HEALTH WORKFORCE MIGRATION: RESULTS FROM PILOT DATA COLLECTION AND PROPOSAL TO ADD MODULE IN THE JOINT QUESTIONNAIRE OECD Health Data National Correspondents 23 October 2014, Paris

Aim: Begin to update data on international migration of foreign-trained doctors and nurses in OECD countries: – first reported in 2007 chapter in OECD International Migration Outlook – data collection pursued in OECD Health Data questionnaire up to 2009 Part of broader OECD project, also including data collection on foreign-born doctors and nurses (based on the wave of national census around 2010/11) Begin to analyse impact of a number of recent developments on migration trends (e.g., economic crisis in , EU enlargement in 2004 and 2007, Global Code on the International Recruitment of Health Personnel in 2010) Work done in collaboration with WHO-Headquarters OECD pilot data collection in

Focus on doctors and nurses Focus on place of training (foreign-trained, where first diploma was obtained) Collect immigration data from destination countries by all countries of origin (based on professional registries, physician/nurse surveys, other sources) Include both total “stock” and annual “flows” Time series (from 2000 to 2012) Scope and approach to pilot data collection

Doctors: – Stock: 25 countries (out of 29), including 20 with data by countries of origin – Flow: 19 countries (out of 29), including 16 with data by countries of origin Nurses: – Stock: 23 countries (out of 29), including 16 with data by countries of origin – Flow: 16 countries (out of 29), including 13 with data by countries of origin Results of pilot data collection in terms of data availability Note: This pilot data collection was not carried out in Greece, Iceland, Luxembourg, Mexico and Turkey.

AustraliaAustralian Institute of Health and Welfare (AIHW) AustriaAustrian Medical Chamber BelgiumFederal Public Service - Public Health, Database of health work professionals (INAMI - RIZIV) CanadaCanadian Institute for Health Information, Scott’s Medical Database (SMDB) ChileRegistro Nacional de Prestadores Individuales de Salud Czech RepublicCzech Medical Chamber DenmarkStatens Serum Institut, Population Register EstoniaHealth Board, Register of Health Professionals FinlandNational Supervisory Authority for Welfare and Health, Central Register of Health Care Professionals FranceOrdre des Médecins GermanyGerman Medical Association HungaryOffice of Health Authorisation and Administrative Procedures, Operational Registry IrelandIrish Medical Council, Medical Council Annual Report IsraelHealth Information Division, Ministry of Health, Physician License Registry NetherlandsCIBG, Beroepen in de Gezondheidszorg (BIG) New ZealandMedical Council of New Zealand, Medical Register NorwayNorwegian Registration Authority for Health Personnel, the health personnel register PolandPolish Supreme Chamber of Physicians and Dentists, Central Register of Physicians and Dentists Slovak RepublicNational administrative register of healthcare professionals SloveniaNational Institute of Public Health Slovenia, National Healthcare Providers Database SpainRegional Councils of Physicians, National Institute of Statistics SwedenNational Board of Health and Welfare, NPS-register SwitzerlandFédération des médecins suisses (FMH) United KingdomISD Scotland, HSCIC and GMS Census (Wales) United StatesAmerican Medical Association, Physician Master Files Data sources for pilot data collection Doctors

AustraliaNational health Workforce dataset, Health Workforce Australia BelgiumFederal Public Service - Public Health, Database of health work professionels, (INAMI - RIZIV) CanadaCanadian Institute for Health Information, Nursing Database Chile Registro Nacional de Prestadores Individuales de Salud DenmarkStatens Serum Institut, Population Register EstoniaHealth Board, Register of Health Professionals FinlandNational Supervisory Authority for Welfare and Health, Central Register of Health Care Professionals FranceDRESS, Répertoire Adeli des professions de santé Germany Federal Statistical Office in cooperation with the Federal Statistical Offices of the Länder, Statistics for the Federal Recognition Act (2012) IrelandIrish Nursing Board, An Board Altranais IsraelHealth Information Division, Ministry of Health, Nurse License Registry ItalyFederazione nazionale dei Collegi Ipasvi NetherlandsCIBG, Beroepen in de Gezondheidszorg (BIG) New ZealandNursing Council of New Zealand, New Zealand Workforce Survey Data NorwayNorwegian Registration Authority for Health Personnel, the health personnel register PolandMain Chamber of Nurses and Midwifes, Central Register of Nurses and Midwifes PortugalOrdem dos Enfermeiros, Gestão de Membros da Ordem dos Enfermeiros SloveniaNational Institute of Public Health Slovenia, National Healthcare Providers Database SpainRegional Councils of Nurses, National Institute of Statistics SwedenNational Board of Health and Welfare, NPS-register SwitzerlandFSO Swiss Federal Statistical Office, Administrative Hospital Statistics United KingdomNursing and Midwifery Council United States2013 National Workforce Survey of Registered Nurses, National Council of State Boards of Nursing Data sources for pilot data collection Nurses

Same type of comparability limitations as for the broader data collection on the total number of doctors or nurses (e.g., data for some countries relate to “professionally active” or “all licensed to practice” rather than “practising”, many countries exclude physicians-in-training) Some countries (e.g., Germany) are only able to report data based on “foreign nationality” (not foreign-trained) Problem in distinguishing “foreign-born and foreign- trained” students from “domestic-born but foreign- trained” students returning to their home country (“internationalisation of medical and nursing education”) Data comparability limitations and other issues

Aim: Collect a relevant minimum dataset: – to fill current gap in OECD, Eurostat, WHO-Europe databases – to serve also as an input to national reporting under the WHO Global Code (requirement once every three years) Approach: Follow same specifications as under the OECD pilot data collection, but with an additional specification to identify ‘domestic-born but foreign-trained’ doctors and nurses Frequency: This new module may be included every year or every three years, depending on assessment of benefits of regular updating versus data collection burden Proposal to add a new module in the 2015 Joint Questionnaire

COMMENT on the results from OECD pilot data collection on foreign- trained doctors and nurses COMMENT on proposal to add a new module on health workforce migration in the 2015 Joint Questionnaire Issues for discussion