Physician Brain Drain a Critical Issue for Developing Countries

nurse anne bell of nashville

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Reuters reports today (Kavita Chandran and Tan Ee Lyn) that the

. . .health crisis in developing countries is . . . being exacerbated by the West as countries relax stringent immigration regulations to attract doctors and nurses from less developed countries to boost their own flagging health systems while saving money on expensive training.

The consequences of this “brain drain” are grave as it leaves gaping holes in the healthcare systems of developing countries where diseases such as AIDS, tuberculosis and malaria run rampant and children die daily from diarrhea.

I’ve written a number of times that we seriously underestimated the depth and impact of the globalization of health care and how entangled and interdependent we are with the health problems plaguing the rest of the planet. So at the risk of being a PITA I want to repeat my message.

  1. Our public discourse in health care is often too insular, too self-serving and thus irrelevant when it comes to the rest of the world;
  2. The world, and health care with it, is changing in dramatic ways;
  3. We are not paying enough attention to the above two points.

Step back for a moment and consider the overwhelming preponderance of words, time and money we spend in taking apart the U.S. health care system. Now think about how much of that talk goes toward building an understanding of our dependencies on the rest of the world for that care. Or for that matter, how much of the world’s health care, in turn, depends on us.

Not much. In fact we tend to polarize our thoughts into strict them-and-us compartments that essentially diminish any appreciation of the depth of those inter-relationships.

It also shows in our ignorance of health care systems in other countries (especially so when we boast of the superiority of either theirs or ours); in our odd blindness to the fact that, demographically speaking, the world is already living in our own house; and in our easy dismissal of international health comparisons not favorable to us. We are, to be blunt, isolationist, and to many on the planet, arrogant,when it comes to health care.

Keeping the world at an arm’s length is no longer possible or desirable. Much like an “American” car or anything you can buy at Wal-Mart, health care is fast becoming the product of a complex world-wide process. While the health care services Americans receive may appear to be local, each drug, patient record, and operating room is the culmination of a complicated international exchange we need to better understand.

Every health care issue confronting today has underlying global aspects. The U.S. health care is discovering itself inextricably caught up in international diplomacy, the throes of globalization, and even the murky dealings of illegal transnational organizations.

We’re witnessing the emergence of a new order, with its corresponding growth opportunities, intractable problems, and chaotic flash points. For example, the drug industry: new drug biologics, research, testing, manufacturing, pricing, distribution, profits, and counterfeiting — all are derivatives of active public and private global networks. International coordination and information exchange is clearly critical in controlling infectious diseases such as SARS, avian flu, or HIV.

“Medical tourism” (international hospital competition) increases every year. More of our physicians are either foreign-born or being trained in other countries– indeed our entire health care infrastructure is increasingly dependent on foreign labor. Research into other countries’ health care practices will usher a new wave of alternative and complementary care into mainstream medicine. And, of course, health care IT. Electronic claims transaction, systems installations and software testing, call centers with advanced technology –- you name it — and its major components are more and more often located offshore.

Borders are increasingly, or already, irrelevant to health care. We are either getting flattened, or doing it to others. Adapting to that emerging reality is critical. But we seem to be missing the signals. Even in the grand ideas fermenting in the speeches of our presidential candidates we see little recognition of what is going on around us. So we need to start interrogating the global connection of every health care problem we face.

The message has to get out: the globalization of health care is not an optional sub-specialty anymore. It is front and center required reading.

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Globalizing Charitable U.S. Health Care: The Taxman is Coming

IRS building on Constitution Avenue in Washing...

Image via Wikipedia

The BNA Health Care Policy Report ($$ Subscription) tells us that Steven Grodnitzky, a manager in the IRS exempt organization division recently said that they are

starting to look into the globalization of U.S. health care systems and the tax ramifications for exempt systems that provide advisory services to foreign governments, mostly in the Middle East, to help them construct, establish, and operate new state-of-the-art hospitals and health care facilities, he said.

Some of these exempt health care systems have created subsidiaries that are paid fees to provide these services, he noted. The organization does not own, operate, or control the foreign operation, its role being rather to help get these foreign operations up and running by providing advice, expertise, and training, he added.

As with other exempt entities, the issues are whether these subsidiaries are really charitable and whether they are promoting public health or educational purposes. “This is an area we are starting to see and hear about,” he said.

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My 10 Top “Out-of-the-Box” Questions for Health Care

Very early depiction of Cygnus atratus, given the title

Image via Wikipedia

The method to much of my blogging madness has been to read widely in areas on the fringes or loosely connected to health care, and then try to think about the relevance (to health care) of the ideas, metaphors or insights the works may generate. I then take some of these conceptual rocks (or questions) and throw them into the web’s health care pond and look at the ripples. All this, I readily admit, is my personal strategy for dealing with intellectual entropy and boredom.

I believe a little redundancy will help in my effort to create bigger ripples – some of the boulders I’ve lobbed in are quite large. So here for your review are my “10 Top “Out-of-the-Box” Questions for Health Care.”

  • Globalization: Why are we so insular and provincial when it comes to health care? Can health care become an important factor in re-establishing America’s ‘Soft Power’ in the world? (more..)
  • Privacy 2.0: Are we paying enough attention to the changing nature of health care privacy in the Web 2.0 world? (more…)
  • Everyware: How do we as citizens contend with ubiquitous computing surveillance (ambient, RFID etc) when it comes to health care? (more …)
  • Black Swans: Is what we don’t know about health care far more relevant than what we do know? (more…)
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WHCB: “WHIT 3.0 Conference: Comments on Day One”

Day one of the WHIT 3.0 conference started with a hot and hip review of the first 5,000 days of the internet by Kevin Kelly (Co-founder & Senior Maverick, Wired Magazine) followed by a series of impressive speakers who kept the temperature high until the reception finally cooled us down later that evening. Kelly expounded on the sheer magnitude of the web and his description of the web, which I’ve seen him present before, being just a series of screens to one, huge global machine that is online all the time. He worked the theme that if it’s not on the web or readable by it, it doesn’t exist.

See my entire post over at the World Health Care Blog.

Drinking to Chinese Global Hip-Hop

From Slate’s summary of what’s in other media (Jake Melville):

Foreign Policy describes a Chinese hip-hop show as it analyzes the globalization of the art form: “It was the perfect brew—an African-American entrepreneur promoting a Polish vodka owned by a French corporation using Chinese performers practicing an Afro-Latin influenced art form that originated in the inner cities of the United States.”

We are definitely not in Kansas any more Toto.

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