Project

Geographical aspects in the migration of Hungarian healthcare professionals

Goal: The work-related international migration of healthcare professionals is a long-lasting phenomenon but the last few decades have witnessed a considerable intensification of the process at a global scale. The volume of health workers’ migration is especially immense in Central and Eastern Europe (including Hungary), and in some regions the massive outflow of doctors and nurses poses a serious threat to health service provision.

In this project we examine the causes, motivations and impacts of the work-related emigration of healthcare professionals from Hungary (involving expatriates and health workers who are still working in Hungary). Previous research has mainly focused on the effects of migration on healthcare systems or on the sociological dimensions of the phenomenon, and less attention has been paid to geographical aspects. Our main objective is to understand the role of space and place in the out-migration of healthcare professionals (e.g. migration decisions, policy responses), simultaneously paying attention to the importance of international, national and subnational scales. Our multi-method research design combines statistical analyses, content analysis, questionnaire survey among medical students and qualitative interviews with healthcare professionals and policy makers.

This three-year project (2017-2020) is financed by the Hungarian National Research, Development and Innovation Office (project no.: 124938), and it has a total budget of HUF 15.295 million (€ 49,337).

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Private Profile
added a research item
The migration of health care professionals has significant effects on the health care provision of the source countries. Thus it is an important policy issue and highly debated topic in political and everyday discourses. Understanding the motivations of migrants is a crucial task, since it can contribute towards the design of efficient health care and migration policies. As several theories point out, migration decisions are shaped both by rational (e.g. higher wages, better quality of life, professional development, better working conditions etc.) and emotional factors (place attachment, identity, family ties etc. Not only the emigration itself is related to these factors, but also the decision whether to stay or return to the home country. To reveal the complexity of migration-related decisions, it is important to reveal the role of emotional factors behind the decisions. The research aims to analyze the role of identity behind the migration and re-migration decisions of Hungarian health care professionals. The study is based on a questionnaire survey conducted among health care students and semi-structured interviews of health care professionals with migration experiences. Or results show that the planning and the decisions of migration or re-migration are indeed influenced by identity and place attachment. Thus, future policies should focus on these aspects as well. This study was funded by the Hungarian National Research, Development and Innovation Office within the framework of the research project "Geographical aspects in the migration of the Hungarian health care professionals" (pr. nr.: K124938).
Szabolcs Fabula
added 5 research items
In line with international trends, recent decades have witnessed an increasing shortage of skilled workers in the Hungarian public healthcare system. This absolute deficit is exacerbated by imbalances in the spatial distribution of health labour force, which is mirrored, for example, by patterns of vacant jobs in public health at the local level. However, geographical aspects of the uneven distribution of health workforce have drawn relatively little attention so far from scholars in Hungary. The main aim of this study is to analyse the spatial-temporal patterns of the distribution of health labour force at regional and local levels in Hungary, and to provide recommendations for health policy makers. For this purpose, three research questions are addressed: (1) What are the geographical patterns of health labour force capacity in the general practitioner (GP) service in Hungary, especially at regional and local levels? (2) In which regions and local municipalities can shortage of GPs be observed? (3) What are the lessons of a geographical analysis of health labour force shortage in GP service for policy making? The main hypothesis of this article is as follows: adopting a core-periphery model, in Hungary, shortage of health workers in GP service is more severe in local municipalities which are at the lower levels of the settlement hierarchy (i.e. municipalities with less population and/or not legally classified as towns). To answer the research questions, a quantitative analysis has been carried out, using data obtained from various sources (e.g. Hungarian Central Statistical Office, National Healthcare Services Centre). Results have been illustrated by using diagrams and thematic maps prepared in Microsoft Excel and Quantum GIS 2.18. The hypothesis has been confirmed by the results of the quantitative analysis. There is a higher shortage of GPs and paediatricians at lower levels of the settlement hierarchy in Hungary, and in these local municipalities the workload of practicing doctors is larger than in municipalities classified legally as towns or having more population. Keywords: health workers, health inequalities, settlement hierarchy, local municipalities, core-periphery, quantitative analysis
The shortage and uneven geographical distribution of highly skilled health professionals is a major problem within the European Union (EU). According to recent studies, although the absolute number of practicing medical doctors has increased significantly in the EU over the last two decades, their regional distribution still shows significant inequalities. These inequalities are well exemplified by the fact that the density of physicians is consistently greater in urban areas than in rural and sparsely populated remote regions. The main objective of our presentation is to explore the patterns of and temporal changes in the regional distribution of physicians at various geographical scales within the EU. For this purpose, a mix of statistical methods is used, including descriptive statistics, indices of concentration and inequality (e.g. Gini coefficient), and bivariate correlation analysis. The main data source is Eurostat, involving statistics at the NUTS 2 regional level for the 2006-2018 period, supplemented by other data sources. Regarding our main results, the values of global concentration and inequality indices corroborate that there are significant regional disparities in the geographical distribution of registered medical doctors at EU level. It is also confirmed that the regional distribution of physicians shows a centre-periphery pattern, as there is a significant difference between the physician supply of capital/metropolitan regions and that of rural/remote regions. In terms of temporal changes, the uneven regional distribution of physicians shows a slow increase in the period under review.
Az egészségügyi szakemberek migrációját az eddigi magyarországi kutatások alapvetően kvantitatívan közelítették meg, elsősorban a humánerőforrás-veszteségre koncentrálva. A migráció motivációs tényezőit is több kutatás során vizsgálták kérdőíves felmérések alkalmazásával. E kutatások kimutatták, hogy a jövedelmi viszonyoknak és a munkakörülményeknek fontos szerepe van a migrációs folyamatban, azonban kevéssé koncentráltak olyan tényezőkre, mint az identitás, illetve a helyhez való kötődés. Ebből kiindulva előadásunkban azt mutatjuk be, hogy miként jelenik meg a "hely" mint földrajzi kategória magyar egészségügyi szakemberek migrációval kapcsolatos elbeszéléseiben. E célhoz kapcsolódva kutatásunkban összesen 58 egészségügyi szakemberrel készítettünk félig-strukturált interjúkat 2019 és 2020 során. Az interjúalanyok között egyaránt szerepelnek különböző szakterületeket képviselő orvosok, valamint egészségügyi szakdolgozók. Az interjúalanyok csoportját négy alcsoportra osztottuk a migráció szempontjából: olyanokra, akik eddig mindig Magyarországon dolgoztak; olyanokra, akik jelenleg külföldön dolgoznak; olyanokra, akik dolgoztak külföldön, de visszatértek Magyarországra; és végül olyanokra, akik más országból települtek Magyarországra munkát vállalni. A kutatás során a következő kérdésekre keressük a választ. (1) Milyen tartalmi elemekkel jelenik meg a "hely" mint földrajzi kategória az egészségügyi dolgozók külföldi munkavállalással kapcsolatos narratíváiban? (2) Milyen elbeszélésmód kapcsolódik a "hely" különféle értelmezéseihez ezekben a narratívákban (pl. milyen egyéb fogalmakat, jelzőket kapcsolnak a hely fogalmához)? (3) E két stratégia révén milyen kapcsolat alakul ki az egészségügyi dolgozókban a személyes identitás és a "hely" között? Az interjúk elemzéséből megállapítható, hogy mind az identitás mind a helyhez való kötődés megjelenik az interjúalanyok migrációs döntéseinek (elvándorlás, visszavándorlás) kialakulása során, bár az egyes vázolt csoportoknál nagy különbségek tapasztalhatók, és jelentősek a különbségek e tényezők fontosságát illetően, továbbá megfigyelhetők generációs sajátosságok is. Ritkán fordul csak elő, hogy a hely és az identitás egyáltalán nem számítson az összetett döntéshozatali mechanizmus során. Az eredmények hozzájárulhatnak a magyar egészségügyi dolgozók migrációval kapcsolatos döntéseinek jobb megértéséhez, ezáltal pedig hatékonyabb egészségügyi szakpolitikák kialakításához. Kulcsszavak: egészségügyi szakemberek, migráció, hely, identitás, interjúk (A magyar egészségügyi szakemberek migrációjának földrajzi vonatkozásai [K124938] számú projekt az Innovációs és Technológiai Minisztérium Nemzeti Kutatási Fejlesztési és Innovációs Alapból nyújtott támogatásával valósult meg.) X. Magyar Földrajzi Konferencia-Absztraktkötet 47
Szabolcs Fabula
added a research item
The shortage and uneven geographic distribution of health workers is considered a severe global problem nowadays. Recent studies examining inequalities in health workforce supply at various spatial scales suggest that health workers’ geographic distribution follows a core-periphery pattern as the more developed areas are generally better supplied with health labour than the less developed ones. Here, we explore the regional patterns and temporal changes of the geographic distribution of physicians in the European Union (EU) at the Nomenclature of territorial units for statistics (Nomenclature des unités territoriales statistiques – NUTS) 2 level between 2006 and 2018. We also compare the levels of concentration and inequality in the geographic distribution of physicians, economic development, and health outcomes. We utilise a mix of statistical methods such as descriptive statistics, indices of concentration and inequality, and bivariate correlation analysis based on Eurostat data. Our results provide evidence that the regional distribution of physicians in the EU shows a core-periphery pattern: NUTS regions with capital cities or metropolitan areas have more physicians. In addition, the regional patterns of the distribution of physicians in the EU are stable in time, and their geographic concentration is strengthening in the long run. Our results also suggest that there is a positive relationship between the geographic distribution of physicians and health outcomes; however, this relationship needs further investigation.
Private Profile
added a research item
The migration of health workers is a global phenomenon with considerable impact on health care systems, which issue became a policy concern in Hungary after the Eastern Enlargement of the European Union in 2000s and early 2010s. The main aim of this paper is to reveal the migration intentions and motives of Hungarian medical students and health professionals. Keywords: health professionals, labour migration, mobility, brain drain, Hungary
Szabolcs Fabula
added 2 research items
There are considerable regional inequalities in the human resource supply of health care systems, which situation is further compounded by the intra-and international migration of health workers. Recent studies on the migration of health workers have examined this phenomenon mostly by conducting macro-scale analyses, using mainly statistical methods, and focusing on the geographical patterns of human resource supply and demand, and migration flows. Other studies have investigated migration at the micro scale, focusing mainly on individuals' motives, but often isolating migration-related decision making from the socio-spatial networks in which these decisions are embedded. Among these networks, the family and the household have utmost importance, and in this study these are considered geographical, spatially diffuse concepts. Though it is not a completely new theoretical approach in migration research, recent technological development (especially in telecommunication) has had a far-reaching impact on the spatial organisation of the family and the household (e.g. cross-border family ties, commuting, online communication). Moreover, for highly skilled labour, such as health workers, new types of communication and new forms of family/household organisation are expected to be highly relevant. Our main research question is as follows: What are the roles of the household, the family and kinship ties, the micro-environment and locality in the migration of health workers? The presentation aims to highlight the influence of family and household ties on the well-being of migrants and their relatives through the examples of Hungarian health workers. During our research various methods have been used: i) motivations and migration experiences of health workers were assessed by using semi-structured interviews; ii) migration-related aims and motivations of students in health education were investigated in a questionnaire survey; iii) and social representations of the migration of health workers, focusing on kinship and social ties, was evaluated in a content analysis.
One of the greatest challenges faced by healthcare systems worldwide is the shortage of skilled health workers. Besides, the problem of global medical human resource deficit is becoming more complex due to the uneven geographical distribution of healthcare professionals. International labour mobility is key important in this process: migration of health workforce can mitigate shortfalls in receiving areas, while further aggravating the situation in sending areas. Consequently, migration can contribute to growing inequalities in the geographical distribution of health workers, and thus it can indirectly shape the geographical patterns of health outcomes (i.e. health inequalities). Regional income disparities are often presented as the main cause of labour migration. However, the geographies of healthcare professionals' spatial mobility are more complex than might be expected from the analysis of regional income inequalities. Recent studies suggest that local factors such as kinship ties and work environment can play a role in the migration-related decisions of health workers, and in shaping the patterns of their movement (e.g. out-migration, return-migration, circular migration). In this presentation, two main research questions are addressed: 1) How do geographical factors (especially the characteristics of geographical places) influence the migration decisions of healthcare professionals?; 2) How can this knowledge about geographical factors be used to support evidence-based policy making? This contribution has a case-study approach, examining the migration of health workers with relation to the healthcare system in Hungary. To answer the research questions, both qualitative and quantitative methods are used: content analysis of online media, semi-structured interviews with health workers (mainly with practicing doctors), and a questionnaire survey with medical university students. Analysing the data gathered from these sources, the most important push-and pull-factors in health workers' migration are revealed, and an attempt is made to quantify the strength of these factors (to what extent they contribute to migration intentions). Regarding the second research question, this presentation ends with some policy recommendations for national and local level decision makers to retain or attract skilled health workers, and to reduce health inequalities.
Szabolcs Fabula
added a research item
The migration of health care professionals is one of the most discussed topics within the scientific literature on international migration. The results of researches often depend on the level of analysis and the focus of the approaches. Thus, it is important to gain information on the various theories of migration – this makes possible to reveal their potentials and constraints. To this end, we conducted content analysis on the international literature focusing on the migration of health care professionals. According to our results, micro, meso and macro level approaches can be defined. There are differences between them regarding the factors taken into account and the social and spatial level of analysis. Kulcsszavak: orvosmigráció, brain drain, migráció, elmélet
Private Profile
added a research item
The migration of health care professionals has widespread effects on Hungarian health care services. Thus, this process is a highly debated one in public and professional discourses. Our study analyses the media representation of medical brain drain: the presentation of processes and the actors involved. Furthermore, we also analyse the role of space and place in media narratives. According to our results, the state is the most often presented and the most powerful actor in relation to the outmigration of health care professionals. Thus, the role of localities is limited in these discourses; they only serve as the locations of events. In the media discourses on the effects of medical migration, places are often mentioned only as general, abstract places, such as peripheries, or rural areas. In the framing of migration the so-called traditional approach seems to be the most often used; thus, medical migration is interpreted as a loss of human resources and training costs, which endangers heath care provision.
Szabolcs Fabula
added a project goal
The work-related international migration of healthcare professionals is a long-lasting phenomenon but the last few decades have witnessed a considerable intensification of the process at a global scale. The volume of health workers’ migration is especially immense in Central and Eastern Europe (including Hungary), and in some regions the massive outflow of doctors and nurses poses a serious threat to health service provision.
In this project we examine the causes, motivations and impacts of the work-related emigration of healthcare professionals from Hungary (involving expatriates and health workers who are still working in Hungary). Previous research has mainly focused on the effects of migration on healthcare systems or on the sociological dimensions of the phenomenon, and less attention has been paid to geographical aspects. Our main objective is to understand the role of space and place in the out-migration of healthcare professionals (e.g. migration decisions, policy responses), simultaneously paying attention to the importance of international, national and subnational scales. Our multi-method research design combines statistical analyses, content analysis, questionnaire survey among medical students and qualitative interviews with healthcare professionals and policy makers.
This three-year project (2017-2020) is financed by the Hungarian National Research, Development and Innovation Office (project no.: 124938), and it has a total budget of HUF 15.295 million (€ 49,337).