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