Sequal volume to Health professional mobility and health systems: evidence from 17 European countries / edited by Matthias Wismar ... [et al.]. c2011.

The mobility of health professionals affects the performance of health systems, and increasingly so since the European Union (EU) enlargements in 2004 and 2007. This publication presents research on the gaps in knowledge about the numbers, trends, impacts and policy responses to this dynamic situation, in particular in Austria, Belgium, Estonia, Finland, France, Germany, Hungary, Italy, Lithuania, Poland, Romania, Serbia, Slovakia, Slovenia, Spain, Turkey and the United Kingdom. Conducted within the framework of the European Commission s Health PROMeTHEUS project, the research posed a set of questions of key interest to policy-makers: * What are the scale and characteristics of health professional mobility in the EU? * What have been the effects of EU enlargement? * What are the motivations of the mobile workforce? * What are the resulting impacts on health system performance? * What is the policy relevance of those impacts? * What are the policy options to address health professional mobility issues? In answering these questions, this publication offers policymakers evidence of the nature and extent of health professional mobility in the EU, analyzes its impact on country health systems and outlines some major policy strategies to address mobility.

Health workers in the European Union (EU) are free to seek employment in another Member State as guaranteed by EU law. This mobility of health professionals changes the composition of the health workforce in source and destination countries and may aggravate or mitigate existing problems such as shortages, mal-distribution and skill-mismatches of health professionals. To mitigate unwanted effects and strengthen positive ones, the Member States of the World Health Organization have adopted the Global Code of Practice on the International Recruitment of Health Personnel. The Code, however, needs to be contextualized for Europe, taking into account the freedom of movement in the EU. Mitigating unwanted effects and strengthening positive ones is highly relevant in the EU as some Member States rely to a large extent on foreign health professionals while others experience important outflows. In the EU free mobility area, flows of health professionals are dynamic, often changing direction and magnitude, and affect all countries. Countries are faced with the constantly changing conundrum of efficiency and equity, that is, between the free mobility of health professionals in the European labour market on one hand, and the planning requirements of health systems ensuring universal health coverage on the other hand. It is necessary to disentangle the conundrum and make it accessible to policy-makers and stakeholders as health professional mobility: has clear effects on efficiency and equity; is a complex phenomenon, neither positive nor negative per se, but implying merits and drawbacks for both source and destination countries; and affects the EU as a whole and destination and source countries simultaneously. Three sets of policy options can be used to address the consequences of health professional mobility on efficiency and equity at EU and country level: policy options to foster health workforce sustainability; policy options to manage mobility; and EU action to address the consequences and opportunities of free mobility. Countries can choose from a wide range of policy options that correspond best with their needs (Table 2). Implementing policy options will often require strong intersectoral governance and consensus building across government departments and stakeholders.

Patient mobility across Europe is markedly increasing and new generations will actively ask to be treated by the health-care system that best meets their needs. At a political level, the EU issued the EU Directive no. 24/2011/CE of 9th March 2011 concerning the application of patients’ rights in cross-border health care and has contributed to improving the level of freedom of choice for the European citizen, but it does not seem to have increased actual patient mobility across Europe. Freedom to choose is necessary to grant the people of Europe the same access to public-sector health-care services. The latter is a key instrument for an efficiently functioning “single market” ensuring real mobility within the EU. The aim of this book is to study the current European health care market and discuss the hypothesis of a European right of citizenship with reference to health-care services. It examines patients' mobility from several perspectives: determinants of patient mobility, governance of cross-border mobility at EU level as concerns patients and health-care professionals, policy implications, and case studies. It is intended for health researchers, decision-makers and professionals concerned with health-care provision and patient mobility. The goal is to provide, through scientific and methodological rigor, new informative tools useful for the implementation of new policies in the health-care sector in order to implement effective health-care integration in the European Union.

The book can be seen as a welcomed contribution to this field of study. . . [it] raises some important questions and problems of scientific mobility. Høgni Kalsø Hansen, Papers in Regional Science This is a very timely book looking at East West migration, which has recently become a hot political issue in various West European countries. It does an excellent job in laying out the intricacies of mobility that affect different groups, particularly knowledge migrants . The book successfully shows that knowledge migrants follow different motivational routes than other groups of migrants in their choice of mobility between institutes and nations. It makes a valuable contribution to a growing body of research that seeks to change established thinking and rhetoric about migration and to shift it from a dualistic thinking of migration in terms of economic vs. non-economic migrants. What this book shows is that the professional identity of people often supersedes their nationalities in relation to why and where they move. Sami Mahroum, NESTA, UK Based on excellent empirical research on migrating scientists from Poland and Bulgaria to the UK and Germany, this book follows an innovative agenda which is crucial to the world today the movement of people and the movement of knowledge. It achieves this by a creative blend of analysing personal stories, embedded in their professional and family networks, on the one hand, and macro-scale discussions of brain drain, brain gain and national and European policy implications on the other. Russell King, University of Sussex, UK This book makes a timely contribution to understanding the circulation of scientific knowledge via international mobility. It skillfully combines an analysis of structural and institutional changes, with a focus on individual circumstances, life courses and motivations. The outcome is a compelling account of the role of international migration in the transfer of knowledge across borders, and in shaping the careers of individual scientists. This places people and human mobility at the heart of the debate about how the knowledge economy is produced and reproduced. Allan Williams, London Metropolitan University, UK Moving People and Knowledge provides a fresh examination of the processes of highly skilled science migration. Focusing on intra-European mobility and, in particular, on the new dynamics of East West migration, the authors investigate the movement of Polish and Bulgarian researchers to and from the UK and Germany. Key questions include: who is moving, how long for, and why? In addressing the motivations and experiences of mobile scientists and their families, insights into professional and personal motivations are provided, demonstrating how relationships, networks and infrastructures shape decision-making. This book provides a useful perspective on the implications of increasing researcher mobility for both sending and receiving regions and the individuals concerned which is necessary for the construction of future policies on sustainable scientific development. This empirical account provides a nuanced analysis of the duration and flow of scientific mobility showing the prevalence of repeat and shuttle moves in science careers. It will be of particular interest to researchers in European social policy, migration studies and EU law, as well as policymakers in the field of highly skilled migration especially those working on the free movement of persons provisions and the European Research Area and European Area of Higher Education.

This volume, developed by the Observatory together with OECD, provides an overall conceptual framework for understanding and applying strategies aimed at improving quality of care. Crucially, it summarizes available evidence on different quality strategies and provides recommendations for their implementation. This book is intended to help policy-makers to understand concepts of quality and to support them to evaluate single strategies and combinations of strategies.

Explains and illuminates the specific relationship between health professions and the state. Eight countries in Europe are examined and topical issues include: market policies, performance and quality, professional monopolies and expertise.

V šestih prispevkih monografije so analizirani obstoječi in porajajoči se izzivi na področju delovne mobilnosti v Evropski uniji, pri čemer jih avtorji obravnavajo skozi prizmo mobilnih delavcev v različnih poklicih. Z večdisciplinarnim pristopom in uporabo različnih metodoloških prijemov so avtorji ustvarili ogrodje za analitične diskusije o učinkih mobilnosti v EU, učinkovitosti in pravičnosti prostega pretoka oseb znotraj EU ter večplastnosti posledic za posameznike, države članice in nacionalne politike. Prvi prispevek je teoretski uvod v tematiko, ki mobilnost izčrpno predstavi kot teoretski koncept, politično agendo in temeljno evropsko vrednoto. Kompleksni preplet mnogoterih učinkov delovne mobilnosti, ki se pojavljajo na več ravneh, je v nadaljevanju obravnavan v petih študijah primera. Le-te osvetljujejo dileme, paradokse, učinke in posledice notranje mobilnosti v EU na primerih mobilnih zdravstvenih delavcev, umetnikov in kulturnih delavcev, napotenih delavcev, skrbstvenih delavk in visoko izobraženih delavcev. Vsi predstavljeni primeri so rezultat večletnih znanstvenoraziskovalnih prizadevanj in aktivnega delovanja avtorjev v različnih projektih s področja mobilnosti.