The Brain Drain Game

How can health systems be “strengthened to provide interventions effectively, efficiently, and equitably?”1 The need for increased cooperation in developing better performing health systems globally would get us closer to achieving the Millennium Development Goals of 2015. There is minimal research on ways to strengthen the health systems. However, one focus is to attain more equitable services to the poor and disadvantaged.

International “brain drain” is one issue that is weakening the health systems. Doctors and nurses are being lured from high need, low pay areas to places that provide greater rewards in remuneration, quality of life, professional status, etc. Another “brain drain” or “resource drain” taking primary care away from locals is medical tourism. Foreign patients will travel long distances for medical procedures that are unaffordable in their own country (i.e. Americans without health insurance or for uninsured procedures- cosmetic surgery). They will ‘jump’ the waiting list (UK) as they become impatient and have the treatment performed outside their country’s health care system.  Privileged Middle Easterners and Africans are drawn to countries with better technology and medical expertise.

A conflict of interest regarding medical tourism is seen with the Indian government. They are expanding their economy by investing in the health systems infrastructure and then aggressively trying to attract foreign patients. They have implemented a special medical visa so that patients can enter the country easily. In return the hospitals are suppose to provide some free health care to the local poor populations.  A 2005 report by the Indian Government’s Public Accounts Committee found that most of the institutions had not offered the care. “Countries that see medical tourism as a solution to development of their health-care centers, should be cautious.”2

The economic inequalities globally, the disparities in law (seeking treatment that is illegal in their native country) and the differing standards of care internationally, all contribute to the surge in medical tourism.  Raising the compensation and the incentive structures (adapted to each country) is a must if we are going to keep health care providers on their own front line servicing the low income. Performance incentives, improved working conditions/facilities, continuing education opportunities, subsidized housing and schools for their dependents and improved professional status would be a motivation for the local providers to stay, provide care, help improve the health status of the country and attain a sense of national pride.

-Susan Tierney-

PS. In October 11, 2011 NY Daily News!

1.Mills, Rasheed, Tollman  – Strengthening Health Systems. Chapter 3

2.Shetty – Medical tourism booms in India, but at what cost?








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