Michael Clemens at the CGD in Washington has a paper on physician migration that a lot of people, at least a lot of public health people, like to hate. In his paper – Do Visas Kill? – he compares rates of external migration of African physicians with measures of health system performance in the sending country and does not find evidence to support the claim that higher rates of migration are associated with poorer health system performance. To avoid the possibility of reverse causality (namely that doctors migrate because of poor health system performance) he uses a number of instruments for rates of migration. In all, it is a pretty tight argument and is pretty convincing.
Part of his argument, and mostly what I think people who hate this paper don’t understand, is an argument that is based on an assumption that higher rates of migration effectively increase the expected wage of people deciding to go to school to become doctors. The higher the rate of migration, the higher my expected wage of become a doctor since there is now some chance that I could also earn a Western salary. Rather than depleting human capital, migration may actually increase it.
This has always been the part of the paper that I have found the least convincing. I have my doubts that the elasticity of supply of physicians was ever very responsive to wage rates in Africa. There are so my constraints to the supply of physicians that I have found this assumption somewhat hard to believe.
However, in a recent working paper from the CGD, Michael and his co-author Satish Chand evaluate the effect of high-skilled migration on tertiary educational attainment in a quasi-experimental setting in Fiji. They do find that higher rates of external migration were associated with increases in investments in tertiary education among those left behind.
While again this particular piece of works is very compelling, I again wonder about whether or not any of this might be transferable to Africa or to physicians in general.
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