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EU 2020 and
the healthcare labour market
Future proof for cure and care
Hasselt, 20 September 2011
Willy Palm
Dissemination development Officer
The importance of the health workforce
After the EU Commission’s health
strategy « Together for Health »
(2007)
Developing effective and efficient
health systems, with the capacity
to improve health and prevent
disease, depends on having a high-
quality, efficient health workforce
with the right skills – throughout the
EU Member States
2008 EU Commission’s
Green Paper on the
European Workforce for Health
Developing sufficient, capable,
motivated and supported health
workers is essential for overcoming
bottlenecks to achieve national and
global health goals.
Working Together for Health
World Health Report 2006
2
The EU policy context
• EU = 27 Member States, 493
million citizens
• Health sector
• Total expenditure on health:
8.2% of GDP (OECD 2006)
(with 70% of budget allocated
to salaries and other charges)
• Employer for 10% of the EU
workforce (15 million people)
• EU2020 strategy for smart,
sustainable and inclusive
growth
• New skills and new jobs
• Youth on the move
3
The health workforce crisis
• Increasing needs
• Ageing workforce
• Changing expectations (work-
life balance, career planning)
• Unattractive remuneration and
working conditions (workload,
etc.)
• Evolving skills and
competencies (quality and
safety)
• Organisational change
• Regulation and policy
• Mobility (within and between
countries)
• External factors
– Labour market dynamics
– Economic crisis
– Societal perception and
appreciation
4
Main concern: growing shortages
• By 2020: nearly 1,000,000*
health workers missing
• Representing almost 15% of
the necessary care to be
covered
Moreover
• The figure of 1.000.000
doubles if long-term care and
ancillary health professions
are taken into account
Health
professionals
Estimated
shortage by
2020
Estimated % of
care not
covered
Physicians 230.000 13.5%
Dentists,
pharmacists,
physiotherapists
150.000 13.5%
Nurses 590.000 14%
Total 970.000 13.8%
5
Source. European Commission,
DG Health & Consumers
(internal estimates)
6
“Workforce stocks and flows”
Health
Workforce Immigration Emigration
Education Re-entry
Retirement
Death
Parental
leave
Working
time
reduction Other
occupation
Working time
Directive
2003/88/EC
PQ Directive
2005/36/EC
The EU mandate on health workforce?
• Union action to respect
responsibilities of the
Member States for the
organisation and delivery
of health care, incl.
management and
allocation of resources
(art. 168.7 TFEU)
– Community to complement
policies of the Member
States
• Working Time Directive
2003/88/EC
– Currently under revision
• Directive on the
recognition of
professional qualifications
2005/36/EC
– Currently under evaluation
7
PROMeTHEUS - the Project Health PROfessional Mobility in THe European Union Study
The research leading to these
results has received funding from
the European Community's Seventh
Framework Programme (FP7/2007-
2013) under grant agreement
n°223383.
1. What is the magnitude: reliance &
trends?
2. What are the geographical patterns?
Effects of EU enlargement?
3. What are the motivations to move?
4. What are the impacts on HS
performance?
Policy relevant?
5. What are the policy options?
Matthias Wismar, Claudia Maier, Irene Glinos,
Gilles Dussault, Josep Figueras (eds.)
Magnitude of mobility: significant but diverse INFLOWS
Proportion foreign inflows/ all new entrants (2008):
• Foreign medical doctors: UK (43%), BE (25%),
AU (13.5%), HU (5%), POL (3%)
• Foreign nurses: IT (28%), UK (15%), BE (14%),
HU (2%)
• Foreign dentists: FIN (43%), AU (41%), UK (34%),
BE (19%), HU (10%), POL (3%)
After EU enlargement:
Outflows Significant
but lower than expected • Annual emigration intentions in
EU-12: ca.3%
• Peaks e.g.: EST 6.5% of MDs 2004;
SK 7.4% nurses 2005-6
• Decreasing trend after accession
– Return flows, e.g.: Polish MDs
• New surge in outflows (2009-10)
e.g.: EST, HU, RO
• East-West asymmetries worsened – Outflows in all MS but EU-15 have
significant inflows
Prof. JM Martin-Moreno, WHO/Europe, 2010
Policy relevance and implications
• Migration is rather a symptom of broader health
workforce problems, but it can aggravate them
significantly
• In the face of growing shortages, there is a need for a
more integrated approach at EU level
– Improve transparency and monitoring
– Support planning and training capacity
– Foster skills and competences
– Strenghten general workforce strategies (retention and
recruitment)
13
Green paper and consultation
1. Demography and the promotion of a sustainable health workforce
2. Public Health Capacity
3. Training
4. Managing mobility of health workers within the EU
5. Global migration of health workers
6. Data to support decision-making
7. Impact of new technology on efficiency and effectiveness of health workforce
8. Role of health professional entrepreneurs in the workforce
9. Cohesion policy
• Overwhelming support for a European dimension and need for EU action
• Action needs to be cross-cutting (human resources, education and training) (EU employment, social affairs, internal market and cohesion policies)
• Priorities
1. Assessing future needs (workforce forecasting)
2. Mapping skills and competences (training)
3. Raising attractiveness by improving working conditions
4. Addressing the challenges of global migration and mobility within EU
14
Investing in Europe’s Health Workforce of Tomorrow: Scope for Innovation and Collaboration
– Assessment of future health workforce needs
– Adapting skills to new needs and lifelong learning
– Create an attractive and supportive working environment
– Improving performance for quality and safety
BE Presidency conclusions
• Need for collaboration on the short, medium and long term
• Involving MS, EC, patient representatives, and other relevant stakeholders
• Develop by 2011 a joint action providing a platform for cooperation between member states on forecasting HWF needs and workforce planning
• Development of comprehensive action plan on HWF by 2012
• Implementation of the WHO Code of Practice and continue taking up EU leading role in this process
EU action on health workforce
• Green Paper on the European Workforce for Health
(Dec 2008)
• Followed by a public consultation and a series of policy
dialogues in 2009-10
• BEL Presidency 2010:Investing in Europe’s Health
Workforce of Tomorrow: Scope for Innovation and
Collaboration
– joint action on forecasting HWF needs and workforce planning
– Implementation of the WHO Code of Practice international
recruitment of health personnel
• HUN Presidency 2011:
– health professional mobility and health systems
– Towards modern, responsive and sustainable health systems
17
EU 2020 Strategy for smart,
sustainable and inclusive growth
• Exit from the crisis, entry into structural change
• 5 target areas, including employment, innovation,
education
• 7 flagship initiatives, including
– Youth on the move
– An agenda for new skills and jobs
• Instruments
– Structural funds
– Joint actions
– European Innovation Platform "Active and Healthy Ageing”
18
Analysing
Health Systems and Policies
Thank you
for your attention
wpa@obs.euro.who.int
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