Key Messages

• Health workers in the European Union (EU) are free to seek employment in another Member State as guaranteed by EU law. This mobility of health professionals changes the composition of the health workforce in source and destination countries and may aggravate or mitigate existing problems such as shortages, mal-distribution and skill-mismatches of health professionals.
• To mitigate unwanted effects and strengthen positive ones, the Member States of the World Health Organization have adopted the Global Code of Practice on the International Recruitment of Health Personnel. The Code, however, needs to be contextualized for Europe, taking into account the freedom of movement in the EU.
• Mitigating unwanted effects and strengthening positive ones is highly relevant in the EU as some Member States rely to a large extent on foreign health professionals while others experience important outflows. In the EU free mobility area, flows of health professionals are dynamic, often changing direction and magnitude, and affect all countries.
• Countries are faced with the constantly changing conundrum of efficiency and equity, that is, between the free mobility of health professionals in the European labour market on one hand, and the planning requirements of health systems ensuring universal health coverage on the other hand. It is necessary to disentangle the conundrum and make it accessible to policy-makers and stakeholders as health professional mobility:
  • ○ has clear effects on efficiency and equity;
  • ○ is a complex phenomenon, neither positive nor negative per se, but implying merits and drawbacks for both source and destination countries; and
  • ○ affects the EU as a whole and destination and source countries simultaneously.
• Three sets of policy options can be used to address the consequences of health professional mobility on efficiency and equity at EU and country level:
  • ○ policy options to foster health workforce sustainability;
  • ○ policy options to manage mobility; and
  • ○ EU action to address the consequences and opportunities of free mobility.
• Countries can choose from a wide range of policy options that correspond best with their needs (Table 2). Implementing policy options will often require strong intersectoral governance and consensus building across government departments and stakeholders.

Contents

• Executive Summary
• Policy brief
  • 1. Introducing the Efficiency-Equity Conundrum
  • 2. Trends in Mobility: A New Map of Europe?
  • 3. Unpacking the Efficiency-Equity Conundrum: A Matrix
  • 4. Policy Options: How to Make Mobility Work Better
  • 5. Implementation Considerations
  • 6. Conclusions
• Acknowledgements
• References
• Joint Policy Briefs

The authors and editors are grateful to the reviewers who commented on this publication and contributed their expertise.

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The theme of this policy brief has been developed and discussed in the context of a workshop organized jointly by the Swiss Federal Office of Public Health and the European Observatory on Health Systems and Policies in October 2014 at the European Health Forum in Gastein.

The policy brief builds on work presented at the Informal Meeting of Ministers of Health in Gödöllö on 4–5 April 2011 under the Hungarian EU Presidency.

This policy brief was presented jointly with the World Health Organization report entitled “Making Progress on Health Workforce Sustainability in the WHO European Region”. They were launched at the 65th session of the WHO Regional Committee for Europe, September 2015, in Vilnius, Lithuania.