Jaime, thanks for that thoughtful comment. Your point about migration in a welfare state was exactly the analysis done by the OECD (most of whose members fall into this category). They looked at the net contribution of migrants to the fiscal balance (taking into account more than just medical services--that was just an illustration) and found it to be zero or positive. On the costs of doctors' migrating, I agree that the cost of a child dying is unspeakably high. But most of the evidence points to the fact that these children are dying all the time, and the number who die because a doctor migrates is no higher. In rural Tanzania, for instance, public doctors spend an average of 29 minutes a day seeing patients. This tells me that there is a shortage of patients, not doctors. (In fact, these doctors are also working in private practice, and try to encourage the patients to come to their private clinics and pay fees). If this is the state of medical services in poor countries, the migration of doctors is the least of their problems.