Transnational markets in medical education and training

Ramila Bisht

The education of healthcare professionals and workers is a crucial component of a healthcare provisioning and delivery system. However, we are witnessing the growth of models for healthcare education and training which are based on transnational movements and market-based provision. Based on online data and interviews with key stakeholders in the UK, China and India, in this presentation we will outline two markets we see emerging. First, we discuss the case of Indian medical students studying undergraduate medicine in China. Second, we present preliminary findings on medical professionals receiving advanced level training in the UK.

India has a history of students going abroad for medical study, and there remains substantial demand-supply gap. In 2019, 1.4 million students took the National Eligibility cum Entrance test (NEET) for medical training, when seats available were just 80,000; medical aspirants have increasingly turned to opportunities offered by the expanding global market, including in China. For its part, the Chinese government has encouraged its medical education sector to engage in transnational markets as part of its wider effort to become a global education provider. A brokerage industry has developed around this transnational market; China has employed individuals and agencies to operate as official admission agents, and private agencies varying by size and scale of operation also operate in this market. We are also witnessing the growth of allied new markets, such as pertaining to the training for the Foreign Medical Graduates Examination (FMGE) examination which all foreign graduates must pass to obtain a license to practice medicine in India.

Our second case pertains to the rapidly expanding transnational market for postgraduate clinical placements. While there is no quantified information on the size of this transnational market, we have seen a trend in our study whereby NHS hospitals in the UK are looking to generate revenue from these kinds of placements. Historically, hospitals and their clinical departments have provided training placements for free but a decade of austerity in public institutions, a relaxation of NHS rules on private revenue generation, and growing international demand for placements in prestigious UK hospitals are driving the transition into fee-paying arrangements. Here, too, the complexities and costs involved in these training placements has stimulated a nascent industry aimed at brokering relations between demand (in China and India) and supply (in UK). Crucially, much of this activity lacks central oversight and regulation, and responsibility has been largely left to individual providers.

Commonalities across these cases include neoliberalisation in public policy (healthcare and education) as an important driver of these transnational markets. It has limited the public provision of services and has led to emphasis on entrepreneurialism in public institutions, creating the demand and the supply for market provision. Cultural capital is important too: medical education and training carries significant expectations for social mobility, and socially and geographically mobile elites use international exposure as a means of social distinction. Third, the complexity of transnational markets for medical education and training has created a conducive environment for brokerage agencies. Opaque costs and unpredictable outcomes mean there are significant risks attached. Fourth, state regulation is patchy and a lot needs to be done in this regard to prevent exploitation of the people involved.