Ten years on: time for a public health celebration or sober reflection?

Abstract

Ten years ago Malta was deeply divided into two camps: those in favour and those against membership of the European Union (EU). The referendum was a narrow victory for supporters of membership, and the rest is history. At the time of accession, the health sector was not one of the key areas targeted for debate or scrutiny.1 This may have been due to the fact that European competence in health was limited and Member State competence in matters of health policy was held to be supreme. The potential ‘brain drain’ resulting from the free movement of health-care professionals was highlighted at the time of enlargement.2 While professional mobility is a complex phenomenon, recent analysis of data indicates that although the numbers of doctors from the new EU 12 present in the old EU 15 more than doubled between 2003 and 2007, estimated outflows have rarely exceeded 3% of the domestic workforce.3 Malta was particularly concerned about the potential loss of health-care professionals to other countries.4 Shortly after accession, ∼80% of newly graduated doctors started to migrate annually. This situation called for immediate …