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Review of Insourced: How Importing Jobs Impacts the Healthcare Crisis Here and Abroad

Posted By Guy Pfeffermann, Thursday, June 27, 2013

Guy Pfeffermann

GBSN Advisor Dr. Kate Tulenko recently published Insourced: How Importing Jobs Impacts the Healthcare Crisis Here and Abroad.

Dr. Tulenko’s book is a must read for anyone interested in international development (as well as those whose interest revolves around health issues within the United States). Put most simply, the book is about highly toxic "agglomeration effects”. Just as William Easterly showed that an inordinate share of US wealth is concentrated in a handful of zip codes, so it is with health workers. Market forces – meaning salaries and working conditions – draw talent to the highest-income locations within countries, and, internationally, to the highest-income countries. The social costs of such private incentives are appalling. With the exception of the most affluent metropolitan districts, whole countries, whereInsourced Cover diseases are rampant, are bereft of the nurses and doctors their inhabitants need. The same alas is true of rural areas in the United States, although general health conditions are far better there than in low-income countries.

Dr. Tulenko lists actions which the United States federal , state and local governments can take in order to stem the health skills drain: train more healthcare workers, more primary-care workers, more midlevel providers; train and employ more behavior-change healthcare workers; align student recruitment and training with healthcare needs; reduce the cost of healthcare-worker education; overhaul the way healthcare-worker training is funded; open the federal bonding system to all funders; increase healthcare workers’ productivity ; and last but not least, rationalize the US healthcare labor market; mitigate the impact of the recruitment of foreign healthcare workers. The list is daunting, but Dr. Tulenko offers practical suggestions for making progress on each of these fronts.


Click here to find Insourced online.


Guy Pfeffermann is the CEO and founder of the Global Business School Network.

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