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      Out-migration and attrition of physicians and dentists before and after EU accession (2003 and 2011): the case of Hungary


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          This paper employs a large-scale, individual-level, panel dataset to analyse the effect of EU accession on the probability of out-migration on the part of Hungarian physicians and dentists between 2003 and 2011. The study uses event history modelling and competing risk models. The results show that EU accession did not at the time affect the probability of out-migration while after the end of the transitional period of restrictions on the free movement of labour from the new EU member states to Austria and Germany, the probability of doctors’ migration increased considerably. Relative wages and peer pressure also exercise a significant role in the out-migration decisions of young medical doctors. We also find that more than half of those medical doctors who left the country during the observation period returned some time later. The data furthermore suggest a massive flow of doctors to domestic jobs outside the health care system.

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          A Proportional Hazards Model for the Subdistribution of a Competing Risk

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            The metrics of the physician brain drain.

            There has been substantial immigration of physicians to developed countries, much of it coming from lower-income countries. Although the recipient nations and the immigrating physicians benefit from this migration, less developed countries lose important health capabilities as a result of the loss of physicians. Data on the countries of origin, based on countries of medical education, of international medical graduates practicing in the United States, the United Kingdom, Canada, and Australia were obtained from sources in the respective countries and analyzed separately and in aggregate. With the use of World Health Organization data, I computed an emigration factor for the countries of origin of the immigrant physicians to provide a relative measure of the number of physicians lost by emigration. International medical graduates constitute between 23 and 28 percent of physicians in the United States, the United Kingdom, Canada, and Australia, and lower-income countries supply between 40 and 75 percent of these international medical graduates. India, the Philippines, and Pakistan are the leading sources of international medical graduates. The United Kingdom, Canada, and Australia draw a substantial number of physicians from South Africa, and the United States draws very heavily from the Philippines. Nine of the 20 countries with the highest emigration factors are in sub-Saharan Africa or the Caribbean. Reliance on international medical graduates in the United States, the United Kingdom, Canada, and Australia is reducing the supply of physicians in many lower-income countries. Copyright 2005 Massachusetts Medical Society.
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              Informal payments and the financing of health care in developing and transition countries.

              Informal, under-the-table payments to public health care providers are increasingly viewed as a critically important source of health care financing in developing and transition countries. With minimal funding levels and limited accountability, publicly financed and delivered care falls prey to illegal payments, which require payments that can exceed 100 percent of a country's median income. Methods to address the abuse include establishing official fees, combined with improved oversight and accountability for public health care providers, and a role for communities in holding providers accountable.

                Author and article information

                +36 30 816 42 74 , varga.julia@krtk.mta.hu
                Eur J Health Econ
                Eur J Health Econ
                The European Journal of Health Economics
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                2 December 2016
                2 December 2016
                : 18
                : 9
                : 1079-1093
                ISNI 0000 0001 2149 4407, GRID grid.5018.c, Institute of Economics, Centre for Economic and Regional Studies, Hungarian Academy of Sciences, ; Budaorsi ut 45, Budapest, 1112 Hungary
                © The Author(s) 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                : 1 July 2016
                : 21 November 2016
                Funded by: FundRef http://dx.doi.org/10.13039/501100003825, Magyar Tudományos Akadémia;
                Original Paper
                Custom metadata
                © Springer-Verlag GmbH Germany 2017

                Economics of health & social care
                medical doctors’ migration,attrition,competing risk model,eu enlargement,c41,c55,i10,j4,j40,j45,j60,j61


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