Economic influences on and impacts of the migration of health professionals

  • Shaolin Wang

    Student thesis: Doctoral ThesisDoctor of Philosophy


    Migration has become an important feature of health labour markets due to the global shortage of health professionals. While there exists an extensive Labour Economics literature studying the general migration, policy development remains hampered by limited research undertaken in the health sector. This thesis fills some of that gap by examining the economic influences on and impacts of the migration of health professionals. The migration of skilled health professionals has exhibited strong sectoral properties, such as the motivation of career development and various regulatory regimes. We incorporate these features into the self-selection model by Borjas and Bratsberg (1996) and examine factors that influence the scale and skill composition of the migration flow. Our model suggests that the restrictive relicensing regime and work permit requirements for non-EEA professionals adopted by the British government to maintain practice standards and secure employment opportunities for native graduates, could only limit the migration from countries with higher returns to skills. The effect is ambiguous for most donor countries, which provide lower returns to skills.Using the administrative data derived from the Scottish dental system, we also examine the impacts of health professional migration within EU on the host country by investigating the performance of EEA dentists contracted under the Scottish NHS in terms of retention and treatment provision. A discrete-time survival analysis has been applied to characterize the time trend of the retention and identify factors associated with the likelihood of a dentist leaving the NHS. We also compare treatments provided by migrant and non-migrant dentists by estimating a difference-in-differences model. Unobserved heterogeneity in dentists is controlled using fixed effects.Our results suggest that EEA health professionals can be a good substitute to British graduates. They provide marginally different treatments and exhibit strong assimilation within two years post-entry. However, a constant issue we have found is their high turnover rates in the NHS: half of them left the service by the 26th month following entry. The primary policy recommendation of our analyses is that there is need for the government to develop recruitment initiatives so as to retain migrant dentists. Our results suggest hazards of leaving are significantly associated with dentists’ age-at-entry, arrival cohort and patient composition, but not with dentists’gender, country and practice deprivation. These findings potentially help to set evidence-based targets for international recruitment programmes
    Date of Award2010
    Original languageEnglish
    SupervisorMartin Chalkley (Supervisor) & Colin Tilley (Supervisor)


    • Migrant health professionals
    • Self-selection
    • Retention
    • Treatment difference
    • Assimilation
    • British NHS
    • Administrative data

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