title: Mobility of health professionals pre and post 2004 and 2007 EU enlargements: evidence from the EU project PROMeTHEUS.
abstract: BACKGROUND
  EU enlargement has facilitated the mobility of EU citizens, including health professionals, from the 2004 and 2007 EU accession states. Fears have been raised about a mass exodus of health professionals and the consequences for the operation of health systems. However, to date a systematic analysis of the EU enlargement's effects on the mobility of health professionals has been lacking. The aim of this article is to shed light on the changes in the scale of movement, trends and directions of flows pre and post 2004 and 2007 EU enlargements.
  
  
  METHODS
  The study follows a pan-European secondary data analysis to (i) quantitatively and (ii) qualitatively analyse mobility before and after the EU enlargement. (i) The secondary data analysis covers 34 countries (including all EU Member States). (ii) Data were triangulated with the findings of 17 country case studies to qualitatively assess the effects of enlargement on health workforce mobility.
  
  
  RESULTS
  The stock of health professionals from the new (EU-12) into the old EU Member States (EU-15) have increased following EU accession. The stock of medical doctors from the EU-12 in the EU-15 countries has more than doubled between 2003 and 2007. The available data suggest the same trend for dentists. The extremely limited data for nurses show that the stock of nurses has, in contrast, only slightly increased. However, while no reliable data is available evidence suggests that the number of undocumented or self-employed migrant nurses in the home-care sector has significantly increased. Health professionals trained in the EU-12 are becoming increasingly important in providing sufficient health care in some destination countries and regions facing staff shortages.
  
  
  CONCLUSIONS
  A mass exodus of health professionals has not taken place after the 2004 and 2007 EU enlargements. The estimated annual outflows from the EU-12 countries have rarely exceeded 3% of the domestic workforce. This is partly due to labour market restrictions in the destination countries, but also to improvements in salaries and working conditions in some source countries. The overall mobility of health professionals is hence relatively moderate and in line with the overall movement of citizens within the EU. However, for some countries even losing small numbers of health professionals can have impacts in underserved regions.
authors.affiliation: Berlin University of Technology, Germany. diana.ognyanova@tu-berlin.de
authors.forename: Diana
authors.initials: D
authors.lastname: Ognyanova
authors.forename: Claudia B
authors.initials: CB
authors.lastname: Maier
authors.forename: Matthias
authors.initials: M
authors.lastname: Wismar
authors.forename: Edmond
authors.initials: E
authors.lastname: Girasek
authors.forename: Reinhard
authors.initials: R
authors.lastname: Busse
mesh_terms: D003815:Dentists / Q000706:statistics & numerical data / Q000600:supply & distribution; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005062:European Union / Q000706:statistics & numerical data*; D006282:Health Personnel / Q000706:statistics & numerical data*; D006280:Health Workforce / Q000706:statistics & numerical data; D006801:Humans; D008507:Medically Underserved Area; D009726:Nurses / Q000706:statistics & numerical data / Q000600:supply & distribution; D010820:Physicians / Q000706:statistics & numerical data / Q000600:supply & distribution