Medical Brain Drain : Zimbabwe's Health Delivery System at Stake

다국어 초록 (Multilingual Abstract)

This paper analyzes the impact of medical brain drain on the public hospitals’ health delivery system in Zimbabwe. The paper employs the nationalist model which prioritizes costs over benefits on the remaining population and argues that medical brain drain has adverse effects on the public health delivery system in Zimbabwe.
The negative effects include opportunity costs of investment in medical education, an increase in replacement costs of practitioners and nurses with very expensive expatriates or “doctors without borders”, very high physician and nurse patient ratios which have increased the workloads and working hours of the remaining health professionals in Zimbabwe’s public health sector. These factors have led to an increase in the risk of errors and spreading of diseases, an increase in lives lost due to lack of non-emergency and specialist care, it has also crippled the development of new programs and medical innovations.
However, the benefits of medical brain drain on Zimbabwe’s public health delivery system were also incorporated in the analysis. Concerning the benefits of medical brain drain, there are certainly some benefits as the remittances are flowing back to Zimbabwe. However, they are not being fully invested in the public hospital health delivery system, rather they are being consumed. Thus, the thesis shows that medical brain drain has had negative effects on the public hospitals’ health delivery system in Zimbabwe which calls for serious policy interventions.

국문 초록 (Abstract)

이 논문은 짐바브웨의 의료 두뇌유출이 공공의료 서비스 시스템에 미치는 영향을 분석한다. 이 논문은 국민들을 위한 유익보다 비용을 우선시 하는 내셔널리스트 모델 (Nationalist model)을 적용하여 의료 두뇌유출이 짐바브웨의 공공의료 시스템에 부정적인 영향을 미쳤다고 주장한다.
부정적인 효과에는 다음과 같은 것이 포함된다: 의료교육 투자의 기회 비용, 해외 의사와 간호사로 대체하는데 드는 고비용 증가, 의사/간호사 1명당 상당히 높은 환자 비율로 인해 이들 의료진의 과중한 업무량 증가, 이로 인해 짐바브웨의 공공의료 부문에서 근무하는 의료진이 의료 사고를 일으키고 질병을 전파시키는 위험 증가, 응급실 부족과 전문가의 치료 부족으로 생명을 잃게 되는 가능성 증가. 이 논문의 저자는 이러한 문제점들이 새로운 의료 프로그램과 의료개선을 발전을 저해하였다고 주장한다.
한편, 의료 두뇌유출이 짐바브웨에 미친 긍정적 효과도 있다. 그 긍정적 측면에는 이들이 해외에서 짐바브웨로의 보내는 송금액이 포함된다. 그러나 이 송금액이 공공의료시스템 개선을 위해 재 투자되지 않고 단지 소비되고 있다. 따라서 이 논문은 의료 두뇌유출이 공공의료서비스 시스템에 부정적 영향을 미치고 있으며 이를 해결하기 위한 정책적 조치가 매우 필요하다는 점을 주장한다.

목차 (Table of Contents)

• Ⅰ. INTRODUCTION = 1
• A. Statement of the problem = 1
• B. Justification and significance of the problem = 1
• C. B.Brief Outline of the thesis = 2
• Ⅱ. CRITICAL REVIEW OF LITERATURE = 4
• A. Concept of Brain Drain = 4
• B. Theoretical Literature Review = 6
• C. Empirical Literature Review = 10
• D. Implications of the Literature Review = 18
• Ⅲ. ANALYTICAL FRAMEWORK = 20
• A. Analytical Framework Specification = 20
• B. The Determinants = 21
• 1. Absolute measures of Medical Brain Drain = 21
• 2. Relative measures of Medical Brain Drain = 21
• 3. Effects of Medical Brain Drain on Health Delivery System = 22
• Ⅳ. ANALYSIS OF MEDICAL BRAIN DRAIN IN ZIMBABWE = 25
• A. Presentation and Analysis of Findings = 25
• B. Absolute Measures of Medical Brain Drain in Zimbabwe = 25
• C. Relative Measures of Medical Brain Drain in Zimbabwe = 27
• D. Causes of Medical Brain Drain in Zimbabwe = 29
• E. Effects of Medical Brain on Health Delivery System in Zimbabw = 36
• Ⅴ. CONCLUSIONS AND RECOMMENDATIONS = 43
• A. Key Findings of the Research = 43
• B. Theoretical and Empirical Significance of the Research = 45
• C. Recommendations = 45
• D. Limitations and Suggestions for Further Study = 48
• References = 50
• ABASTRACT in Korean = 55