The impact of physician migration on mortality in low and middle-income countries: An economic modelling study

Research output: Contribution to journalArticle


Background The WHO estimates a global shortage of 2.8 million physicians, with severe deficiencies especially in low and middle-income countries (LMIC). The unequitable distribution of physicians worldwide is further exacerbated by the migration of physicians from LMICs to high-income countries (HIC). This large-scale migration has numerous economic consequences which include increased mortality associated with inadequate physician supply in LMICs. Methods We estimate the economic cost for LMICs due to excess mortality associated with physician migration. To do so, we use the concept of a value of statistical life and marginal mortality benefit provided by physicians. Uncertainty of our estimates is evaluated with Monte Carlo analysis. Results We estimate that LMICs lose US$15.86 billion (95% CI $3.4 to $38.2) annually due to physician migration to HICs. The greatest total costs are incurred by India, Nigeria, Pakistan and South Africa. When these costs are considered as a per cent of gross national income, the cost is greatest in the WHO African region and in low-income countries. Conclusion The movement of physicians from lower to higher income settings has substantial economic consequences. These are not simply the result of the movement of human capital, but also due to excess mortality associated with loss of physicians. Valuing these costs can inform international and domestic policy discussions that are meant to address this issue.


  • Saurabh Saluja
  • Niclas Rudolfson
  • Benjamin Ballard Massenburg
  • John G. Meara
  • Mark G. Shrime
External organisations
  • Yale University
  • Harvard University
  • University of Washington
  • Boston Children's Hospital
  • Massachusetts Eye and Ear Infirmary
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Public Health, Global Health, Social Medicine and Epidemiology
  • Health Care Service and Management, Health Policy and Services and Health Economy


  • epidemiology, health economics, health policies and all other topics, medical demography
Original languageEnglish
Article numbere001535
JournalBMJ Global Health
Issue number1
Publication statusPublished - 2020
Publication categoryResearch