RESEARCH PAPER ON IMPACT OF HEALTH WORKER MIGRATION ON HEALTH

RESEARCH RATIONALE

 

 

            The increase of health worker migration around the world is one of the issues that the international healthcare industry currently faces. This phenomena has had shares of appraisals and criticisms from economic critics around the world, however, there is still no consensus about its role the progress and development of healthcare service to the country being migrated into and the country where the migrant came from. Logically, it can be a disadvantage for the country where migrants came from because it decreases the skilled health workers in that country since the employers demand for the highest qualified skills; while can be an advantage to the country hiring the migrant nurses because it will fill their need for skilled workers and be able to function better than normally.

 

In the issue of health worker migration, the most affected healthcare professionals are nurses. Adkoli (2006) stated that about 11% of nurses practicing in the

United States

are foreign-born, out of which 80% are fromdeveloping countries. Similarly, in 2000, the

United Kingdom

hired more than 8000 nurses and midwives from outside the European Union. The reason for this increase in migrant nurses is because of the different external pulls and internal pushes taking place. As an external pull, there is a great shortage of nurses in Western countries because many are either unqualified or lack the experience needed. Friss (1994) stated that periods of shortage and excess in the supply of registered nurses (RNs) have frequently occurred in the

United States

and are of concern to many groups, including health care consumers, payers, employers, and policymakers. Others argue that shortages are related to a lack of or lagged increase in real wages (Friss 1994), or the delay between the point when potential workers observe an increase in wages and the time it takes them to receive the training necessary to enter the labor market (Yett 1975). Internal push, on the other hand, is from the fact that due to increasing global poverty, more and more nurses are pushing their luck abroad in hope that they can earn more than they can earn in their home country.

 

This relationship is complicated because it may have implications on the development of quality health service of both countries. The quality of health services and skills of staff may improve of developed countries outsourcing nurses from developing countries, but the opposite may happen to the latter as they will lose a considerable amount of skilled health workers. Thus, the aim of this study is to explore how health worker migration affects the quality of health service and skills of staff in both the developed country and the developing country. Specifically it will explore the quality of services of hospitals, one each from

UK

and the

Philippines

. The UK is a country that outsource a large number of nurses from developing countries; while Philippines is a country that promotes overseas works for their countrymen, and is one of the developing countries that has a high distribution of nurses and caregivers around the world.

 

The following research questions will be explored in this study:

 

1.      Which country provides better quality healthcare service and mostly has skilled nursing staff?

2.      How do outsourced nurses contribute to the quality of the

UK

hospital?

3.      How does the increasing nurse migration of Filipinos affect the quality of service in the chosen hospital in the

Philippines

?

4.      Does the Philippine hospital experience staff shortage?

5.      What are the advantages and disadvantages of the increasing nurse migration for both countries?

 

 

BACKGROUND OF THE STUDY

 

 

            Because of the growth of information technology and the increase use of the Internet, business processes has become global. It is widely asserted that we live in an era in which the greater part of social life is determined by global processes, in which national cultures, national economies and national borders are dissolving (Hirst and Thompson, 1996). Products, services and culture of individual countries can now be promoted globally with ease, thanks to technological advancements. Also, companies and agencies have expanded geographically all over the globe. There has been an increasing integration of the national economies of both advanced and developing countries. Material and human resources, knowledge and cultures are being shared with less and less problems because of the information superhighway, which basically increased the business competition. Indeed, the world market is becoming more and more compressed because of globalization.

           

One of the human functions being affected by globalisation is migration. Migration refers to the process of moving, either across an international border, or within a State. It encompasses any kind of movement of people, whatever its length, composition and causes; it includes migration of refugees, displaced persons, uprooted people, and economic migrants (International Organization for Migration, 2004). Because of globalisation, most people migrate in order to find better jobs (Afsar, 2003). Because of globalisation, and also of the increasing number of industries, careers and available jobs, more and more people are becoming far less dependent on agriculture and other related rural work (Afsar, 2003). These migrants, which means a person moving to another country or region to better their material or social conditions and improve the prospect for themselves or their family, seek better lives and opportunities in urban areas and developed countries (International Organization for Migration, 2004). One of the reasons for this attitude is the growing global concern for poverty. The number of people living in poverty is alarming, for instance in 1998, statistics show that 1.2 billion people still lived on less than a dollar a day, and 2.8 billion on less than two (The PANOS Institute, 2002). The poverty situation in developed countries is almost as worse as that of the underdeveloped countries. In the United States alone, the number of Americans living in poverty increased by 1.1 million to 37 million in 2004, up from 35.9 million in 2003 (Reed, 2005). In

Australia

the rates were significantly lower, but nonetheless still high. There is a consensus that the numbers of Australians living in poverty generally ranges from 2 to 3.5 million (

Mission

Australia

, 2004).

 

Specifically, one of the industries that are experiencing a global migration phenomenon is the healthcare industry. According to Bueno de Masquita and Gordon (2005), migration of health workers is rapidly increasing due to the fact that their skills are transferable and needed in every country. Over the years, there has been a gradual increase of demand for skilled health workers in developed countries (Martineau, Decker and Bundred, 2002). The rationale is that human resources are critical to the provision of health services, and the human resource crisis in certain parts of the developing world creates a corresponding crisis in the health system, with implications for the health of individuals served by that system. Since developed countries have higher standards of services and skills, they also have the highest need for healthcare professionals. Basically, there is a need for developed countries to outsource skilled nurses from other countries, and the need for developing countries to provide healthcare workforce to developed countries for economic reasons.

 

The reasons why health workers migrate are categorized into two factors: the “internal push” and the “external pull” (Adkoli, 2006). The external ‘pull’ is a result of globalization, free market economy and international flow of doctors from relatively deprived nations to greener pastures (Adkoli, 2006). There has been an acute shortage of nursing staff owing to ageing population, shortage of nursing schools, and competing professions becoming more lucrative in terms of salaries, perks and status (Adkoli, 2006). On the other hand, the internal push comes from surplus production of health personnel, resultant unemployment, less attractive salary, stagnation or underemployment coupled with lack of infrastructure (Adkoli, 2006). This is usually the situation in developing countries, and as a result, potential migrants try their luck on other countries in the hope that their skills will not be wasted, and at the same time, earn money for their family.

 

It has been a “give and take” relationship for developed and developing countries and there are few studies that already explored the advantages that migration gave to both. Currently, migration is said to have been doubled since 1965 and is predicted to increase more over the next few years (Stillwell et al, 2004). Statistics also show that in 2000, almost 175 million people, or 2.9% of the world’s population, were living outside their country of birth for longer than one year, and about 65 million are economically active. A renowned study about migration of health workers, on the other hand, revealed that 6% of physicians and 5% of nurses were living outside their country of birth (Meija et al, 1979). Currently, it is difficult to determine the number of physicians and nurses who migrated, but probably, this has increased due to the changing economic conditions and the increasing demands for healthcare professionals (Stillwell et al, 2004).

 

However, there is still a need for confirmation of results as there is a lack of investigative focus on certain areas such as its impact on health for both. Little research shows that migration may be a disadvantage to poor countries, while it is an advantage to developed countries (Martineau, Drecker and Bundred, 2002).

This study will be specifically focus on that issue and will descriptively try to explore the several perceived health benefits of migration for both the provider (developing country) and the receiver (developed country). The aim of the study is to be able to determine the role of health worker migration in the improvement of health services, its provision and development of better standards. It will explore advantages and disadvantages, and will try to develop a framework that will highlight the impact of health worker migration on healthcare in developed and developing countries.

 

AIM OF THE STUDY

 

The aim of the study is to investigate the impact of health worker migration to the health of the country being migrated, and the health of the country where the migrant came from. In this aim, two hospitals from different countries will be assessed in terms of quality of service and skills of health worker staff. The hospitals should be from countries with migration relationships. In this case, the study will investigate the quality of services and skills of staff in a specific

UK

hospital that has employed a considerable number of migrant health workers. Then, this will be compared with the service quality and skills of staff of hospitals from the

Philippines

(one of the developing countries that have a high rate of migrant nurses around the world). The comparison of the service quality and skills of staff of these two hospitals will be helpful in determining the impact of health worker migration on both sides.

 

OBJECTIVES OF THE STUDY

 

 

          The study will address the following objectives:

 

1.      To determine the impact of health worker migration by comparing the quality of services and staff skills of nurses of specific

UK

hospitals and Philippine hospitals.

2.      To determine the advantages and disadvantages of nurse migration in

UK

hospitals.

3.      To determine the advantages and disadvantages of migration trends in Philippine hospitals.

4.      To contribute to healthcare academic research and to create a framework that explains the impact of health worker migration for both the provider and recipient country.

 

HYPOTHESIS OF THE STUDY

 

            The study will test the following hypotheses:

Ø      Because most nurses from the

Philippines

migrate outside the country to look for better opportunities, it currently suffers a shortage of skilled nurses which makes services and skills stagnant.

Ø      The migration of nurses in the

UK

improves the quality of healthcare services and skills of staffs in the country.

LITERATURE REVIEW

 

            A literature review will be provided in the actual study, which will be put in the second chapter. Literatures will be about studies on migration and health worker migration specifically.

 

            Literatures will be acquired from online journal databases such as Blackwell Synergy, Emerald and Questia. Literatures will be reviewed to increase the knowledge about the topic and to help in the analysis of data.

 

            Initially, several related literatures have already been researched for this study. One of them is the research by Stilwell et al (2003) entitled: “Migration of health-care workers from developing countries: strategic approaches to its management”. Another is Adkoli’s (2006) study entitled: “Migration of Health Workers: Perspectives from

Bangladesh

,

India

,

Nepal

,

Pakistan

and

Sri Lanka

”. Those literatures were found useful because they give additional knowledge about health worker migration, specifically about the reasons for migration, the effects, pros and cons, etc.

 

METHODOLOGY

 

The study will be deductive as its aim is to test hypotheses. It is also positivistic and descriptive. The descriptive research design was chosen for the study because it intends to present facts concerning the nature and status of a situation, as it exists at the time of the study (Creswell, 1994). It is also concerned with relationships and practices that exist, beliefs and processes that are ongoing, effects that are being felt, or trends that are developing. (Best, 1970) In addition, such approach tries to describe present conditions, events or systems based on the impressions or reactions of the respondents of the research (Creswell, 1994).

 

Data Collection

 

 

            Primary data will be collated from the nursing staffs of a specific hospital in

UK

and the

Philippines

. The total number of nurses in the both hospitals will be acquired and 100% of them will be surveyed. The criterion for the

UK

hospital is that 30 to 50% of their nurses should be migrants.

 

            A semi-structured survey questionnaire will be constructed and will be sent to the respondents through email. Ranking style questions will be used to measure the degree of agreement of the respondents. A 5-point Likert Scale will be used.

 

Data Analysis

 

 

            Data will be analyzed with the latest SPSS software. The weighted mean and percentage of data will be acquired.

 

            Results from the two sets of respondents will be compared using Analysis of Variance statistical technique.