Summary

The international migration of health professionals from low-income under-staffed health systems worsens the extreme global inequality in health services. The politics and economics of these migration patterns challenge neat boundaries around ‘national’, ‘international’ and ‘aid’, bringing into focus the embeddedness of national health services in internationally integrating markets and cross-border social relationships. This chapter uses the challenging aspects of health professionals' migration as a ‘lens’ for examining aspects of the economics of international redistribution in health care.

The chapter first demonstrates the distributive consequences of migration of health professionals: a perverse redistribution of resources from poor to rich. This is examined within a policy framework that takes as an assumption that labour markets are populated by individuals with equal human rights, and considers the implications for international obligations of rich countries' governments and citizens. It then provides evidence that health services financing and provision within countries is typically progressive, including public health care in much of sub-Saharan Africa, a fact obscured by international emphasis on its shortcomings. In most rich countries, the embedding of redistributive processes within institutionalized commitments to universalist health service provision has long stabilized governmental and social commitment to economic redistribution, while within federal countries and the EU, labour migration is often associated with cross-border redistributive transfers to enhance efficiency and equity.

It follows that as labour markets integrate between rich and poor countries, the economic arguments for sustained redistribution across borders become stronger, while the experience of stable redistribution within health services suggests that health may be an excellent site for progressive international fiscal transfers.