Fwd: Re: Issue of freedom and migration, Re: CPOE time studies and a word from the other side.
Note: forwarded message attached. __ Do You Yahoo!? Tired of spam? Yahoo! Mail has the best spam protection around http://mail.yahoo.com ---BeginMessage--- --- Tim Churches [EMAIL PROTECTED] wrote: I am not sure about these arguments. Migration is one issue as it is a possible permanent loss of a skilled person from one country to another. There is a loss of British, Australian, Austrian and others who also move to the USA for example. This is promoted by the USA too. The number of British scientists who have been recruited in such a manner to the US is well known. Do you think the British have not lost? The other problem is that the skilled medical or others in the poorer countries are not given the facilities to work. They can be thoroughly frustrated as a result. Their knowledge and skill is NOT appreciated in their own country. They maybe too qualified and skilled for the country of their origin. They try really hard to do something useful but nobody cares to help - particularly the administrators. They can be lost to their own citizens. What if some other country can make use of them to help their own people, and they want to have a better health care system, and can and will give them the conditions they need to work to the best of their skill and knowledge? Must they be lost to everyone? Take away migration. Many of them do NOT want to migrate, They want to work w few years in another country which will allow them to improve their skills and knowledge and also earn enough to save something and go back to their own country. This is good for both countries. If this is encouraged and made easier to do, but migration is not, then neither side will lose. Nandalal On Wed, 2004-10-13 at 05:41, Andrew Ho wrote: On Tue, 12 Oct 2004, Karsten Hilbert wrote: When the UK, Canada or Australia recruits such a person to work in the UK, Canada or Australia, do they reimburse the South African government for the cost Double standard you use. No. Or rather, yes. Question is WHY a double standard is used. Tim believes applying a double standard is the morally right thing to do in this particular situation. This discussion needs to include consideration of personal freedom and discrimination (or preferential treatment) based on country of origin. Indeed, and our argument is that there should NOT be preferential treatment, through active recruitment and assisted migration, of skilled health care professionals from needy countries to wealthy countries. I think we are in violent agreement. -- Tim C PGP/GnuPG Key 1024D/EAF993D0 available from keyservers everywhere or at http://members.optushome.com.au/tchur/pubkey.asc Key fingerprint = 8C22 BF76 33BA B3B5 1D5B EB37 7891 46A9 EAF9 93D0 ___ Do you Yahoo!? Declare Yourself - Register online to vote today! http://vote.yahoo.com ---End Message---
Re: Issue of freedom and migration, Re: CPOE time studies and a word from the other side.
On Wed, 13 Oct 2004, Nandalal Gunaratne wrote: ... There is a loss of British, Australian, Austrian and others who also move to the USA for example. This is promoted by the USA too. The number of British scientists who have been recruited in such a manner to the US is well known. Do you think the British have not lost? Tim and Nandalal, Looking at it a different way, both British and U.S. (and the entire human race) gain when individuals migrate and maximize their opportunity to contribute their talents. This is analogous to free software developers who abandon one project and re-direct their time and energy to a different project. The other problem is that the skilled medical or others in the poorer countries are not given the facilities to work. They can be thoroughly frustrated as a result. Their knowledge and skill is NOT appreciated in their own country. They maybe too qualified and skilled for the country of their origin. They try really hard to do something useful but nobody cares to help - particularly the administrators. Right, they should have a choice to migrate if they so choose. Employers and societies should freely compete for the time and energy of their workers - this is a feature of free market economy. Organizations (e.g. countries, cities) exist to serve their members, not the other way around. They can be lost to their own citizens. What if some other country can make use of them to help their own people, and they want to have a better health care system, and can and will give them the conditions they need to work to the best of their skill and knowledge? Must they be lost to everyone? Well said. This is why barriers to free flow of human resources hurt everyone in the end. Take away migration. Many of them do NOT want to migrate, It takes lots of work to migrate. However, sometimes there are sufficient reasons for people to do so. They want to work w few years in another country which will allow them to improve their skills and knowledge and also earn enough to save something and go back to their own country. True, that can happen too. A key question is _who_ should decide where and when to move? This is good for both countries. If this is encouraged and made easier to do, but migration is not, then neither side will lose. My view is that it is up to each society to attract and keep their productive memebers. A permanent migration can become a temporary one if sufficient incentives are given to recruit the individuals back to their country of origin. Similarly, a temporary migration can become permanent. Best regards, Andrew --- Andrew P. Ho, M.D. OIO: Open Infrastructure for Outcomes www.TxOutcome.Org
Re: Issue of freedom and migration, Re: CPOE time studies and a word from the other side.
On Wed, 2004-10-13 at 19:28, Nandalal Gunaratne wrote: I am not sure about these arguments. Migration is one issue as it is a possible permanent loss of a skilled person from one country to another. There is a loss of British, Australian, Austrian and others who also move to the USA for example. This is promoted by the USA too. The number of British scientists who have been recruited in such a manner to the US is well known. Do you think the British have not lost? Yes, but countries like Britain and Australia are better able to make up that loss than less wealthy countries. That was my point. The other problem is that the skilled medical or others in the poorer countries are not given the facilities to work. They can be thoroughly frustrated as a result. Their knowledge and skill is NOT appreciated in their own country. They maybe too qualified and skilled for the country of their origin. They try really hard to do something useful but nobody cares to help - particularly the administrators. Sure. But the solution to that problem is not for rich countries to try to attract these disaffected health professionals to migrate. The solution is more aid to help build and/or reform the health systems in poorer countries. They can be lost to their own citizens. What if some other country can make use of them to help their own people, and they want to have a better health care system, and can and will give them the conditions they need to work to the best of their skill and knowledge? Must they be lost to everyone? See above. Take away migration. Many of them do NOT want to migrate, They want to work w few years in another country which will allow them to improve their skills and knowledge and also earn enough to save something and go back to their own country. This is good for both countries. If this is encouraged and made easier to do, but migration is not, then neither side will lose. Sure, I have no problem with that, as long as it is not a permanent loss. Nor am I in favour of banning migration of skilled professionals from poorer countries to richer countries. I am just against richer countries actively promoting and assisting such migration flows. Tim C Nandalal On Wed, 2004-10-13 at 05:41, Andrew Ho wrote: On Tue, 12 Oct 2004, Karsten Hilbert wrote: When the UK, Canada or Australia recruits such a person to work in the UK, Canada or Australia, do they reimburse the South African government for the cost Double standard you use. No. Or rather, yes. Question is WHY a double standard is used. Tim believes applying a double standard is the morally right thing to do in this particular situation. This discussion needs to include consideration of personal freedom and discrimination (or preferential treatment) based on country of origin. Indeed, and our argument is that there should NOT be preferential treatment, through active recruitment and assisted migration, of skilled health care professionals from needy countries to wealthy countries. I think we are in violent agreement. -- Tim C PGP/GnuPG Key 1024D/EAF993D0 available from keyservers everywhere or at http://members.optushome.com.au/tchur/pubkey.asc Key fingerprint = 8C22 BF76 33BA B3B5 1D5B EB37 7891 46A9 EAF9 93D0 ___ Do you Yahoo!? Declare Yourself - Register online to vote today! http://vote.yahoo.com -- Tim C PGP/GnuPG Key 1024D/EAF993D0 available from keyservers everywhere or at http://members.optushome.com.au/tchur/pubkey.asc Key fingerprint = 8C22 BF76 33BA B3B5 1D5B EB37 7891 46A9 EAF9 93D0
Re: Issue of freedom and migration, Re: CPOE time studies.
When the UK, Canada or Australia recruits such a person to work in the UK, Canada or Australia, do they reimburse the South African government for the cost Double standard you use. No. Or rather, yes. Question is WHY a double standard is used. Tim believes applying a double standard is the morally right thing to do in this particular situation. Karsten -- GPG key ID E4071346 @ wwwkeys.pgp.net E167 67FD A291 2BEA 73BD 4537 78B9 A9F9 E407 1346
Re: Issue of freedom and migration, Re: CPOE time studies.
On Tue, 12 Oct 2004, Karsten Hilbert wrote: When the UK, Canada or Australia recruits such a person to work in the UK, Canada or Australia, do they reimburse the South African government for the cost Double standard you use. No. Or rather, yes. Question is WHY a double standard is used. Tim believes applying a double standard is the morally right thing to do in this particular situation. This discussion needs to include consideration of personal freedom and discrimination (or preferential treatment) based on country of origin. Furthermore, intentionally discriminatory policies may have very limited effects anyways within a free market economy. Best regard, Andrew --- Andrew P. Ho, M.D. OIO: Open Infrastructure for Outcomes www.TxOutcome.Org
Re: Issue of freedom and migration, Re: CPOE time studies.
On Wed, 2004-10-13 at 05:41, Andrew Ho wrote: On Tue, 12 Oct 2004, Karsten Hilbert wrote: When the UK, Canada or Australia recruits such a person to work in the UK, Canada or Australia, do they reimburse the South African government for the cost Double standard you use. No. Or rather, yes. Question is WHY a double standard is used. Tim believes applying a double standard is the morally right thing to do in this particular situation. This discussion needs to include consideration of personal freedom and discrimination (or preferential treatment) based on country of origin. Indeed, and our argument is that there should NOT be preferential treatment, through active recruitment and assisted migration, of skilled health care professionals from needy countries to wealthy countries. I think we are in violent agreement. -- Tim C PGP/GnuPG Key 1024D/EAF993D0 available from keyservers everywhere or at http://members.optushome.com.au/tchur/pubkey.asc Key fingerprint = 8C22 BF76 33BA B3B5 1D5B EB37 7891 46A9 EAF9 93D0
Re: Issue of freedom and migration, Re: CPOE time studies.
On Tue, 2004-10-05 at 20:11, Calle Hedberg wrote: Finally, just to put the focus back where it started: One key difference between countries with far too few doctors - but often easier access to e.g. admin staff (South Africa has 40% unemployment rate, many of them matriculants that could fill admin positions) - is that it makes little sense to increase doctor workload but decrease admin workload. It makes more sense to do the opposite, and I think that's one reason why most EHR systems don't work well here - they are tailored for health systems with a much higher density of doctors. So while we might regret excessive brain-drain, it is not likely to change much in the short term. What needs to change is the design and focus of EHR systems in societies with already over-loaded health personnel. These are excellent points, and in such contexts handwriting recognition software is not the issue - rather it is designing paper forms in a way which maximise the ease of use by health care professionals, and minimise transcription errors when admin staff keypunch the information captured on them. There may be lessons to be learnt from other industries which also still thrive on paper forms filled out by clients and sales agents - such as the insurance industry. Has anyone done any RD into voice recording for health information systems, I wonder? Certainly there are highly developed dictation systems for radiologists and procedural specialists (such as endoscopists) who need a hands-free recording capability. Some of these systems even use voice recognition as opposed to a human typist. I recently borrowed a solid state MP3 player with 256MB of flash memory to record a seminar session with its in-built microphone. I was impressed by the quality of the recording, and many hours could be squeezed on to the device (even more if voice-specific compression algorithms like Speex were used). Might a cheap, ruggedised version of these devices designed specifically for voice recording might find application in healthcare settings in the two-thirds world? -- Tim C PGP/GnuPG Key 1024D/EAF993D0 available from keyservers everywhere or at http://members.optushome.com.au/tchur/pubkey.asc Key fingerprint = 8C22 BF76 33BA B3B5 1D5B EB37 7891 46A9 EAF9 93D0
Issue of freedom and migration, Re: CPOE time studies.
On Mon, 5 Oct 2004, Tim Churches wrote: On Tue, 2004-10-05 at 08:01, Calle Hedberg wrote: ... Add to that the fact that UK, Canada, Australia and other countries systematically poach doctors and nurses from SA (we have over 30,000 vacant nurse positions now) - the impact on workload should be obvious. Yes, and it is a totally unconscionable trade in human resources. Calle and Tim, Why is it unconscionable to freely trade human resources? Have you interviewed individuals who chose to migrate? I have. - begin quote The German free-market economist Wilhehm Roepke once suggested that modern nationalism and collectivism have, by the restriction of migration, perhaps come nearest to the servile state . Man can hardly be reduced more to a mere wheel in the clockwork of the national collectivist state than being deprived of his freedom to move - end quote from In Defense of Free Migration, Richard Ebeling, The Future of Freedom Foundation http://www.fff.org/freedom/0691b.asp It's okay for rich countries to fight amongst themselves for trained health staff, I see. There are different kinds human beings: those born to rich countries and those born to poor countries? And it is _harmful_ to offer the same opportunities to individuals from poor countries? As we all know, major motivation for free software is to increase freedom and lower costs. If vendor lock-in impedes progress and adds to information costs, country-of-birth lock-in carries even higher human and economic costs. Best regards, Andrew --- Andrew P. Ho, M.D. OIO: Open Infrastructure for Outcomes www.TxOutcome.Org
Re: Issue of freedom and migration, Re: CPOE time studies.
On Tue, 2004-10-05 at 09:47, Andrew Ho wrote: On Mon, 5 Oct 2004, Tim Churches wrote: On Tue, 2004-10-05 at 08:01, Calle Hedberg wrote: ... Add to that the fact that UK, Canada, Australia and other countries systematically poach doctors and nurses from SA (we have over 30,000 vacant nurse positions now) - the impact on workload should be obvious. Yes, and it is a totally unconscionable trade in human resources. Calle and Tim, Why is it unconscionable to freely trade human resources? It is unconscionable because the rich countries do not pay a fair price for the very valuable human resources they are encouraging (and helping) to migrate to their countries. For example, it probably costs the South African government (and hence the South African people) between US$50,000 and US$150,000 to train a medical student through to being a specialist physician or surgeon. When the UK, Canada or Australia recruits such a person to work in the UK, Canada or Australia, do they reimburse the South African government for the cost of that training, plus the much greater opportunity cost of having to train a replacement over a ten year period? No, they don't. That situation seems unconscionable to me, especially when the relative need for trained health staff in South Africa is so much greater than in the UK, Canada and Australia. - begin quote The German free-market economist Wilhehm Roepke once suggested that modern nationalism and collectivism have, by the restriction of migration, perhaps come nearest to the servile state . Man can hardly be reduced more to a mere wheel in the clockwork of the national collectivist state than being deprived of his freedom to move - end quote from In Defense of Free Migration, Richard Ebeling, The Future of Freedom Foundation http://www.fff.org/freedom/0691b.asp Sorry, all that laissez-faire, totally free-market, right-wing libertarianism stuff is wasted on me. I unapologetically believe that the state has a role and responsibility to help redistribute wealth from the rich to the poor. It's okay for rich countries to fight amongst themselves for trained health staff, I see. There are different kinds human beings: those born to rich countries and those born to poor countries? That's the unfortunate but undeniable reality of the world today. The key is for governments and individuals to act in ways which reduce those disparities, not increase them. And it is _harmful_ to offer the same opportunities to individuals from poor countries? It is harmful for governments of rich nations to actively recruit and to facilitate the migration of desperately needed, expensively-trained individuals from poor countries. As we all know, major motivation for free software is to increase freedom and lower costs. If vendor lock-in impedes progress and adds to information costs, country-of-birth lock-in carries even higher human and economic costs. Neither Calle or I, or anyone else, have suggested that people be prevented from migration. The argument is against active recruitment and facilitated, preferential immigration programmes for skilled health care personnel from poorer countries to richer countries. It is morally wrong. -- Tim C PGP/GnuPG Key 1024D/EAF993D0 available from keyservers everywhere or at http://members.optushome.com.au/tchur/pubkey.asc Key fingerprint = 8C22 BF76 33BA B3B5 1D5B EB37 7891 46A9 EAF9 93D0
Re: Issue of freedom and migration, Re: CPOE time studies.
On Mon, 5 Oct 2004, Tim Churches wrote: ... Yes, and it is a totally unconscionable trade in human resources. Calle and Tim, Why is it unconscionable to freely trade human resources? It is unconscionable because the rich countries do not pay a fair price Tim, The concept of trading freely includes mechanism for establishing fair pricing that is acceptable by both seller and buyer. ... For example, it probably costs the South African government (and hence the South African people) between US$50,000 and US$150,000 to train a medical student through to being a specialist physician or surgeon. So what? It probably costs the same or more to train an U.S. medical student. Does that mean it is unconscionable for the people of France or South Africa to offer a position to this physician? When the UK, Canada or Australia recruits such a person to work in the UK, Canada or Australia, do they reimburse the South African government for the cost Double standard you use. If I decide to move to South Africa, would South Africans reimburse the U.S. government? ... That situation seems unconscionable to me, especially when the relative need for trained health staff in South Africa is so much greater than in the UK, Canada and Australia. Needs typically exheed the ability to fill the need; this is called scarcity in economics, please read: http://www.socialstudiesforkids.com/articles/economics/scarcityandchoices1.htm With greater scarcity, each unit of goods/service will command a higher price. In a free market, the higher price will eventually cause increased availability of the goods/services and reduction of scarcity. On the other hand, if price-control is instituted, then the relative shortage will never be resolved. ... And it is _harmful_ to offer the same opportunities to individuals from poor countries? It is harmful for governments of rich nations to actively recruit and to facilitate the migration of desperately needed, expensively-trained individuals from poor countries. It is not as simple as that. Most expensively-trained and talented individuals choose to migrate even in the face of active discouragements and barriers. As we all know, major motivation for free software is to increase freedom and lower costs. If vendor lock-in impedes progress and adds to information costs, country-of-birth lock-in carries even higher human and economic costs. Neither Calle or I, or anyone else, have suggested that people be prevented from migration. ... ok - as long as you are not advocating discrimination based on country-of-origin. Best regards, Andrew --- Andrew P. Ho, M.D. OIO: Open Infrastructure for Outcomes www.TxOutcome.Org
Re: Issue of freedom and migration, Re: CPOE time studies.
On Tue, 2004-10-05 at 14:21, Andrew Ho wrote: Needs typically exheed the ability to fill the need; this is called scarcity in economics, please read: http://www.socialstudiesforkids.com/articles/economics/scarcityandchoices1.htm With greater scarcity, each unit of goods/service will command a higher price. In a free market, the higher price will eventually cause increased availability of the goods/services and reduction of scarcity. Yes Andrew, eventually, and in theory, but in the meantime who provides health care for the huge numbers of HIV +ve people in Africa? Neither Calle or I, or anyone else, have suggested that people be prevented from migration. ... ok - as long as you are not advocating discrimination based on country-of-origin. No, we are against active recruitment and facilitated migration of trained health professionals from needy countries to wealthy countries. -- Tim C PGP/GnuPG Key 1024D/EAF993D0 available from keyservers everywhere or at http://members.optushome.com.au/tchur/pubkey.asc Key fingerprint = 8C22 BF76 33BA B3B5 1D5B EB37 7891 46A9 EAF9 93D0
