Deber Raisa
Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto.
Healthc Pap. 2010;10(2):22-7; discussion 51-5. doi: 10.12927/hcpap.2010.21796.
Selecting policies for integrating internationally educated healthcare professionals (IEHPs) into the healthcare workforce depends on how the underlying policy questions are defined and how the resulting trade-offs are managed. Baumann, Blythe and Ross give excellent answers to the question of how to use IEHPs to alleviate health human resources shortages while ensuring quality; this can be linked to the questions of how many providers are "needed" by the system, as well as to how they are paid, who assumes the risks of oversupply and under-supply and whether data are available to track the workforce. But the questions could also be framed as fairness to the IEHPs themselves, fairness to the countries these providers come from or even as ensuring intergovernmental coordination within Canada, where decisions about immigration are not always aligned with decisions about training and certification. Boom-bust cycles have occurred before, and proven both counterproductive and wasteful. Particularly when there are no obviously correct answers, wisdom and balance by policy makers in framing the questions is essential.
选择将国际教育背景的医疗保健专业人员（IEHPs）融入医疗保健劳动力队伍的政策，取决于如何界定潜在的政策问题以及如何处理由此产生的权衡取舍。鲍曼、布莱斯和罗斯就如何利用国际教育背景的医疗保健专业人员缓解卫生人力资源短缺同时确保质量这一问题给出了出色的答案；这可能与系统“需要”多少医疗服务提供者的问题相关，也与他们的薪酬方式、谁承担供应过剩和供应不足的风险以及是否有数据来跟踪劳动力队伍有关。但这些问题也可以从对国际教育背景的医疗保健专业人员自身的公平性、对这些专业人员来源国的公平性，甚至是确保加拿大境内政府间的协调等角度来阐述，在加拿大，移民决策并不总是与培训和认证决策保持一致。之前已经出现过繁荣与萧条的周期，事实证明这既适得其反又浪费资源。特别是当没有明显正确的答案时，政策制定者在构建问题时的智慧和平衡至关重要。
