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Policy Context of Filipino Nurses' Migration to the United States and Canada

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Policy Context of Filipino Nurses' Migration to the United States and Canada
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    1   Policy Context of Filipino Nurses ’  Migration to the United States and Canada Dr. Trinidad Osteria  Occasional paper No.4 2 Introduction The substantial increase in the elderly population in the US and Canada in the next decades will have an unprecedented effect on the health care system. A major issue that emanates from this demographic phenomenon is the need to balance the supply of and demand for health care workers. The pool of nurses in these countries will further decrease as large numbers retire or reduce their length of service. At the same time, the increasing number of the elderly consumes a disproportionate share of the health services and intensifies the need for nursing care 1 . Several questions are raised that will be addressed in this paper: 1.   What were the “pull” factors in the deployment of nurses to United States and Canada? 2.   What recruitment policies were adopted by these countries to attract such migration? 3.   How did the Philippines respond to the increased demand for nurses and what were the implications in terms of training and quality of instruction? 4.   What were the consequences of the significant increase in nurses’ deployment overseas on the manpower supply particularly in rural areas in the Philippines? 5.   What are the current developments in the receiving countries that may affect future recruitment of Filipino nurses?; and 6.   What are the recommendations to maximize the economic impact of nurses’ remittances?      3   A. The Ageing of the Population in US and Canada: Implications on Nursing Manpower Demand In the past decade, demographers from the United States and Canada noted the “second demographic transition”  with sub-replacement levels of growth, improved mortality (reduction in age specific mortality rates and increase in life expectancy) and declines in fertility. This resulted in the shift in the age structure of the population with an increasing proportion in the older age group (65 years and over). Population ageing imperils many institutions. The most evident are the health and pension systems. Policy makers estimated the manpower required to meet the emerging health needs and adjusted their migration policy to facilitate the overseas recruitment of nurses. The need for foreign nurses stems from three major concerns: the care of the increasing number of elderly; their demand for critical and chronic services; and the decline in the number of nurses. The governments realized that immigration policies tailored to attract nurses from developing countries can alleviate the anticipated health burden 2 . Tables 1a and 1b give the estimated number and percentage of the elderly population in the United States and Canada for selected years. In the United States, the number of adults 65 years and older will increase from 35 million or 12.5 percent of the total population in 2000 to 54.6 million or 16.4 percent by 2020; and 86.7 million or 20.7 percent by 2050. The number of people 85 years and older (the “oldest - old”) will increase from 4.3 million (1.6%) in 2000 to 7.3 million (2.3%) in 2020 and 20.9 million (5%) by 2050 (Table 1a). The millions of American children born between 1946 and 1964 known as the “baby boomers” will become elderly between 2013 and 2029. The American life expectancy continues to increase such that a substantial percentage of these baby boomers will live to celebrate their 85 th  birthday and beyond 3 . The number of Canadian elderly was estimated as 4.2M in 2005 representing 13 percent of the total population. By 2021, the number will rise to 6.8M or almost a fifth (18.7%) of the total 4 . By 2051, the elderly will number 11.1M or more than a fourth (26.5%) of the population (Table 1b).  Occasional paper No.4 4 The increasing percentage of the elderly with time progression in the two countries is succinctly illustrated in Figures 1a and 1b. Table 1a. Number and Percentage of the Elderly Population, US (in thousands), 2000-2050 Year 2000 2010 2020 2030 2040 2050 Age Group (Years) No. % No. % No. % No. % No. % No. % 65-84 30,794 10.9 34,120 11.0 47,363 14.1 61,850 17.0 64,460 16.5 65,844 15.7 85+ 4,267 1.6 6,123 2.1 7,269 2.3 9,603 2.6 15,409 4.0 20,861 5.0 Total 35,061 12.5 40,243 13.1 54,632 16.4 71,453 19.6 79,869 20.5 86,705 20.7 Source: US Census Bureau, 2004, “Projected Population of the United States, by Age and Sex: 2000 to 2050. ”Retrieved from   http://www.census.gov/ipc/www/usinterimproj/natprojtab02a.pdf    Table 1b. Number and Percentage of the Elderly Population, Canada (in thousands), 2005-2051 Year 2005 2011 2021 2031 2041 2051 Age Group (Years) No. % No. % No. % No. % No. % No. % 65-84 3,725.7 11.5 4,243.5 12.5 6,036.5 16.5 8,015.2 20.5 8,435.7 20.7 8,691.6 20.7 85+ 492.0 1.5 639.2 1.9 810.1 2.2 1,120.8 2.9 1,815.5 4.5 2,418.8 5.8 Total 4,217.7 13.0 4,882.7 14.4 6,846.6 18.7 9,136.0 23.4 10,251.2 25.2 11,110.4 26.5 Sources: “Population Projections for Canada, Provinces and Territories,” Catalogue No. 91-520-XIE, Statistics Canada, Demography Division, 2005 and Statistics Canada, “Population Characteristics”, 2006. Retrieved from   http://www40.statcan.ca/101/cst01/demo10a.htm      5   Figure 1a. Percentage of the Elderly Population (65+ Years), US, 2000-2050 05101520252000 2010 2020 2030 2040 2050 Year      %    Source: US Census Bureau, 2004, “Projected Population of the United States, by Age and Sex: 2000 to 2050” Retrieved from http://www.census.gov/ipc/www/usinterimproj/natprojtab02a.pdf    Figure 1b. Percentage of the Elderly Population (65+ Years), Canada, 2005-2051   0510152025302005 2011 2021 2031 2041 2051 Year      %    Sourc es: “Population Projections for Canada, Provinces and Territories,” Catalogue No. 91-520-XIE, Statistics Canada, Demography Division, 2005 and Statistics Canada, “Population Characteristics”, 2006. Retrieved from: http://www40.statcan.ca/101/cst01/demo10a.htm  Predicted Shortfall in Nurses The shortage of nurses became more pronounced in the mid-1990s. Apparently, these countries did not invest sufficient resources in their education and retention to anticipate the projected needs. Table 2. American and Canadian Registered Nurse (RN)  Workforce and Foreign Nurses’ Contribution, Selected Years  
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