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Presentation

Session: Human Health Resources
Room: Meeting Rooms 22+23
Time: Thu 10:15-11:30

Presenter: Shaolin Wang (University of Dundee. Economic Studies)

Abstract

Overseas qualified health professionals have made a significant and escalating contribution to health care labour markets in industrialized countries. In the UK, for example, 33% (69813) of doctors and 10% (65000) of nurses working in the NHS in 2006 obtained their qualifications overseas. There are obvious questions regarding the extent to which migrants are perfect substitutes for domestically trained professionals and in the realm of health care, where in the presence of asymmetric information health care professionals have considerable discretion over the type of care they deliver, this raises concerns regarding both the quality and safety of healthcare (OECD, 2008; Simoens and Hurst, 2006). Assessing the extent to which there are differences between internationally recruited and domestically trained health professionals is, therefore, clearly a concern for public policy. Until now, however, there has been little empirical work comparing the services delivered by migrant and indigenously trained health care professionals.
Using administrative data from the Scottish dental system, we compare the treatments provided by all non-UK qualified dentists who started providing dental services in the GDS after January 2006 with the treatment provided by a comparison group consisting of the recently domestically trained dentists who subsequently worked in the GDS during their first two years after entry. A difference-in-differences model is estimated to examine how migrant dentists’ responses to different case mix and individual circumstances (treatment category, patient type, remuneration, etc.) compare with non-migrant dentists’ responses, and whether there is a convergence between the two groups of dentists as migrants assimilate into the host country. Given the longitudinal nature of the data, we control for time-invariant unobserved heterogeneity in dentists using fixed effects method.
Our results suggest that migrant dentists have marginally different practice styles: compared with non-migrant dentists with comparable characteristics, migrant dentists provide significantly different value of treatment only for patients who require prosthetic treatment and male patients. Furthermore, there is also evidence that, after adjusting for observed heterogeneity across CoTs and dentist fixed effects, the variation diminishes over time within two years of practice: the difference of treatment value between migrant and non-migrant GDPs significantly reduces by 4.32% since the second six months after entry.
As the international recruitment becomes commonly used in OECD countries as a flexible and low-cost adjustment to temporary or regional imbalance, whether patients registered with migrant and non-migrant healthcare professionals receive consistent services is clearly an important concern. Our findings suggest that there is significant convergence in practice style of migrant and non-migrant dentists over time during the first two years following entry.

Key Terms

migration of health professionals, British NHS, administrative data, treatment intensity

Authors:

Shaolin Wang (University of Dundee. Economic Studies) , Martin Chalkley (University of Dundee. Economic Studies) and Colin Tilley (NHS Education for Scotland)

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