Should I stay or should I go now? The impact of "pull" factors on physician decisions to remain in a destination country

A review of the United Arab Emirates healthcare systems on medical tourism and accreditation

This paper aims to review the healthcare system in the United Arab Emirates (UAE) and the utilisation of international accreditation to improve the quality of healthcare services and to grow its medical tourism industry. Medical tourism has contributed to the UAE's economy. Hence, the country mandated international accreditation in public and private facilities to attract patients and boost medical tourism. Accreditation is recognised worldwide as one of the main drivers for implementing quality and patient safety standards, which has sparked considerable interest in studying the effects and outcomes of such assessments. Therefore, the second aim of this paper is to review the UAE's strategic goals to improve the quality of healthcare services using international accreditation. Although striving to achieve global accreditation attracts tourists, it is essential to understand the needs and outcomes of such assessments. This review showed how the UAE healthcare sector has evolved to improve the quality of its healthcare services through accreditation. While enhancing the quality of such services and increasing the medical tourism industry provided many opportunities for expatriates to move to the UAE, the country should aim to strengthen its medical services by expanding to other Middle Eastern countries. This paper could influence policymakers implementing international accreditation in the UAE and the Middle Eastern region.

Drivers of health workers' migration, intention to migrate and non-migration from low/middle-income countries, 1970-2022: a systematic review

BACKGROUND

The migration of healthcare workers (HWs) from low/middle-income countries (LMICs) is a pressing global health issue with implications for population-level health outcomes. We aimed to synthesise the drivers of HWs' out-migration, intention to migrate and non-migration from LMICs.

METHODS

We searched Ovid MEDLINE, EMBASE, CINAHL, Global Health and Web of Science, as well as the reference lists of retrieved articles. We included studies (quantitative, qualitative or mixed-methods) on HWs' migration or intention to migrate, published in either English or French between 1 January 1970 and 31 August 2022. The retrieved titles were deduplicated in EndNote before being exported to Rayyan for independent screening by three reviewers.

RESULTS

We screened 21 593 unique records and included 107 studies. Of the included studies, 82 were single-country studies focusing on 26 countries, while the remaining 25 included data from multiple LMICs. Most of the articles focused on either doctors 64.5% (69 of 107) and/or nurses 54.2% (58 of 107). The UK (44.9% (48 of 107)) and the USA (42% (45 of 107)) were the top destination countries. The LMICs with the highest number of studies were South Africa (15.9% (17 of 107)), India (12.1% (13 of 107)) and the Philippines (6.5% (7 of 107)). The major drivers of migration were macro-level and meso-level factors. Remuneration (83.2%) and security problems (58.9%) were the key macro-level factors driving HWs' migration/intention to migrate. In comparison, career prospects (81.3%), good working environment (63.6%) and job satisfaction (57.9%) were the major meso-level drivers. These key drivers have remained relatively constant over the last five decades and did not differ among HWs who have migrated and those with intention to migrate or across geographical regions.

CONCLUSION

Growing evidence suggests that the key drivers of HWs' migration or intention to migrate are similar across geographical regions in LMICs. Opportunities exist to build collaborations to develop and implement strategies to halt this pressing global health problem.

Driving forces of GPs' migration in Europe: an exploratory qualitative study

BACKGROUND

The shortage of GPs is a worldwide phenomenon, which encourages the migration of GPs and consequently exacerbates the GP shortage. This shortage imposes a threat for the entire healthcare system.

AIM

To explore the driving forces of GPs' migration in Europe and their reasons to stay in the new country, to migrate further, or to return to their home country.

DESIGN & SETTING

An exploratory, qualitative study of European GPs who have migrated within Europe.

METHOD

Individual interviews were conducted until data saturation and audio-recordings were transcribed. Thematic analysis was performed using NVivo.

RESULTS

Fifteen interviews with GPs from eight different European countries were conducted. The reasons why European GPs migrate and decide to stay or to leave were grouped under the following three themes: professional development; personal reasons; and the situation in the home country or the organisation of health care. New professional challenges, better working environment, and higher quality training programmes were mentioned as the main reasons for migration. Personal reasons, such as family's satisfaction with the living environment, closeness to other family members, and financial considerations, seemed to influence the decision to stay or leave the most.

CONCLUSION

Migration caused by dissatisfaction with the working and living environment is something countries could potentially work on in order to retain their GPs. As some countries in Europe rely more and more on international recruitment to combat the GP shortage, which in turn worsens the situation in other countries, a more unified Europe-wide approach to GP shortage and migration is needed.

Health literacy in a high income Arab country: A nation-wide cross-sectional survey study

INTRODUCTION

Health literacy is a powerful predictor of health outcomes, but remains a global challenge. There is a paucity of published data and limited understanding of the health literacy of patients in the Middle East. The purpose of this study was to assess the patient health literacy levels in the United Arab Emirates (UAE) and identify associated demographic characteristics.

METHODS

A cross-sectional survey of adult patients attending public and private hospitals and primary care clinics was conducted across the UAE between January 2019 and May 2020. Chi-square test was used to analyze the association between health literacy and demographic variables. Ordinal regression was adopted to analyze the data for statistically significant independent variables.

RESULTS

2349 of 2971 patients responded (79% response rate). Slightly less than one-quarter (23.9%) of patients surveyed demonstrated adequate health literacy. Over a third of women respondents (31.7%) possessed adequate health literacy, as compared to only 13% of men surveyed (p<0.001). Participant age was significantly (p<0.001) associated with health literacy levels, with approximately 50% of participants above age 50 years (51-75 years) demonstrating inadequate health literacy. Education was also positively correlated with health literacy. Adequate health literacy levels were twofold higher (30.5%, p<0.001) in patients with high school education, as compared to patients without secondary education.

CONCLUSIONS

The high proportion of patients with inadequate health literacy in our study confirms that the health literacy deficit is a challenge in the UAE. Targeted interventions are needed to improve health literacy, particularly for older individuals, to optimize healthcare utilization and improve individual and population health outcomes.

Factors Influencing Physicians Migration—A Case Study from Romania

Brain drain is a phenomenon that, over time, has followed an upward trend. It is an important component represented by physicians’ migration. For the country of destination, the migration of physicians offers several advantages, whereas the country of origin loses skilled and sometimes highly trained individuals. This process will be reflected both in the efficiency of the health system (severe employment shortage) and in the quality of the health system services. After Romania’s accession to the EU, the migration of doctors intensified, significantly increasing the shortage of physicians. The purpose of this article is to identify the push factors that influence the physicians’ decision to migrate from Romania. For this, a panel regression analysis was applied, highlighting that physicians’ migration is influenced by several factors, such as the number of beds in hospitals, the number of emigrants, unemployment rate, and income. At the same time, we analyzed the extent to which public policy measures addressed to the remuneration of medical staff influenced the propensity towards external mobility of the practicing doctors, already employed and/or graduates. The results confirm that public policies can be a tool for redistributing the labor force allocation on the labor market. Moreover, the results of our analysis highlight that specific measures do not solve the system crises facing the health sector. Systemic, multidimensional changes are needed, adapted to the needs of medical services specific to the geographical area and adequate to the health status of the population.

Comparing Push and Pull Factors Affecting Migration

The purpose of this research was to conduct a comparison of the push and pull factors affecting migration between Poland and Romania. The study aimed to find out which among the push and pull factors have a greater effect overall and individually on the migration activities. The study was conducted using primary data collected from migrants in both countries using a structured questionnaire. There were data from 298 and 288 surveys for Poland and Romania, respectively. The push and pull migration framework was applied to guide the study. The model suitability was confirmed satisfactory on validity, reliability and factor analysis. The hypothesis was analyzed and evaluated using multiple regression analysis. The findings of the study indicated that pull factors have a greater influence on migration in these two countries as compared to the push factors. Five out of six (economic, political and social in Poland and economic and political in Romania) pull factors were found significant as compared to two (social in Poland and in Romania) out of six push factors. Pull economic factors were significant determinants of migration in all the countries. Pull political factors were found to have the highest effect in both countries, because they influenced migrants in Romania. Economic factors are the major factors that influence migration, including the hope of finding better jobs and better life in the foreign countries, and these factors should be addressed in the effort to reduce migration. In addition, political issues such as unfair legal system, violent conflicts, underdevelopment, poverty, political instability and corruption should be addressed to control the issue of migration.

Critical Factors Favoring Outward Physician Migration from an Affluent Gulf Country

Background

Physician retention is essential to creating a strong and stable healthcare system worldwide. The density of physicians and nurses significantly impacts important population health outcomes. Globalization has enabled the mobility of physicians, but the recruitment and retention of quality physicians have not been without challenges. The purpose of this study was to identify the outward migration factors affecting expatriate physicians who have resided and worked in the United Arab Emirates (UAE) for at least 5 years, as compared with newly emigrated physicians. This physician population has likely adapted to the local environment and actively contributed to the advancement of medical care in the country; their attrition is a significant loss to the UAE healthcare system.

Methods and Statistical Analysis

A 23-point validated survey questionnaire, consisting of four domains, was electronically administered to the participants (n = 374), and responses were statistically analyzed, using descriptive statistics and the Chi-square test.

Results

Our results indicate that all physicians considered a ten-year visa to be factor contributing to retention, more so for the recent physician migrants to the UAE. Professional development opportunities, career-specific plans and income promoted only short-term retention of physicians in the UAE. Non-financial factors related to living and working conditions prevented migration of physicians who lived in the country for more than five years.

Conclusion

Lifestyle-related factors are an important consideration in long-term retention of physicians in the UAE. Initiatives to promote career advancement and improve job satisfaction for mid- and late-career clinicians are necessary to set the foundation for a robust physician retention policy and to enhance the quality of the healthcare system. Long-term visas provide an additional factor for retention.