healthcare workers

[OPINION] Stop blaming migration for the country’s nursing woes

Julan Omir Aldover

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[OPINION] Stop blaming migration for the country’s nursing woes

Alejandro Edoria/Rappler

'As the Philippines strives to fortify its healthcare sector, solutions to the sector's gaps must come from a more comprehensive understanding of the complex forces at play'

Citing higher pay abroad as the primary motivation, President Bongbong Marcos lodges blame on migration for the country’s pressing nurse shortage.

The President’s remarks came from a meeting dated March 29 with the Private Sector Advisory Council’s Health Sector Group. The episode provided a glimpse into how the Chief Executive views the issue of nurse migration: a zero-sum game. For the President, migration leads to a loss of nursing talents that could have filled the country’s healthcare system. However, this simplistic notion ignores that increased foreign demand also increases supply in the domestic market, and the effect of migration through this channel leads to a net growth for the country’s domestic nurse supply.

To test this, imagine a scenario where foreign countries cut off demand for Filipino nurses. If you are a prospective college student with an undecided major, the lack of foreign demand for nurses means there are fewer career opportunities for nurses. This acts as a huge disincentive against taking up a nursing major, thereby lessening the supply of future nurses. The disincentivizing effect applies to all college majors but is amplified if career opportunities abroad present the biggest financial returns as it is with nursing. 

If other countries demand high numbers of Filipino nurses instead, there is a huge incentive to apply for a nursing major that is amplified by the job’s high wages abroad, thereby increasing the supply of nurses. If the potential for high returns abroad create a powerful enough incentive, the increase in supply will exceed the demand for Filipino nurses abroad. The surplus supply will end up working in the Philippines as part of the country’s domestic workforce. In this scenario, foreign countries’ appetite for Filipino nurses increases the country’s domestic supply of nurses.

All else equal, the former scenario is deleterious for the country’s healthcare system. The same level of demand for healthcare coupled by a lower domestic supply of nurses will strain the country’s healthcare system even worse than the present nurse shortage.

Fortunately, the Philippines’ actual experience tracked the latter scenario. Research indicates that accommodative immigration policies by foreign countries for nurses increase the number of nurses working domestically. One study exploited the looser US visa policy for foreign nurses and their families from 2000-2007 to identify how migration affects the domestic supply of nurses in the Philippines. It determined that:

Combining data on all migrant departures and post-secondary institutions in the Philippines, we show that nursing enrolment and graduation increased substantially in response to greater US demand for nurses. The supply of nursing programs expanded to accommodate this increase. Nurse quality, measured by licensure exam pass rates, declined. Despite this, for each nurse migrant, 10 additional nurses were licensed. New nurses switched from other degree types, but graduated at higher rates than they would have otherwise, thus increasing the human capital stock in the Philippines.

While there is a decrease in the quality of nurses, a 10 to 1 ratio of new nurses to migrated nurses is a drastic improvement in nurse supply, and the study notes that many of the new nurses worked in underserved areas. The increase in supply was manifold due to the powerful combination of high pay rates for nurses abroad and the chance of obtaining legal status for their families in the United States. These incentives attracted many hopefuls to take up nursing for a shot at migrating overseas.

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The truth is that statistics on the lack of nurses prove only that there is a lack of nurses. It does not say anything about what caused the scarcity or if migration had an exacerbating impact. Factors such as population growth or increased incomes may have a greater effect than the miniscule deductions caused by migration on domestic nurse supply. The migration-supply dynamic demonstrated above contradicts the view held by the President on the nursing shortfall.

To be fair, the President is not the only official in the government cadre to succumb to this narrative. In one of the most forthright depictions of the zero-sum migration mindset I have seen, Health Undersecretary Maria Rosario Vergeire referred to the nurse shortage as a “bleeding” that needs to be stopped during an interview with foreign media.

“The countries getting our nurses should also be for some form of exchange so there would be something for our country,” she remarked in an obvious demand for a quid pro quo.

It is worrisome that this faulty assumption about migration dominates policy circles. Unfortunately, there is no public pushback against the faulty narrative. Recent conversations I’ve had with some members of the public indicate that the general opinion has subscribed to the faulty narrative of migration as well. The rising sentiment that migration is contributing to the scarcity of nurses in the country increases the risk of misguided public health and migration policies being passed with much public fanfare.

As the Philippines strives to fortify its healthcare sector, solutions to the sector’s gaps must come from a more comprehensive understanding of the complex forces at play. Policymakers can start by learning that migration is not a game of winners and losers. –

Julan Omir P. Aldover is a BA Political Science graduate from Leyte Normal University. He is an advocate for better economic education and has written for the Foundation for Economic Education, a US think tank.

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