Barefoot and footloose doctors: optimal resource allocation in developing countries with medical migration

In light of the shortage of healthcare professionals, many developing countries operate a de facto two-tiered system of healthcare provision, in which Community Health Workers (CHWs) supplement service provision by fully qualified physicians. CHWs are relatively inexpensive to train but can treat only a limited range of medical conditions. This paper explicitly models a two-tiered structure of healthcare provision and characterizes the optimal allocation of resources between training doctors and CHWs, and implications for population health outcomes. We analyze how medical migration alters resource allocation and population health outcomes, shifting resources towards training CHWs. In the model, migration stimulates health care provision at the lower end of the illness severity spectrum, improving health outcomes for those patients; sufferers of relatively severe medical conditions who can only be treated by doctors are made worse off. It is further shown that donor countries must be reimbursed by at least the training cost of emigrating physicians in order to restore aggregate population health to the pre-migration level.

[1]  Jstor,et al.  Invention in the Industrial Research Laboratory , 1963, Journal of Political Economy.

[2]  Y. Kinfu,et al.  The health worker shortage in Africa: are enough physicians and nurses being trained? , 2009, Bulletin of the World Health Organization.

[3]  Koichi Hamada,et al.  The brain drain, international integration of markets for professionals and unemployment; a theoretical analysis , 1974 .

[4]  Kevin Holmes,et al.  People’s Republic of China , 2016, IMF Staff Country Reports.

[5]  P. Bundred,et al.  Medical migration: who are the real losers? , 2000, The Lancet.

[6]  Janet L. Yellen,et al.  Factor Mobility, Regional Development, and the Distribution of Income , 1977, Journal of Political Economy.

[7]  L. Winters,et al.  The brain drain: curse or boon? A survey of the literature , 2004 .

[8]  P. Goodfellow,et al.  Disease and development , 1992, Nature.

[9]  F. Gubert,et al.  Aid, Remittances, Medical Brain Drain and Child Mortality: Evidence Using Inter and Intra-Country Data , 2013 .

[10]  J. Vidal.  The effect of emigration on human capital formation , 1998, Journal of population economics.

[11]  Jordan J. Cohen,et al.  Medical schools in sub-Saharan Africa , 2011, The Lancet.

[12]  Taxation and Skilled Indian Migration to the United States: Revisiting the Bhagwati Tax , 2009 .

[13]  M. Dayrit.  Transformative scale-up of health professional education , 2012 .

[14]  A. Deaton.  What Does the Empirical Evidence Tell Us About the Injustice of Health Inequalities? , 2011 .

[15]  N. Ford,et al.  The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis , 2011, BMJ : British Medical Journal.

[16]  F. Docquier,et al.  Globalization, Brain Drain and Development , 2012, SSRN Electronic Journal.

[17]  T. Akhtar,et al.  Physician migration: views from professionals in Colombia, Nigeria, India, Pakistan and the Philippines. , 2005, Social science & medicine.

[18]  Strengthening the performance of community health workers in primary health care. Report of a WHO Study Group. , 1989, World Health Organization technical report series.

[19]  W. Adams,et al.  The brain drain. , 1969, Journal of the Irish Medical Association.

[20]  Kaspar Wyss,et al.  Global health initiative investments and health systems strengthening: a content analysis of global fund investments , 2013, Globalization and Health.

[21]  Carsten Krüger,et al.  Medical schools in sub-Saharan Africa , 2011, The Lancet.

[22]  Janet L. Yellen,et al.  Consequences of a tax on the brain drain for unemployment and income inequality in less developed countries , 1975 .

[23]  M. O'Neil,et al.  Evaluation of Malawi’s Emergency Human Resources Programme , 2010 .

[24]  Esther Duflo,et al.  HEALTH, HEALTH CARE, AND ECONOMIC DEVELOPMENT: Wealth, Health, and Health Services in Rural Rajasthan. , 2004, The American economic review.

[25]  A. Bhargava,et al.  Modeling the effects of physician emigration on human development. , 2011, Economics and human biology.

[26]  A. Bhargava,et al.  HIV Pandemic, Medical Brain Drain, and Economic Development in Sub-Saharan Africa , 2008 .

[27]  C. A. Rodríguez.  Brain drain and economic growth: A dynamic model , 1975 .

[28]  F. Docquier,et al.  Brain drain and economic growth: theory and evidence , 2001 .

[29]  L. Winters,et al.  Is the medical brain drain beneficial? Evidence from overseas doctors in the UK. , 2007, Social science & medicine.

[30]  Angus Deaton,et al.  The Great Escape: health, Wealth, and the Origins , 2013 .

[31]  A Mountford,et al.  Can a brain drain be good for growth in the source economy? , 1997, Journal of development economics.

[32]  Guilbert Jj.  The World Health Report 2006: working together for health. , 2006 .