras Chapter 3 Health professional mobility and health systems in Europe: 67 conclusions from the case-studies Irene A Glinos, Matthias Wismar, Claudia B Maier, Willy Palm, Josep Figueras Part II Case studies from countries that joined the EU before 2004 87 Chapter 4 Mobility, language and neighbours: Austria as source and 89 destination country Guido Offermanns, Eva Maria Malle, Mirela Jusic Chapter 5 Of permeable borders: Belgium as both source and host country 129 Anna Safuta, Rita Baeten Chapter 6 Changing context and priorities in recruitment and employment: 163 Finland balances inflows and outflows of health professionals Hannamaria Kuusio, Meri Koivusalo, Marko Elovainio, Tarja Heponiemi, Anna-Mari Aalto, Ilmo Keskimäki vi Health Professional Mobility and Health Systems Chapter 7 Nationally moderate, locally significant: France and health 181 professional mobility from far and near Marie-Laure Delamaire, François-Xavier Schweyer Chapter 8 A destination and a source: Germany manages regional health 211 workforce disparities with foreign medical doctors Diana Ognyanova, Reinhard Busse Chapter 9 Oversupplying doctors but seeking carers: Italy’s demographic 243 challenges and health professional mobility Luigi Bertinato, Irene A Glinos, Elisa Boscolo, Leopoldo Ciato Chapter 10 Opportunities in an expanding health service: Spain between 263 Latin America and Europe Beatriz González López-Valcárcel, Patricia Barber Pérez, Carmen Delia Dávila Quintana Chapter 11 A major destination country: the United Kingdom and its 295 changing recruitment policies Ruth Young Part III Case studies from countries that joined the EU in 337 2004 or 2007 Chapter 12 Migration and attrition: Estonia’s health sector and cross-border 339 mobility to its northern neighbour Pille Saar, Jarno Habicht Chapter 13 From melting pot to laboratory of change in central Europe: 365 Hungary and health workforce migration Edit Eke, Edmond Girasek, Miklós Szócska Chapter 14 Awareness, planning and retention: Lithuania’s approach to 395 managing health professional mobility Žilvinas Padaiga, Martynas Pukas, Liudvika Starkienė Chapter 15 When the grass gets greener at home: Poland’s changing 419 incentives for health professional mobility Marcin Kautsch, Katarzyna Czabanowska Chapter 16 Emergent challenge of health professional emigration: 449 Romania’s accession to the EU Adriana Galan, Victor Olsavszky, Cristian Vladescu Chapter 17 Regaining self-sufficiency: Slovakia and the challenges of health 479 professionals leaving the country Kvetoslava Beňušová, Miloslava Kováčová, Marián Nagy, Matthias Wismar Contents vii Chapter 18 Addressing shortages: Slovenia’s reliance on foreign health 511 professionals, current developments and policy responses Tit Albreht Part IV Case studies from third countries having applied for 539 EU membership Chapter 19 Geopolitics, economic downturn and oversupply of medical 541 doctors: Serbia’s emigrating health professionals Ivan M. Jekić, Annette Katrava, Maja Vučković-Krčmar, Vesna Bjegović-Mikanović Chapter 20 At the crossroads:Turkey’s domestic workforce and restrictive 569 labour laws in the light of EU candidacy Hasan
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