Australia's Place in the Global Health Care Chain

1
Australia's Place in the Global Health Care Chain

• John Connell
• University of Sydney
• Macquarie University, April 2007

2
An Age of Migration?

• but 2.9 live across borders
• Migration potential .. or desire to stay
• Europe, Polish plumbers and general
  elections ..
• The Selectivity of Migration
• IT, education, sportsmen, aviation etc

3
The Migration of Health Workers

• The Market in the North
• aging populations, greater expectations,
• recruitment, attrition
• And in the South
• the same
• plus wages, working conditions,
• political instability, HIV/AIDS,
• external restructuring
• and .. recruitment

4
The Skill Drain

• The Inverse Care Law
• From doctors to nurses
• Towards a global crisis
• poaching and the new slave trade

5
Two Global Phases

• 1960s/1970s India, Iran, Ireland ..
• Doctors
• Global Stagnation (except Gulf)
• 2000s global sourcing.
• Nurses
• Changes
• 1. Dominance of Women social costs
• 2. Active recruitment ..body shoppers
• 3. Complexity of Chains (eg Cuba-Pacific-
  Australia-UK)
• 4. Globality Japan, China, commuter migration
  

6
Issues

• Brain/Skill drain
• overflow?
• training costs
• permanence vs.remittances
• Unmet needs (inequity and urban bias)
• Loss of morale
• Cost/Quality of replacements

7
Australia

• A history of migrant medics
• 1960s - incipient brain drain
• 1970s - brain drain India,Malaysia
• servicing inequality
• 1980s - quiescence, oversupply
• 1990s - new immigration

8
Growing Demand

• Aging population
• Increased NCDs, especially dementia
• Increased expectations, expenditure
• New geographies Queensland,
• also WA, Victoria

9
Workforce

• 450,000 professionals (50 nurses)
• Shortages GPs
• some specialisms, dentistry, nursing..
• rural regional, indigenous
• Overseas doctors 25 (19 1996)
• UK, India, Malaysia, Sri Lanka
• temporary , areas of need
• Overseas nurses (only 2000)

10
Why Shortages?

• Training numbers
• Attrition (especially rural?

11
Ending Shortage

• Preventive health care
• Increased recruitment, training capacity
• Better retention, re-entry
• More migration

12
Rural and Remote

• Major shortages
• limited support services
• social life (family)
• limited continuing professional
  development
• Directed migration
• Onward urban migration

13
Brains in Drains

• No pretence of self-reliance
• Overseas trained save time and money
• Inequity (only 2000 nurses)
• Issues of cultural competence and accreditation
• Racism, discrimination
• Brain waste, deskilling ..

14
Ending the Brain Drain

• A thirty-five year package workforce
  conditions
• Public sector solutions against the tide of
  history
• Uneven development
• Meeting the market (or selling out)

15
And in Australia/ the North?

• Ethics and Codes .. and Compensation
• Managed Migration - a mantra in search of a
  practice
• State regulation or freedom of movement