Monday, November 29, 2004

How Africa Subsidizes U.S. Health Care

Check out this interesting editorial in Wapo by Sebastian Mallaby:

(excerpt here)

It isn't a surprise that Africa is short of doctors and nurses: The continent has 1.4 health workers per 1,000 people, compared with 9.9 per 1,000 in North America. What's shocking is that this shortage is partly created by rich countries. Poor nations such as Malawi and Zambia are paying to train medics who emigrate to staff the hospitals of the United States and Europe. We should be helping Africa. Instead, Africa is subsidizing us.

Not just slightly, either. Ghana trains 150 doctors annually; five years after graduation, 80 percent have left, according to Ghanaian data reported by the World Bank. For pharmacists, the proportion is about 40 percent; for nurses and midwives, it's about 75 percent -- which is why half the nursing posts in Ghana are vacant. Meanwhile, South African doctors emigrate at a rate of about 1,000 annually. In 2001, Zimbabwe graduated 737 nurses; 437 left for one country, Britain.


And then there is another reform that applies specifically to one country. The United States must end its nutty overpayment for health care, which not only wastes billions but also sends price signals that depopulate hospitals in the poor world. Elliott Fisher of Dartmouth Medical School has demonstrated that regions of the United States with a high concentration of medics spend extra on health care without becoming healthier: This country actually has too many health workers. Meanwhile in Africa a single nurse can be responsible for 50 patients. Because of America's dysfunctional system, the global labor market is siphoning doctors from places where they are needed into places where they accomplish nothing measurable at all.

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