Migration of Healthcare Worker, Elder Care and Globalization
Introduction
There is a global concern over growing shortages of healthcare workers, particularly nurses in most developed countries – predominantly female workforce (Yinger, 2011; Meardi, Riera & Martin, 2016). These shortages are likely projected to increase shortly all over the world due to ageing population and advancement in the biomedical field. Also, the life expectancy of the world population has significantly increased. Currently, the world is also expecting the older population to increase faster than the working population. For example, by 2050, the number of individuals aged sixty years and above is expected to increase from 10% to 20%, which is about 2 billion (Fagen, 2009; WHO, 2012). A society with such a high number of older adults requires more healthcare workers for some reasons. For one, change of lifestyle has placed older people to retirement homes (Connell, 2010; Connell, 2012). In these homes, the aged experience a significant increase in disease burden that requires more healthcare workers to provide the care. With the functional decline, even those who are not taken to retirement homes also experience these problems and require such care or assistance. It is problematic to the countries in which the number of care providers does not equally increase together with their increasing ageing population. Globalization, which is defined as the integration of countries and people of the world by breaking down of barriers to the flow of goods, services, knowledge and people across borders (Stiglitz, 2002), helps to ease the process of healthcare worker migration from one country to another. However, the massive migrations of healthcare workers, known as brain drain phenomenon, can have a positive or negative impact on the care provision in the sending and receiving countries. The concept of global care chain effect drives the flow of international migration of healthcare workers. It brings many socio-economic and political issues to the countries involving in the migration process. This paper aims to evaluate the issues of healthcare worker migration associated with globalization and ageing by systematically reviewing the relevant academic literature.
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The Trends of Healthcare Workers Immigration
Franklin and Brancati (2015) evaluated the trends in the care workforce and the role of the immigrant healthcare workers within the United Kingdom. These scholars confirm the purported increase in the number of immigrant healthcare workers throughout the globe. In the UK, they account for 18.4% of the entire healthcare workforce. These workers are majorly from developing countries such as Nigeria, India, and Philippines whiles some are from more developed countries like Poland.
According to Franklin and Branciati (2015), the healthcare system in most developed countries has been exhibiting several challenges that have made it difficult for them to meet the increasing demand of care by the ageing population. For example, the system has been underfunded. Hence it has been difficult to recruit and retain staff. Also, the majority of the domestic workforce have been joining the profession late in life, with at least one in every the worker aged sixty years and above. Others also fail to join because of the unattractive stressful work conditions, low pay and long working hours. The younger and better skilled immigrant workers thus help fill the gap left by the domestic workers. In 1979, WHO published a study on the flow of healthcare workers and reported about 90% of all migrating physicians went to just five developed countries: Australia, Canada, Germany, the United Kingdom and the United States (Ahmad, 2004).
Spencer and his colleagues (2010) affirms the claim by Franklin and Brancati (2015) that the healthcare system is underfunded, even in the most advanced nations. Through their analysis of reports on Ireland, UK, US and Canada, they further acknowledge that care providers are underpaid in these countries. These authors, therefore, speculate that the demand for immigrant care workers is likely to increase in the developed nations that are expecting the ageing population to grow. The demand will be influenced by the fact that immigrants workers are more likely to accept the low wages paid to them, especially in home-based settings. Also, the reports by Spencer et al. (2010), suggests that the users of these services prefer immigrant workers because they are considered more “hardworking and compassion”, reliable and responsible. In essence, they are better skilled to provide care for the elderly like Franklin, and Branati (2015) asserted.
The Global Care Chain
Wright and Mullally (2016) argued that international migration of healthcare workers be a response to multiple socio-economic and political factors. Yeates (2005) described “global care chain” concept which was first invented by Arlie Hochschild in 2000. The term used to describe the phenomenon of international migration of domestic workers. Subsequently, it was extended to international migration of healthcare workers. The global care supply forms a hierarchy of chains. The developed countries at the top of the chain draw workers from the developing countries at lower ranks. (Yeates, 2005). For example, the United States draws workers from Canada; Canada draws from England to replenish the loss; England draws from South Africa, and then South Africa draws from Swaziland. The countries at the bottom chain such as Swaziland supply the international market but are not able to import workers from other countries. (Yeates, 2005). It creates a vicious cycle in the healthcare delivery system of the developing countries, which leads to long-lasting shortage of healthcare workers in the countries at the bottom chain and global inequalities and the crisis in skilled healthcare workers (Connell, 2011). Wright and Mullally (2016) described the emigrant healthcare workers who have achieved the professional success, are also experiencing financial difficulties, professional conflict, culture isolation and racial discrimination.
The Brain-drain Issues
Brain drain phenomenon is defined as the migration of healthcare workers driven by a better standard of living and quality of life, higher income, better access to advanced technology and better security in political conditions worldwide (Dodani & Laporte, 2005). Brain drain can be within countries as internal brain-drain. However, it often refers to the international migration of skilled healthcare workers from the developing countries to the developed ones in most cases (Misau, Al-Sadat & Gerei, 2010).
In the 1940s, many European healthcare workers historically emigrated to the United Kingdom and the United States. Because of losses incurred to the sending countries, international migration of highly skilled healthcare workers was caught attention as a major public health issue (Chen et al., 2006). The mass migration of healthcare workers brain drain has a significant adverse effect on the developing countries (Hidalgo, 2013). The severity of brain drain effect depends on the extent of a country’s development.
Misau et al. (2010) argued that developed countries have a very high ratio of healthcare workers to population, and in contrast, the developing countries may only have just a few. For instance, Sub-Saharan Africa faces great challenges with 25% of global disease burden, yet only 3% of the health workforce. In 2006, the doctor-population ratio was estimated 25.6 per 10000 population in the US, but it was only 0.5 doctors per 10000 in a small country in southern Africa (Misau et al., 2010). The healthcare system in the other developing countries faces similar challenges. Shortage of healthcare workers is the major issue. Their structure of the system is too fragile to provide adequate services to the whole population including the eldercare. The brain drain would complicate the situation and make the system deteriorate further. The healthcare workers remained in the sending countries are unable to provide even basic care and treatment to meet the demands of the ageing population. (Misau et al., 2010; Hidalgo, 2013).
Connell (2011) argues that the negative impact of brain drain skilled healthcare workers can be compensated by remittances and returners. Taking Filipino as an example, the government actively encourages immigration of trained healthcare workers. People specifically choose professions that allow them to emigrate easily. Sending remittances is the main motivator for the most healthcare emigrants. The goal of sending remittances is not only to support the growing family, children education and improve the standard of living, but also as a stepping stone to move to another country. (Nititham, 2011).
The Pull and Push Factors
Buchan (2006) and Kline (2003) have listed some of the pull and push factors attributing to the global migration of healthcare workers. A global shortage of healthcare professionals was estimated as high as 4 million (Chen et al., 2004). Developed countries are ageing rapidly. First, the inadequate internal supply of healthcare workers to meet the increasing needs of the ageing population, serves as a major pull-factor influencing the migration of healthcare workers from developing countries. Second, poor working condition and low quality of life in many developing countries serves as a push-factor to encourage workers to move out from their home countries. Wage gap between the developed and developing countries is another important push-factor in global migration of healthcare workers. In addition to wage, career development in the developed countries also motivates workers to migrate from their home countries (Bach, 2006). The academic discussion on the pull and push factors tends to only focus on an individual level (Kingma, 2003; Kine, 2003; Hooper, 2008). However, Kaelin (2011) analyzed that the mass migration of healthcare workers would never happen without the economic and political instabilities in the sending countries and attractive benefits in the receiving countries.
Healthcare emigrates from developing countries are aged between 15 to 45 years (Misau et al., 2010). They have higher levels of education and earn higher income compared with the same age group in the home country. Healthcare industry generates great revenues in the developed countries such as Europe, Japan and the United States (Misau et al., 2010). It attracts healthcare workers from the developing countries to pursue a better life and career advancement. However, it causes detriment the developing countries who invested in training those healthcare workers. Kirigia et al. (2006) calculated that the real cost of producing a doctor in Kenya is not only the total education cost incurred but also the cumulative dollar value of the investment made by the society. They eventually lose their investment if the healthcare workers choose to emigrate after their training (Hidalgo, 2013).
The Ethical Consideration
Mills et al. (2008) claimed that active recruitment of healthcare workers from developing countries such as African countries could be considered as an international crime because it is largely affecting the quality of care delivery in the developing countries. They also recognize that globalization allows the freedom of healthcare workers to choose where they want to live and work (Dwyer, 2007). To prevent them migrate to developed countr
