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

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


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For years, opponents of outsourcing have argued that offshoring American jobs destroys our local industries, lays waste to American job creation, and gives foreigners the good jobs and income that would otherwise remain on our shores. Yet few Americans realize that a parallel dynamic is occurring in the healthcare sector—previously one of the most consistent sources of stable, dependable living-wage jobs in the entire nation. Instead of outsourcing high-paying jobs overseas—as the manufacturing and service sectors do—hospitals and other healthcare companies insource healthcare labor from developing countries, giving the jobs to people who are willing to accept lower pay and worse working conditions than U.S. healthcare workers. As Dr. Tulenko shows, insourcing has caused tens of thousands of high-paying local jobs in the healthcare sector to effectively vanish from the reach of U.S. citizens, weakened the healthcare systems of developing nations, and constricted the U.S. health professional education system. She warns Americans about what she’s seeing—a stunning story they’re scarcely aware of, which impacts all of us directly and measurably—and describes how to create better American health professional education, more high-paying healthcare jobs, and improved health for the poor in the developing world.

Product Details

ISBN-13: 9781611682274
Publisher: Dartmouth College Press
Publication date: 05/08/2012
Series: Geisel Series in Global Health and Medicine
Pages: 192
Product dimensions: 5.80(w) x 8.60(h) x 1.00(d)

About the Author

DR. KATE TULENKO is a physician with degrees from Harvard University, Cambridge University, and the Johns Hopkins School of Medicine. The former coordinator of the World Bank’s Africa Health Workforce Program, she currently serves as director of clinical services for a global health nonprofit and resides in Washington, D.C.

Table of Contents

Foreword – Laurie Garrett • Preface • Acknowledgments • Introduction • Shortage in the Land of Abundance • How the United States Created Its Healthcare-Workforce Problem • The Path to America • The Damage Done • The Fox and the Hydra: Failed Attempts to Address Insourcing • Successful Efforts to Curb Insourcing • The Way Forward • Notes

What People are Saying About This

Jennifer Ng'andu

“An important book for those who wish to tackle the root cause of inequity within U.S. health care. Tulenko takes a deep look inside the health professions establishment, and illuminates core elements of the system that contribute to widening economic, racial, and geographic health disparities. What she finds is often that the underserved are often doubly disadvantaged by the narrow health workforce pipeline — their intellectual capital tossed aside on one end, while they are often the victims of errors caused by workforce shortages at the other.”

Pape Gaye

“In an increasingly inter-connected world, Dr. Tulenko offers a powerful barometer for looking into the root causes of the US domestic health care workforce woes and their direct impact on the global health worker shortage. This compelling testimonial is a must read for global health practitioners, students and international development champions looking for long lasting solutions for strengthening health systems worldwide.”

Richard Scheffler

"Tulenko provides a thought provoking story on how and why the US is making the global workforce crisis even worse and what should be done about it now. This compelling book is a must read for all those who work in or care about global health."
Richard Scheffler, director, Global Center for Health Economics, UC Berkeley, and author of Is There a Doctor in the House? Market Signals and Tomorrow's Supply of Doctors

Lord Nigel Crisp

“This is an important and timely book which throws down a challenge to policy makers and planners in the US and other rich countries. It comes at a time when power is shifting globally and relations between countries are changing and is a valuable contribution to global debate and policymaking.”

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