Nurse Emigration Has Consequences for Life Expectancy
ResearchZEW-ifo Study Examines the Impact of Skilled Worker Shortages in Hospitals
A representative study conducted by ZEW Mannheim and the ifo Institute examines the consequences of nurses emigrating abroad and analyses the effects on patient mortality in the border region with Switzerland. Mortality in hospitals close to the border increased by almost five per cent, which in turn slowed the rise in life expectancy in the region. In 2011, many German nurses living near the border began working in Switzerland. This led to a twelve per cent reduction in nursing staff in German hospitals near the border and thus to poorer health care for patients. The result was a reduced staff-to-patient ratio and a lower probability of receiving (necessary) operations.
“The reduction in necessary medical procedures caused by the shortage of nursing staff particularly affected older patients and emergency cases. Their mortality rates increased. Life expectancy stagnated in the affected regions, while it continued to rise in the rest of Germany. From this, it can be conducted that a skills shortage can have a negative impact not only on economic growth but also on the increase in life expectancy,” explains study author Oliver Schlenker, Research Associate at the ZEW “Labour Markets and Social Insurance” Research Unit and Deputy Director of the Ludwig Erhard ifo Center for Social Market Economy and Institutional Economics in Fürth.
Due to the shortage of nursing staff, hospitals in the affected German regions also began to prioritise patients according to their medical needs and, in particular, to reduce the number of non-urgent operations (‘triage’). Nevertheless, the care rate for emergency patients also fell, which is why their mortality rate increased particularly sharply. For example, mortality increased by 11.6 per cent for patients with sepsis and by 17.7 per cent for those suffering from heart attacks. Overall, regional mortality rose, particularly among older individuals and life expectancy in the border region declined by around 0.3 statistical life years compared with similar inland districts.
Attractive salaries in Switzerland as a trigger
In 2011, in the wake of the European debt crisis, the Swiss franc appreciated significantly and was effectively bound to the euro at a high level by the Swiss National Bank. Combined with stable living costs in Germany, high demand for staff in Switzerland and stagnating wages in German hospitals, changing positions became particularly attractive for qualified nurses. As a result, the number of new cross-border workers in the health care sector rose sharply in 2011, leading to an increase in unfilled positions in German hospitals in the border region.
Further research on the topic is urgently needed, Schlenker emphasises: “In this study, we focused on mortality. It would also be important to investigate the consequences of the nursing shortage on younger and healthier patients as well as on the remaining staff themselves. It is plausible that shortages also contribute to other negative health outcomes, such as chronic diseases and long-term consequences.”
Data foundation
The study was based on various representative datasets from the statistical offices of Germany and Switzerland, including Swiss cross-border commuter statistics, German hospital statistics and regional data. The researcher examined all inpatient hospital cases over a period of twelve years (2006 to 2017) to determine the impact of the skills shortage on mortality and life expectancy.
