The challenge of the changing health labor market
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Transcript of The challenge of the changing health labor market
The challenge of the changing health labor market
GILLES DUSSAULTEUREGIO III
3RD MASTER CLASS PROGRAMME23 MARCH, 2011
Overview• Why discuss health workforce
issues (HW) now? • What needs to be done to find the
right balance?
Why discuss HW issues now?
• Needs change • Demand changes• Supply changes• Many alerts: WHO reports, EU Green
paper/Conclusions• Time lag
Education pipelineNationals trained abroadImmigrationContracting
Stock/ supply of health workers
CompositionDistribution
Statutory retirement
Attrition
Emigration
Returners
A simple model of health labour market dynamics (stock and flows)
Socio-demographic, economic,organizational, legal determinants
Needs change• Aging population• Epidemiological profile (chronic diseases, mental health, re/emerging diseases)• Values (religious requests, palliative care, euthanasia)• New diagnosis/treatment tools and strategies
Aging in the WHO-EUROPE Region, EU and CIS
Demand changes
• EU Health Policy, Cross-border directive• WHO renewed primary care policy• New organizational strategies: team
work, integration of services, ambulatory/home care. Telemedicine • Medicalization of healthy life• Better informed, more demanding
users (average time of consultations)
Supply changes
• Aging: Average/nurses = 41-45 in Den., Isl., Nor., Swe., Fra. • Scaling-up of general practice, of
nursing (expanded functions)• Values and expectations (work-life
balance, non-financial incentives)• Mobility: within countries, between
countries, im/emigration (freedom of movement, Bologna process, Blue EU Labour Card)
16%
4% 4% 5%
34%
19%11% 12%
19%
28%
17% 14%
11%
29%
25%20%
9% 12%
26%24%
7%6%
14%20%
4% 2% 2% 4%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1987 1996 2004 2007
70+
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
GPs, Denmark
• England 2010: 14,000 nurses (Mooney H, 2007)• Netherlands: 7,000 nurses (Simoens et al 2005)• Norway: 3,300 nurses (Askildsen et al 2003)• Switzerland: 3000 nurses (Irving J 2001)
• USA– 500000 nurses (2025) (Buerhaus et al. in print)
– 44000 (2025) family practitioners (Colwill 2008)
Predicted shortages
12
Estimated shortage of HRH (DG-SANCO)
Health professionals or other health workers
Estimated shortage by 2020
Estimated percentage of care not covered
Physicians 230.000 13,5% Dentists, pharmacists and physiotherapists 150.000 13,5% Nurse 590.000 14,0% Total 970.000 13,8%
Migratory flows: ‘push’ e ‘pull’• Compensation• Working conditions• Working environment• Better career opportunities• Access to specialized training• More security and stability
• “Global Code of Practice on the International Recruitment of health personnel”
Source: Buchan J et al 2003
% physicians and nurses with foreign nationality(OECD 2007)
05
101520253035404550
Austria Finland Ireland NewZealand
Norway Portugal UK USA
%
Doctors Nurses
Which workforce?• First, need to answer a few tricky
questions:– Where do we start from?– Future health needs?– Which services? How will they be
organized? – Who will do what?– How will supply and labour market
evolve?– How much are we prepared to spend?
Which workforce?
• What is the capacity of the country, of individual organizations?– To attract/recruit the right type of future health
workers – To educate/train them– To employ them– To retain them
What countries can (should) do?
• HW policy in line with services and health policies
• Build the information base (numbers, availability, productivity, projections, expectations, multiple employment, private sector)
• Mobilize stakeholders in support of change• Mobilize resources and capacity
Conclusions• The toughest challenge: building the
workforce of tomorrow• A global approach is needed• How to move from awareness to
effective action ?