Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 1205 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
Health Policy Plan. 2021 Jun 3;36(5):630-638. doi: 10.1093/heapol/czaa193.
Although critical for understanding health labour market trends in low- and middle-income countries (LMICs), longitudinal LMIC health worker emigration and return migration trends are not routinely documented. This article seeks to better understand SA's trends in physician emigration and return migration and whether economic growth and related policies affect migration patterns. This study used physician registry data to analyse patterns of emigration and return migration only among SA-trained physicians registered to practice in top destination countries such as Australia, Canada, New Zealand, the USA or the UK between 1991 and 2017, which represent the top five emigration destinations for this group. A linear regression model analysed the relationship between migration trends (as dependent variables) and SA's economic growth, health financing and HIV prevalence (as independent variables). There has been a 6-fold decline in emigration rates from SA between 1991 and 2017 (from 1.8% to 0.3%/year), with declines in emigration to all five destination countries. About one in three (31.8% or 5095) SA physicians returned from destination countries as of 2017. Annual physician emigration fell by 0.16% for every $100 rise in SA GDP per capita (2011 international dollars) (95% confidence interval -0.60% to -0.086%). As of 2017, 21.6% (11 224) of all SA physicians had active registration in destination nations, down from a peak of 33.5% (16 366) in 2005, a decline largely due to return migration. Changes to the UK's licensing regulations likely affected migration patterns while the Global Code of Practice on International Recruitment contributed little to changes. A country's economic growth might influence physician emigration, with significant contribution from health workforce policy interventions. Return migration monitoring should be incorporated into health workforce planning.
尽管了解低收入和中等收入国家（LMICs）的卫生劳动力市场趋势至关重要，但纵向 LMIC 卫生工作者移民和返回移民趋势并未定期记录。本文旨在更好地了解 SA 医生移民和返回移民的趋势，以及经济增长和相关政策是否影响移民模式。本研究使用医生登记数据，仅分析了 1991 年至 2017 年间在澳大利亚、加拿大、新西兰、美国或英国等顶级目的地国家注册执业的 SA 培训医生的移民和返回移民模式，这些国家代表了该群体的前五大移民目的地。线性回归模型分析了移民趋势（作为因变量）与 SA 经济增长、卫生筹资和艾滋病毒流行率（作为自变量）之间的关系。1991 年至 2017 年间，SA 的移民率下降了 6 倍（从 1.8%降至 0.3%/年），所有五个目的地国家的移民率都有所下降。截至 2017 年，约有三分之一（31.8%或 5095 人）的 SA 医生从目的地国家返回。SA 人均 GDP 每增加 100 美元（2011 年国际元），每年医生移民人数就会减少 0.16%（95%置信区间为-0.60%至-0.086%）。截至 2017 年，所有 SA 医生中，有 21.6%（11224 人）在目的地国家有有效登记，低于 2005 年的 33.5%（16366 人）的峰值，这一下降主要归因于返回移民。英国许可证法规的变化可能影响了移民模式，而《国际招聘全球行为守则》对变化的影响微乎其微。一个国家的经济增长可能会影响医生移民，而卫生人力政策干预的贡献显著。应将返回移民监测纳入卫生人力规划。
