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The impact of physician migration on mortality in low and middle-income countries : An economic modelling study

Saluja, Saurabh LU ; Rudolfson, Niclas LU ; Massenburg, Benjamin Ballard ; Meara, John G. and Shrime, Mark G. LU (2020) In BMJ Global Health 5(1).
Abstract

Background The WHO estimates a global shortage of 2.8 million physicians, with severe deficiencies especially in low and middle-income countries (LMIC). The unequitable distribution of physicians worldwide is further exacerbated by the migration of physicians from LMICs to high-income countries (HIC). This large-scale migration has numerous economic consequences which include increased mortality associated with inadequate physician supply in LMICs. Methods We estimate the economic cost for LMICs due to excess mortality associated with physician migration. To do so, we use the concept of a value of statistical life and marginal mortality benefit provided by physicians. Uncertainty of our estimates is evaluated with Monte Carlo analysis.... (More)

Background The WHO estimates a global shortage of 2.8 million physicians, with severe deficiencies especially in low and middle-income countries (LMIC). The unequitable distribution of physicians worldwide is further exacerbated by the migration of physicians from LMICs to high-income countries (HIC). This large-scale migration has numerous economic consequences which include increased mortality associated with inadequate physician supply in LMICs. Methods We estimate the economic cost for LMICs due to excess mortality associated with physician migration. To do so, we use the concept of a value of statistical life and marginal mortality benefit provided by physicians. Uncertainty of our estimates is evaluated with Monte Carlo analysis. Results We estimate that LMICs lose US$15.86 billion (95% CI $3.4 to $38.2) annually due to physician migration to HICs. The greatest total costs are incurred by India, Nigeria, Pakistan and South Africa. When these costs are considered as a per cent of gross national income, the cost is greatest in the WHO African region and in low-income countries. Conclusion The movement of physicians from lower to higher income settings has substantial economic consequences. These are not simply the result of the movement of human capital, but also due to excess mortality associated with loss of physicians. Valuing these costs can inform international and domestic policy discussions that are meant to address this issue.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
epidemiology, health economics, health policies and all other topics, medical demography
in
BMJ Global Health
volume
5
issue
1
article number
e001535
publisher
BMJ Publishing Group
external identifiers
  • pmid:32133161
  • scopus:85078325275
ISSN
2059-7908
DOI
10.1136/bmjgh-2019-001535
language
English
LU publication?
yes
id
6d7c8305-54de-4b17-89ac-90ff41c9c80e
date added to LUP
2020-02-07 14:49:52
date last changed
2024-07-24 13:06:36
@article{6d7c8305-54de-4b17-89ac-90ff41c9c80e,
  abstract     = {{<p>Background The WHO estimates a global shortage of 2.8 million physicians, with severe deficiencies especially in low and middle-income countries (LMIC). The unequitable distribution of physicians worldwide is further exacerbated by the migration of physicians from LMICs to high-income countries (HIC). This large-scale migration has numerous economic consequences which include increased mortality associated with inadequate physician supply in LMICs. Methods We estimate the economic cost for LMICs due to excess mortality associated with physician migration. To do so, we use the concept of a value of statistical life and marginal mortality benefit provided by physicians. Uncertainty of our estimates is evaluated with Monte Carlo analysis. Results We estimate that LMICs lose US$15.86 billion (95% CI $3.4 to $38.2) annually due to physician migration to HICs. The greatest total costs are incurred by India, Nigeria, Pakistan and South Africa. When these costs are considered as a per cent of gross national income, the cost is greatest in the WHO African region and in low-income countries. Conclusion The movement of physicians from lower to higher income settings has substantial economic consequences. These are not simply the result of the movement of human capital, but also due to excess mortality associated with loss of physicians. Valuing these costs can inform international and domestic policy discussions that are meant to address this issue.</p>}},
  author       = {{Saluja, Saurabh and Rudolfson, Niclas and Massenburg, Benjamin Ballard and Meara, John G. and Shrime, Mark G.}},
  issn         = {{2059-7908}},
  keywords     = {{epidemiology; health economics; health policies and all other topics; medical demography}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{BMJ Global Health}},
  title        = {{The impact of physician migration on mortality in low and middle-income countries : An economic modelling study}},
  url          = {{http://dx.doi.org/10.1136/bmjgh-2019-001535}},
  doi          = {{10.1136/bmjgh-2019-001535}},
  volume       = {{5}},
  year         = {{2020}},
}