The Economics of Health Professional Education and Careers: Insights from a Literature Review (World Bank Studies)

The formation of health professionals is critical for the health system to function and to achieve its universal health coverage (UHC) goals, and this is well recognized by the majority of governments that plan to ensure enough training places and aim to regulate in order to ensure quality. But the importance of market forces is often overlooked, resulting in interventions and regulations that often fail to achieve their intended effects. This publication aims to inform the design of health professionals'education policies to better manage health labor market forces toward UHC. It documents what is known about the influence of market forces on the health-professional formation process. The report sought to answer the following questions: - What have been the large global and regional trends in the development of health professions? - How have these trends affected the career decisions of current and potential health professionals? - What is the evidence base on the value and effectiveness of health professional education of different types? - How has the market for health professional education evolved, and with what interrelationships with the health labor and health care markets? The contexts of the market for health professional training have been subject to important changes in recent decades, in particular: the growing extent of employment of mid-level cadres of health professionals; changes in technology and the associated growth of high skilled occupations; the increasing interconnectedness of national health systems through globalization, with its implications for international health professional mobility; and the greater complexity of the public-private mix in employment options. There is a need to ensure that market forces align with the intentions of planning and regulation and the needs of UHC goals. This publication provides recommendations to support the design of policies that help to achieve these. Contents (v) 5 Acknowledgments (vii) 7 Executive Summary (ix) 8 Policy Recommendations (xii) 11 Abbreviations (xiii) 12 1. Introduction (1) 13 Figure 1.1 The Interaction between Education Systems, Labor Markets, and Health Systems (2) 14 Box 1.1 Market Failures in Health Worker Labor Markets (3) 15 2. Historical Trends and Globalization (5) 17 Note (8) 20 3. Specialty Choice among Health Professionals and Its Health Labor Market Determinants (9) 21 Figure 3.1 The Bland-Meurer Model of Primary Care Career Choice for Physicians (10) 22 Trends in Specialty Preference (10) 22 Student Characteristics (12) 24 Specialty Characteristics (13) 25 Box 3.1 Effect of General Practitioners’ Reimbursement on Supply in the United Kingdom (14) 26 Figure B3.1.1a Proportion of Graduating Cohorts in U.K. Medical Schools Choosing General Practice (14) 26 Figure B3.1.1b General Practitioners’ Annual Income (15) 27 School Characteristics (17) 29 Notes (18) 30 4. The Value of Health Professional Education (19) 31 Alternative Cadres (19) 31 Estimated Rates of Return to Health Professional Education (19) 31 Figure 4.1 The Hours-adjusted Internal Rate of Return on Additional Training for Five Surgical Specialties and Primary Care Medicine (24) 36 5. The Market for Health Professional Education (27) 38 Linked Markets: Health Professional Education and Health Care (27) 38 Figure 5.1 Interrelationships between Health Professional Job Market and Health Professional Education Market (29) 40 Box 5.1 How Demographics and Positioning of the Nursing Profession Can Interrelate, Israel (30) 41 Privatization of Health Professional Education in LMICs (31) 42 Figure 5.2 Founding Dates of Medical Schools in Sub-Saharan Africa by Sector (32) 43 Box 5.2 Market Failure in Nepal (34) 45 Notes (35) 46 6. Discussion (37) 47 Research Implications (38) 48 Policy implications (41) 51 Appendix A. Literature Search Strategy (45) 54 Table A.1 Search Terms (45) 54 Table A.2 MESH Terms (45) 54 Appendix B. Coverage of the Literature in Relation to Private and Social Perspectives on the Rate of Return (47) 55 References (50) 58 Appendix C. Estimates of Private Rates of Return and Net Present Value (53) 61 References (54) 62 References (57) 64 Environmental Benefits Statement (78) 78 Contents (v)......Page 5 Acknowledgments (vii)......Page 7 Executive Summary (ix)......Page 8 Policy Recommendations (xii)......Page 11 Abbreviations (xiii)......Page 12 1. Introduction (1)......Page 13 Figure 1.1 The Interaction between Education Systems, Labor Markets, and Health Systems (2)......Page 14 Box 1.1 Market Failures in Health Worker Labor Markets (3)......Page 15 2. Historical Trends and Globalization (5)......Page 17 Note (8)......Page 20 3. Specialty Choice among Health Professionals and Its Health Labor Market Determinants (9)......Page 21 Trends in Specialty Preference (10)......Page 22 Student Characteristics (12)......Page 24 Specialty Characteristics (13)......Page 25 Figure B3.1.1a Proportion of Graduating Cohorts in U.K. Medical Schools Choosing General Practice (14)......Page 26 Figure B3.1.1b General Practitioners’ Annual Income (15)......Page 27 School Characteristics (17)......Page 29 Notes (18)......Page 30 Estimated Rates of Return to Health Professional Education (19)......Page 31 Figure 4.1 The Hours-adjusted Internal Rate of Return on Additional Training for Five Surgical Specialties and Primary Care Medicine (24)......Page 36 Linked Markets: Health Professional Education and Health Care (27)......Page 38 Figure 5.1 Interrelationships between Health Professional Job Market and Health Professional Education Market (29)......Page 40 Box 5.1 How Demographics and Positioning of the Nursing Profession Can Interrelate, Israel (30)......Page 41 Privatization of Health Professional Education in LMICs (31)......Page 42 Figure 5.2 Founding Dates of Medical Schools in Sub-Saharan Africa by Sector (32)......Page 43 Box 5.2 Market Failure in Nepal (34)......Page 45 Notes (35)......Page 46 6. Discussion (37)......Page 47 Research Implications (38)......Page 48 Policy implications (41)......Page 51 Table A.2 MESH Terms (45)......Page 54 Appendix B. Coverage of the Literature in Relation to Private and Social Perspectives on the Rate of Return (47)......Page 55 References (50)......Page 58 Appendix C. Estimates of Private Rates of Return and Net Present Value (53)......Page 61 References (54)......Page 62 References (57)......Page 64 Environmental Benefits Statement (78)......Page 78 The formation of health professionals is critical for the health system to function and to achieve its universal health coverage (UHC) goals, and this is well recognized by the majority of governments that plan to ensure enough training places and aim to regulate in order to ensure quality. But the importance of market forces is often overlooked, resulting in interventions and regulations that often fail to achieve their intended effects. This publication aims to inform the design of health professionals' education policies to better manage health labor market forces toward UHC. It documents what is known about the influence of market forces on the health-professional formation process. The report sought to answer the following questions:- What have been the large global and regional trends in the development of health professions? - How have these trends affected the career decisions of current and potential health professionals? - What is the evidence base on the value and effectiveness of health professional education of different types? - How has the market for health professional education evolved, and with what interrelationships with the health labor and health care markets? The contexts of the market for health professional training have been subject to important changes in recent decades, in particular: the growing extent of employment of mid-level cadres of health professionals; changes in technology and the associated growth of high skilled occupations; the increasing interconnectedness of national health systems through globalization, with its implications for international health professional mobility; and the greater complexity of the public-private mix in employment options. There is a need to ensure that market forces align with the intentions of planning and regulation and the needs of UHC goals. This publication provides recommendations to support the design of policies that help to achieve these The formation of health professionals is critical for the health system to function and to achieve its universal health coverage (UHC) goals. This is well recognized by the majority of governments that plan to ensure enough training places and aim to regulate in order to ensure quality. But the importance of market forces is often overlooked, resulting in interventions and regulations that often fail to achieve their intended effects. The Economics of Health Professional Education and Careers aims to inform the design of health professionals’ education policies to better manage health labor market forces toward UHC. It documents what is known about the influence of market forces on the health-professional formation process. The contexts of the market for health professional training have been subject to important changes in recent decades, in particular: the growing extent of employment of mid-level cadres of health professionals; changes in technology and the associated growth of high-skilled occupations; the increasing interconnectedness of national health systems through globalization, with its implications for international health professional mobility; and the greater complexity of the public†“private mix in employment options. There is a need to ensure that market forces align with the intentions of planning and regulation and the needs of UHC goals. This study provides recommendations to support the design of policies that help to achieve these goals.

The formation of health professionals is critical for the health system to function and achieve its universal health coverage (UHC) goals. This is well recognized by the majority of governments that plan for the training and regulations necessary to ensure quality. But the importance of market forces is often overlooked, resulting in interventions and regulations that often fail to achieve their intended effects. The Economics of Health Professional Education and Careers aims to inform the design of health professionals' education policies to better manage health labor market forces toward UHC. It documents what is known about the influence of market forces on the health professional formation process. The contexts of the market for health professional training have been subject to important changes in recent decades, in particular: the growing extent of employment of mid-level cadres of health professionals; changes in technology and the associated growth of high-skilled occupations; the increasing interconnectedness of national health systems through globalization, with its implications for international health professional mobility; and the greater complexity of the public-private mix in employment options. There is a need to ensure that market forces align with the intentions of planning and regulation and the UHC goals. This study provides recommendations to support the design of policies that help to achieve these goals.

This report examines the following questions: What have been the large global and regional trends in the development of health professions? How have these trends affected the career decisions of health professionals? What is the evidence base on the value and effectiveness of health professional education? How has the market for health professional education evolved?