trends in health workforce in europe - ose · 2017. 11. 24. · trends in health workforce in...

TRENDS IN HEALTH WORKFORCE IN EUROPE

Gaétan Lafortune, OECD Health Division Conference, Brussels, 17 November 2017

Health and social workers account for a growing

share of total employment in nearly all EU countries

18 17

16 16

14

13 13 12 12

10 10 10

8 8 7 7 7 6 6 6 6 6

5 5

0

5

10

15

20

2015 2000%

Note: The EU average is unweighted. Source: OECD National Accounts.

A simple framework for analysing the supply of

health workers (basic inflows/outflows model)

Source: Health Workforce Policies in OECD Countries - Right Jobs, Right Skills, Right Places, OECD (2016)

A more complex framework for analysing the

supply and demand for health workers


The number of doctors per capita has increased in

most EU countries, except in Belgium and France

1. In Greece and Portugal, the data refer to all doctors licensed to practice (resulting in a large over-estimation of practising doctors).

2. In France and the Slovak Republic, the data include not only doctors providing care for patients, but also those working as managers,

researchers, etc. (resulting in an over-estimation of practising doctors by 5-10%).

3. In Belgium, a minimum threshold of activities is used to define practising doctors (leading to an under-estimation).

Source: OECD Health Statistics 2017 (based on OECD/Eurostat/WHO-Europe Joint Questionnaire).

6,3

5,1

4,6 4,3

4,2 4,1 4,0 3,9 3,8 3,8 3,7 3,7 3,6 3,6 3,5 3,5 3,4 3,3 3,2 3,2 3,2 3,1 3,0 2,9 2,9 2,8 2,8 2,8

2,3

0

1

2

3

4

5

6

72015 2000Per 1 000 population

The number of doctors has grown more rapidly in

the UK and Netherlands than Belgium and France


100

110

120

130

140

150

160United Kingdom

Netherlands

Germany

France

Belgium

Index (2000=100)

Countries are using a range of policy levers to

address current or future shortages of doctors

0

5

10

15

20

No particularpolicy

Prolong workingtime for

physicians

Targetedimmigration

policy

Introduction orexpansion of

non-physicianpractitioner

Incentives tofoster the take-up of specialtieswhere shortages

exist

Incentives tofoster the take-

up of generalpractice

Financialincentives to

correctgeographic

maldistribution

Increase intraining capacity

Number of OECD countries (based on 29 responses)

Source: OECD Health System Characteristics Survey 2016

Belgium and neighbour countries are using some policy

levers to address current or future shortages of doctors

Source: OECD Health System Characteristics Survey 2016

Belgium France Germany Netherlands United

Kingdom

Increase in training capacity Yes Yes Yes

Prolong working time for physicians No Yes

Targeted immigration policy No Yes

Incentives to foster the take-up of general

practice Yes Yes

Incentives to foster the take-up of

specialties where shortages exist or are

expected

No Yes

Introduction or expansion of non-physician

practitioner roles No

Financial incentives to correct perceived

geographic misdistribution

Yes

(only for GP) Yes Yes Yes Yes

The share of generalists has decreased

over time in Belgium and in other countries

9

Share of generalists as % of all physicians


25

30

35

40

45

50

2000 2002 2004 2006 2008 2010 2012 2014 2016

%

United Kingdom

Germany

Netherlands

France

Belgium

10

But a big concern is about the ageing of doctors Almost 50% of doctors in Belgium and France are aged 55+

Belgium (2015) Netherlands (2015)

France (2015) United Kingdom (2015)


11

But let’s keep in mind that the supply of doctors

is driven by both inflows and outflows


28%

17%

9502

5619

0% 10% 20% 30% 40%

% 55-64

% 65+

35%

12%

77859

25691

0% 10% 20% 30% 40%

% 55-64

% 65+

12 12

Will the projected number of doctors who will

retire exceed the inflows of new doctors?

Doctors by age group (in 2015)

Source: OECD Health Statistics

1180

1176

1289 1359

1614

0

400

800

1200

1600

2000 2005 2010 2015

4384 4717

5040

5365

6025

0

1000

2000

3000

4000

5000

6000

2000 2005 2010 2015

Belgium

France

Rising number of new medical graduates (each year)

Another growing source of doctors in Belgium

and France has been foreign-trained doctors


0

5

10

15

20

25

30

35% foreign-trained doctors

Netherlands

United Kingdom

Germany

France Belgium

The number of foreign-trained doctors in Belgium has increased from less than 2000 in 2000 to over 7000 in 2016

A growing number of foreign-trained doctors in

Belgium have come from Romania since 2007

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Total number of doctors 49695 50502 51389 52303 53418 54851 56363 57623 59070 60138 61899

Domestically-trained doctors 47059 47460 47899 48418 49038 49818 50655 51439 52338 53249 54529

Foreign-trained doctors 2636 3042 3490 3885 4380 5033 5708 6184 6732 6889 7370

% of foreign-trained doctors 5.3% 6.0% 6.8% 7.4% 8.2% 9.2% 10.1% 10.7% 11.4% 11.5% 11.9%

France 530 603 660 711 764 860 1003 1078 1147 1219 1312

Romania 9 135 267 420 566 744 866 975 1064 1172 1247

Netherlands 473 537 607 649 682 739 807 872 940 1037 1112

Italy 186 216 238 275 306 367 425 490 605 687 768

Germany 228 248 283 302 321 357 375 396 416 435 447

Greece 65 86 115 138 154 181 222 236 258 279 301

Spain 163 172 175 180 185 202 219 232 260 280 291

Bulgaria 1 8 19 28 38 50 61 73 78 84 94

Portugal 2 2 4 7 12 15 21 32 49 73 88

Poland 17 26 34 39 41 47 53 60 66 70 76

United Kingdom 33 38 42 45 47 49 52 55 61 67 71

Hungary 11 16 20 24 28 30 34 36 42 46 55

South Africa 30 33 36 36 36 37 42 43 47 51 54

Switzerland 3 11 16 18 18 23 27 29 35 40 48

Czech Republic 9 12 15 18 21 25 30 32 36 42 47

Lithuania 1 3 5 7 12 21 24 30 32 33

Algeria 1 1 22 40 56 61 66 27 31

Austria 1 4 6 8 9 12 15 17 23 25

Note: This table only shows the top 18 countries of origin of foreign-trained doctors in Belgium. Source: OECD Health Statistics

A sizeable number of doctors trained in Belgium

also work in other EU and OECD countries

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015Austria 1 2 2 3 4 5 4 4 4 4

Canada 124 127 127 130 125 126 124 120 117 117

Chile 7 9

Finland 4 4 4 5

France 1748 1746 1773 1773 1773

Germany 195 193 201 211 221 233 247 246 242 244

Ireland 15 14 15 15 16

Israel 60 63 61 61 60 53 49 48 47 45

Netherlands 427 455 477 519 578 616 522 523 562

New Zealand 5 5 8 12 13 12 14 19 21 16

Norway 53 56 53 51 50 45 42 43

Poland 2 2

Spain 58

Switzerland 101 97 101 112 130

Turkey 2 2 2 2 2 2 2 2 2 2

United Kingdom 133 149 133 134 128 131 137 132

United States 985 959 925 901 891 898 909 816 770

# countries reporting data 8 8 11 11 12 15 14 12 14 13

TOTAL 1799 1806 2090 1244 2195 4060 3933 3835 3787 3173


But the number of doctors trained in Belgium who migrate to other countries is smaller than the number of foreign-trained doctors working in Belgium

NURSES

The number of nurses per capita also increased in

most EU countries, including Belgium and France

16,7

14,7

13,3 11,9

11,9 11,1 10,8 10,5

9,9

8,8 8,2 8,1 8,0 7,9 7,9 7,7

6,5 6,4 6,3 6,0 5,8 5,7 5,4 5,3 5,2 5,2 4,7 4,4

3,2

0

3

6

9

12

15

182015 2000Per 1 000 population

1. The data include not only nurses providing direct care to patients, but also those working as managers, researchers, etc.

2. Austria and Greece report only nurses employed in hospital.


The number of nurses in Belgium has grown by

nearly 40% since 2004; in France, by nearly 50%

100

110

120

130

140

150

Netherlands

Germany

France

Belgium

Index (2004=100)


0,6

0,7

0,8

0,9

1,0

50000

60000

70000

80000

90000

2000 2005 2010 2015

HC (left axis) FTE (left axis) FTE/HC (right axis)

But the growth in full-time equivalent nurses

has been slightly slower than in headcounts

Belgium

France

0,8

0,9

1,0

1,1

250000

300000

350000

400000

2000 2005 2010 2015

0,6

0,7

0,8

0,9

300000

400000

500000

600000

2000 2005 2010 2015

Germany


OPPORTUNITIES TO CHANGE THE ROLES AND RESPONSIBILITIES OF

HEALTH PROFESSIONALS

Note: The number of doctors in Greece (EL) and Portugal (PT) is over-estimated as it includes all doctors licensed to practice. The number of nurses in Austria and Greece is under-estimated as it only includes those working in hospital. Source: Eurostat Database

Low number of doctors and high number of nurses

may provide opportunities for greater task sharing

22 22

Development of more advanced roles for nurses: Example of nurse practitioners in some countries

Source: Maier et al., OECD Health Working Paper (2017)

Country Year introduced

Total number of Nurse Practitioners (NPs) (2015)

NPs as % of all RNs (2015)

United States (NP)

1965 174,943 5.6%

Canada (NP)

1967 4,090 1.4%

United Kingdom (Advanced NP, NP)

1983 n/a (because title not regulated)

n/a

Netherlands (Nurse specialist)

1997 2,749 1.5%

Australia (NP)

2000 1,214 0.5%

New Zealand (NP)

2001 142 0.3%

Ireland (Advanced NP)

2001 141 0.2%

Key messages

The share of GPs has declined in most countries (including in Belgium), but remains higher in France and Netherlands

The demand for doctors may be reduced by expanding the scope of practice of other “mid-level” providers (e.g. nurse practitioners, but also pharmacists and other professionals)

The migration of doctors is generally a “two-way street”, although immigration flows have been larger than emigration in Belgium and other Western European countries

The number of doctors and nurses per capita has increased in most EU countries since 2000, except in Belgium and France for doctors

Number of doctors & nurses

Composition (GPs/specialists)

Migration flows

Changing roles & responsibilities

Contact: [email protected]

Website http://www.oecd.org/health/workforce.htm

Twitter @OECD_Social

Newsletter http://www.oecd.org/els/health-systems/oecd-health-update.htm

For more information

mailto:[email protected]

http://www.oecd.org/health/workforce.htm

http://www.oecd.org/health/workforce.htm

https://twitter.com/OECD_Social

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trends in health workforce in europe - ose · 2017. 11. 24. · trends in health workforce in...

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