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The challenge of the changing health labor market
GILLES DUSSAULTEUREGIO III
3RD MASTER CLASS PROGRAMME23 MARCH, 2011
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Overview• Why discuss health workforce
issues (HW) now? • What needs to be done to find the
right balance?
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Why discuss HW issues now?
• Needs change • Demand changes• Supply changes• Many alerts: WHO reports, EU Green
paper/Conclusions• Time lag
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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
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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
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Aging in the WHO-EUROPE Region, EU and CIS
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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)
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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)
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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
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• 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
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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%
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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
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% physicians and nurses with foreign nationality(OECD 2007)
05
101520253035404550
Austria Finland Ireland NewZealand
Norway Portugal UK USA
%
Doctors Nurses
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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?
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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
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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
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Conclusions• The toughest challenge: building the
workforce of tomorrow• A global approach is needed• How to move from awareness to
effective action ?
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