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recruited and placed in both the public and private sectors. Outside of the EC, the Netherlands provides very limited opportunities for migrant health care workers. With a wholly public system, its regulations are enforced across the board. With a potential future demand for migrant health care workers, all three countries are likely to depend on their traditional sources of supply. The United Kingdom and the Netherlands may increasingly depend on the workers from new EU accession states. All have increased domestic professional training programs. Nevertheless, none have developed long-term strategies to meet the increasing demand for health care service provision. Given the complexity of factors leading to health care worker shortages, addressing long-run shortages is not likely to be easily resolved by restricting migration. Even though migration is often touted as part of the problem for developing countries’ health care worker shortages, facilitating these flows also provides economic and social benefits, particularly for destination countries. From a security standpoint, these same countries are likely to tighten the barriers and surveillance for health care workers coming from communities with known terrorist networks. Nevertheless, such “profiling,” as demonstrated from the Glasgow incident, is not likely to prevent terrorists from using health care opportunities and networks or yield information to distinguish competence from intentions. Health care workers are highly sought after and mobile. Thus, a potential terrorist could use an established recruitment and placement service in one country and, having established himself or herself there, enter a third one. The increased privatization of care has made it more difficult to monitor and track these multiple health care migration flows. As any group of migrants, they may or may not be well integrated into the host society. Although most are well integrated economically , they are not necessarily politically integrated and may have multiple allegiances. Recommendations Given the complexity and volatility of health care migration, the following recommendations are made: establish international peer and ethical review procedures and standards; engage professional organizations to engage transnationally in ongoing review and training in ethical standards and practices; provide recruitment and review systems that address the multicultural and linguistic requirements of global health care; determine the cost of all transactions involved in these global care supply chains; analyze specific migration streams, motivations, and organizational/governance structures and their security implications and requirements; and focus security budgets on analysis rather than on the management of fear and stereotyping. The engagement of professional societies in developing and refining professional screening, peer review, and certification would increase the costs and risks for terrorist groups using these networks for their own purposes. Institutional twinning relationships would allow for ongoing monitoring and review and offer LYNELLYN D. LONG 206 THE DEMAND FOR HEALTH CARE WORKERS 207 benefits to both sending and destination societies. New migration restrictions and barriers, particularly by the migration authorities, do not ensure a high-quality migrant health care worker labor force. In contrast to private recruitment and travel agencies, professional peer review may provide in-depth and relevant assessments. Thus, professional societies have an important role in assuring that the health care workforce is appropriately trained and credentialed and that their workers’ motivations, personal history, and ethics reflect the highest professional standards. These kinds of peer review procedures also allow for professional societies to play a role in facilitating integration. Financial support for such an intervention would not necessarily be more costly than enforcing further migration controls and potentially could improve the quality of care. However, review and certification procedures also need to be developed globally and information shared transnationally. Such sharing of information and of practices is one way of circulating knowledge and would improve the human security of both sending and destination countries. In addition, the sharing of this kind of knowledge makes it more difficult for terrorist organizations to operate clandestinely. Destination countries that continue to depend on migrant health care labor will need increased linguistic and multicultural competence in their own assessments and governance of migrant health care workers’ skills and competence. Technical skills alone do not ensure that health care workers share the same understanding or assumptions about standards of practice and care. Many foreign workers are also underutilized in the new setting and/or find that their skills do not readily transfer. Both public and private recruiters need to provide more accurate , up-to-date information about the multicultural and linguistic requirements of specific openings to avoid alienation and disappointment...

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