{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T06:07:44Z","timestamp":1788847664487,"version":"build-2803163510"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Coercive health workforce policy\u2014the use of legal mechanisms to compel professional compliance in ways that override established processes of negotiation, consent, or collective bargaining\u2014has been deployed repeatedly by governments in high-income democracies through statutory wage controls, contract imposition, employment restructuring, and disciplinary orders backed by license sanctions. The conditions under which such policies achieve or fail to achieve their stated objectives remain poorly understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a comparative case study of four jurisdictions (South Korea, Ontario\/Canada, England, and Hungary) over 2015\u20132025. Cases were selected from a defined universe of workforce conflicts in high-income democracies to maximize variation in coercive intensity\u2014classified along a five-level escalation ladder derived inductively from the case material\u2014and in institutional configuration, the latter assessed using third-party indices (World Justice Project, Reporters Without Borders, CIVICUS) from editions preceding each conflict\u2019s onset where available. Outcomes were assessed in three layers: compliance with the instrument, persistence of the instrument, and attainment of each government\u2019s stated objective against objective-specific indicators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In none of the four cases did coercive policy attain its stated workforce objective. South Korea\u2019s return-to-work orders were abandoned amid mass non-compliance, and the quota expansion was reversed during an ensuing constitutional crisis. Ontario\u2019s statutory wage cap was struck down as unconstitutional and repealed. England\u2019s contract imposition produced procedural containment without resolution, followed by training attrition and renewed industrial action. Hungary\u2019s employment restructuring achieved formal compliance amid weakened oversight, yet shortages and emigration persisted. Routine policy correction occurred only where substantive constitutional review of workforce legislation was available (Ontario); where it was absent (England) or eroded (Hungary), coercive policies persisted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Across these four high-income democracies\u2014including jurisdictions ranking among the top 20 worldwide on rule-of-law indices\u2014coercive workforce policies did not produce the stable, motivated, and adequate health workforces their governments sought, and recourse to compulsion appeared across the democratic spectrum studied. These findings suggest the central policy question is not how to make coercion effective, but how to build the consultation and arbitration mechanisms that make it unnecessary.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1878816","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T05:35:03Z","timestamp":1788845703000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["When democracies coerce their health professionals: institutional constraints and policy outcomes across four jurisdictions"],"prefix":"10.3389","volume":"14","author":[{"given":"Myeong Su","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Ewha Womans University Seoul Hospital","place":["Seoul, Republic of Korea"]},{"name":"College of Medicine, Ewha Womans University","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daihun","family":"Kang","sequence":"additional","affiliation":[{"name":"College of Medicine, Ewha Womans University","place":["Seoul, Republic of Korea"]},{"name":"Department of Plastic and Reconstructive Surgery, Ewha Womans University Seoul Hospital","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"510","DOI":"10.2307\/2131904","article-title":"Behavioral assumptions of policy tools","volume":"52","author":"Schneider","year":"1990","journal-title":"J Polit"},{"key":"ref2","doi-asserted-by":"crossref","DOI":"10.1007\/978-1-349-17169-9","volume-title":"The Tools of Government","author":"Hood","year":"1983"},{"key":"ref3","first-page":"25","article-title":"Countervailing powers: a framework for professions in transition","volume-title":"Health Professions and the State in Europe","author":"Light","year":"1995"},{"key":"ref4","volume-title":"WJP Rule of Law Index 2024","year":"2024"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"105536","DOI":"10.1016\/j.healthpol.2025.105536","article-title":"South Korea's 2024 medical school expansion: from healthcare reform to constitutional crisis","volume":"165","author":"Kang","year":"2026","journal-title":"Health Policy"},{"key":"ref6","volume-title":"Constitutional Challenge of Ontario's Wage-Cap Bill Set to Begin","author":"Casey","year":"2022"},{"key":"ref7","volume-title":"Ontario Repeals Bill 124, Wage Restraint Law Twice Found Unconstitutional","year":"2024"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1097\/JAC.0000000000000140","article-title":"Junior doctors in England strike for the first time in 40 years","volume":"39","author":"McKay","year":"2016","journal-title":"J Ambul Care Manage"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"833","DOI":"10.1016\/j.healthpol.2021.04.014","article-title":"The 2020 reform of the employment status of Hungarian health workers: will it eliminate informal payments and separate the public and private sectors from each other?","volume":"125","author":"Gaal","year":"2021","journal-title":"Health Policy"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1478-4491-1-1","article-title":"Human resources for health policies: a critical component in health policies","volume":"1","author":"Dussault","year":"2003","journal-title":"Hum Resour Health"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"5035","DOI":"10.3390\/ijerph20065035","article-title":"Comparing health workforce policy during a major global health crisis: a critical conceptual debate and international empirical investigation","volume":"20","author":"Kuhlmann","year":"2023","journal-title":"Int J Environ Res Public Health"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e012661","DOI":"10.1136\/bmjgh-2023-012661","article-title":"Associations, unions and everything in between: contextualising the role of representative health worker organisations in policy","volume":"8","author":"Sriram","year":"2023","journal-title":"BMJ Glob Health"},{"key":"ref13","volume-title":"Strengthening Health System Governance: Better Policies, Stronger Performance","author":"Greer","year":"2015"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1177\/1065912907313077","article-title":"Case selection techniques in case study research: a menu of qualitative and quantitative options","volume":"61","author":"Seawright","year":"2008","journal-title":"Polit Res Q"},{"key":"ref15","volume-title":"Case Study Research and Applications Design and Methods","author":"Yin","year":"2018"},{"key":"ref16","volume-title":"Case Studies and Theory Development in the Social Sciences","author":"George","year":"2005"},{"key":"ref17","volume-title":"Freedom of Association: Compilation of Decisions of the Committee on Freedom of Association","year":"2018"},{"key":"ref18","volume-title":"Security: A New Framework for Analysis","author":"Buzan","year":"1998"},{"key":"ref19","doi-asserted-by":"crossref","DOI":"10.2139\/ssrn.4774440","volume-title":"V-Dem Codebook v14","author":"Coppedge","year":"2024"},{"key":"ref20","volume-title":"World Press Freedom Index 2024","year":"2024"},{"key":"ref21","volume-title":"People Power Under Attack: Global Analysis 2024","year":"2024"},{"key":"ref22","volume-title":"2,000 Medical School Enrollment Expansion Justification: What Do the Authors of the Three Key Reports Think? [in Korean]","author":"Han","year":"2024"},{"key":"ref23","volume-title":"Increasing Medical School Admissions by 2,000 Won\u2019t Compromise Education Quality? \"An Uninformed Claim\" [in Korean]","author":"Song","year":"2024"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"602","DOI":"10.5334\/pme.1426","article-title":"Professional resistance: why Korean medical students are boycotting over increasing medical school places","volume":"13","author":"de Beer","year":"2024","journal-title":"Perspect Med Educ."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"E372","DOI":"10.1503\/cmaj.109-5332","article-title":"UK junior doctors set for five-day strike action","volume":"188","author":"Dyer","year":"2016","journal-title":"CMAJ"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"532","DOI":"10.2307\/258557","article-title":"Building theories from case study research","volume":"14","author":"Eisenhardt","year":"1989","journal-title":"Acad Manag Rev"},{"key":"ref27","volume-title":"Qualitative Data Analysis: A Methods Sourcebook","author":"Miles","year":"2014"},{"key":"ref28","first-page":"1","article-title":"Hungary: health system review","volume":"13","author":"Ga\u00e1l","year":"2011","journal-title":"Health Syst Transit"},{"key":"ref29","volume-title":"Health at a Glance 2023: OECD Indicators","year":"2023"},{"key":"ref30","volume-title":"Residency Recruitment for 2025 Falls Short: Total Application Rate Hits 8.7% \u2013 Only 68 Applicants for Major Hospitals [in Korean]","author":"Cho","year":"2024"},{"key":"ref31","volume-title":"Aftermath of Martial Law: President Yoon Denounces Opposition as 'Anti-State Forces' and Vows to Fight Impeachment [in Korean]","author":"Cho","year":"2024"},{"key":"ref32","volume-title":"South Korea Reverts Medical School Admissions Quota for 2026 [in Korean]","year":"2025"},{"key":"ref33","volume-title":"R (Justice for Health Ltd) v Secretary of State for Health. 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