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REMUNERATION OF DOCTORS
AND NURSES:
PROGRESS AND PERSISTING ISSUES
Joint session of Health Data Correspondents and Health Accounts Experts
Paris, 17 October 2013
• Remuneration levels of doctors and nurses affect: – Attractiveness/retention in these professions
– Health spending in the country
• Difficult data collection
• Review of data availability and comparability
Background
1. Doctor remuneration
– Definitions, results , limitations
2. Nurse remuneration
– Definitions, results , limitations
3. Comparisons with other workers in the country
Outline
• Average gross annual income, including social security contributions and income taxes payable by the employee
1. Doctor remuneration - Definition
Includes Excludes
- Extra formal payments, bonuses, overtime, etc.
- Income for private practice (for salaried)
- Salaried work (for self-employed)
- Social contributions payable by the employer (for salaried)
- Practice expenses (for self-employed)
- Doctors in training
• Includes only:
– fully-qualified physicians
– Full-time workers
• Distinguishes between:
– GPs and Specialists (all specialties combined)
– Salaried and Self-employed
1. Doctor remuneration - Definition
• Main sources:
– Health insurance schemes (BEL, FRA)
– Salary registers (NLD)
– Ad-hoc studies and surveys (CZE, DNK, DEU, ITA)
1. Doctor remuneration - Data collection
1. Doctor remuneration – Results
Source: OECD Health Statistics 2013
Slovenia
Spain
Turkey 5
United Kingdom 6
1. Physicians in training are included (resulting in an underestimation). 2. Data include practice expenses (resulting in an overestimation). 3.
Data on salaried doctors relate only to public sector employees who tend to receive lower remuneration than those working in the private
sector (resulting in an underestimation). 4. Remuneration of self-employed physicians is net income rather than gross income (resulting in
an underestimation). 5. Figures are net income rather than gross income (resulting in an underestimation). 6. Specialists in training are
included (resulting in an underestimation).
Mexico 3
Netherlands 3
New Zealand
Norway
Poland
Slovak Republic
Greece
Hungary 3
Iceland 3
Ireland
Israel
Italy
Czech Republic ¹
Denmark
Estonia
Finland
France 4
Germany 1
Australia ¹
Austria
Belgium 2
Canada
Chile 3
Remuneration of doctors, US$ PPP, 2011 (or nearest year)
55
127
32
73
29
89
66
43
89
46
48
86
84
116
105
136
136
82
173
143
38
79
76
156
0 100 200 300
USD PPP, thousands
Salaried
Self-employed
General practitioners (GPs)
88
48
127
43
107
85
113
74
34
88
211
103
93
54
143
119
88
34
71
108
207
180
278
213
138
254
83
87
0100200300
USD PPP, thousands
Salaried
Self-employed
Specialists
Underestimation:
• Payments for overtime work, bonuses, other supplementary excluded (AUT for GPs, IRL and NZL for salaried specialists, FRA, ITA, PRT, SVK and SWE);
• Incomes from private practices for salaried doctors excluded (e.g. CZE, HUN, PRT, SVN, ISL, IRL and SWE for specialists);
• Informal payments excluded (e.g. GRC and HUN);
• Public sector only (CHL, DNK, HUN, NOR and SVK);
• Net income rather than gross income (FRA and TUR);
• Physicians in training included (AUS, CZE, DEU, and GBR for specialists)
• Part-time workers included (AUS, AUT, BEL, NLD, and for GPs).
Overestimation:
• Practice expenses included for self-employed GPs (BEL)
1. Doctor remuneration – data limitations
1. Doctor remuneration – Results
1. The growth rate for the Netherlands is for self-employed GPs and specialists.
Source: OECD Health Statistics 2013
Growth in the remuneration of GPs and specialists, 2005-2011 (or nearest year)
3.7
2.2
5.5
3.7
2.7
1.7
0.3
5.4
4.4 4.4
3.9
0.2
3.6
4.54.7
2.7
3.0
5.3
4.44.2
0
1
2
3
4
5
6
GPs Specialists
Average annual growth rate(%, in nominal terms)
• No data – Japan (no split between GPs and specialists)
– Korea (why?)
– Switzerland (reliability of source)
• Lack of recent data – United States (2001)
– Sweden (2002)
– Luxembourg, Portugal (both 2005)
• Serious data comparability issues – Belgium (Practice expenses included)
– France (Net income rather than gross)
– Germany (Physicians in training included)
– United Kingdom (Specialists in training included)
1. Doctor remuneration – data limitations
• Average gross annual income, including social security contributions and income taxes payable by the employee
• Salaried nurses working in hospitals
2. Nurse remuneration - Definitions
Includes Excludes
- Extra formal payments, bonuses, overtime, etc.
- Any supplementary income
- Social contributions payable by the employer
- Care workers without certification in nursing (Nursing aides)
- Midwives - Nurse managers
• Main sources:
– Hospital reports (AUS, GRC)
– Labour force or earnings surveys (CAN, CZE, FIN, DEU, ITA, JPN,USA)
– Payroll data (DNK, IRL)
2. Nurse remuneration - Data collection
2. Nurse remuneration – Results
1. Data refer to registered ("professional") nurses in the United States, Australia and Canada (resulting in an overestimation).
Source: OECD Health Statistics 2013.
Remuneration of hospital nurses, USD PPP, 2011 (or nearest year)
17
18
20
23
23
24
28
34
36
36
37
39
40
42
44
45
46
46
47
47
49
50
51
52
54
56
64
70
82
0 20 40 60 80 100
Hungary
Slovak Republic
Estonia
Czech Republic
Poland
Turkey
Mexico
Slovenia
Greece
France
Italy
Finland
Iceland
Japan
United Kingdom
Israel
Spain
Netherlands
Chile
Germany
New Zealand
Belgium
Canada ¹
Norway
Denmark
Australia ¹
Ireland
United States ¹
Luxembourg
USD PPP, thousands
x 4
Overestimation: • Registered/“professional” nurses only (e.g., in
AUS, CAN and USA).
Underestimation: • Nurses working part-time included(e.g. BEL);
• Additional income (overtime payments and bonuses) and informal payments excluded (e.g. ITA, PRT and SVN);
• Public sector only, health assistants and nurse assistants included (NZL).
2. Nurse remuneration – data limitations
2. Nurse remuneration – Results
Source: OECD Health Statistics 2013 .
Growth in the remuneration of hospital nurses, 2005-2011 (or nearest year)
n.a.
4.2
n.a.
6.2
5.4
0.7
8.6
2.3
4.8
2.9
4.4
8.4
3.8
4.6
5.55.0 4.8
5.9
4.24.5
7.8
-2.8
-1.7
-0.5 -0.3-0.1
0.2
1.21.7 2.0
2.5 2.7 2.8 2.9 3.0
3.3 3.5 3.6
4.5 4.8 4.8 5.1
-6
-4
-2
0
2
4
6
8
10
2005-2008 2008-2011Average annual growth rate(%, in nominal terms)
13.8
-6.1
• No data – Austria, Korea, Sweden, Switzerland.
• Lack of recent data – Portugal (2005)
– France (2009)
• Data comparability issues – Registered nurses (AUS, CAN, USA)
2. Nurse remuneration – data limitations
• Current indicator: – Ratio to average wage of all workers
– Data extracted from the Labour Force Survey database
• Possible new indicator: – Ratio to average wage of tertiary-educated
workers
– Data extracted from the Education database
3. Comparing remuneration level of doctors
and nurses with other workers in the country
1. Physicians in training included (resulting in an underestimation). 2. Practice expenses included (resulting in an over-estimation). 3.
Remuneration of self-employed physicians is net income, not gross income (resulting in an underestimation). 4. Public sector
employees only (resulting in an underestimation). 5. Specialists in training included (resulting in an underestimation).
Source: OECD Health Statistics 2013 , http://dx.doi.org/10.1787/health-data-en.
Remuneration of doctors, ratio to average wage of all workers, 2011 (or nearest year)
Poland
Slovak Republic
Slovenia
Spain
United Kingdom 5
Hungary 4
Ireland
Israel
Italy
Netherlands
Norway
Denmark
Estonia
Finland
France 3
Germany 1
Greece
Australia ¹
Austria
Belgium 2
Canada
Czech Republic ¹2.6
1.6
1.8
1.4
2.0
1.9
2.2
1.8
2.3
2.0
1.9
1.7
2.7
2.3
3.0
2.7
2.1
3.0
3.0
3.4
0 2 4 6Ratio to average wage of all
workers in each country
Salaried
Self-employed
General practitioners (GPs)
n.a.
n.a.
n.a.
n.a.
n.a.
2.3
2.6
2.1
2.6
2.2
2.8
2.6
1.6
3.7
3.1
2.6
3.0
1.8
1.6
2.4
2.3
2.3
4.3
4.2
4.7
3.6
5.3
0246Ratio to average wage of all
workers in each country
Salaried
Self-employed
6.2
Specialists
//
n.a.
Spain
United Kingdom
Remuneration of doctors, ratio to average wage of tertiary-educated
workers, 2011 (or nearest year)
New Zealand
Norway
Poland
Slovak Republic
Slovenia
Greece
Hungary
Ireland
Israel
Italy
Netherlands
Czech Republic
Denmark
Estonia
Finland
France
Germany
Australia
Austria
Belgium
Canada
Chile 1.2
2.0
1.2
1.4
0.9
1.8
1.3
1.4
1.2
1.8
2.4
1.7
1.5
1.6
1.9
2.4
2.1
1.8
2.3
2.0
3.1
0 2 4 6
Ratio to earnings for workers with tertiary education
Salaried
Self-employed
General practitioners (GPs)
n.a.
n.a.
n.a.
n.a.
n.a.
n.a.
1.8
1.2
2.0
1.6
2.1
1.9
1.7
2.6
1.0
2.8
2.8
1.6
2.0
2.7
1.3
1.0
1.9
2.6
2.2
3.7
2.5
5.0
3.8
2.8
3.0
3.6
0246
Ratio to earnings workers with tertiary education
Salaried
Self-employed
Specialists
n.a.
Source: OECD Health Statistics 2013
Remuneration of hospital nurses, ratio to average wage, 2011 (or nearest year)
1. Data refer to registered ("professional") nurses in the United States, Australia and Canada (resulting in an over-estimation).
0.8
0.8
0.9
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.1
1.1
1.1
1.1
1.1
1.1
1.1
1.2
1.2
1.2
1.2
1.3
1.41.4
0.0 0.5 1.0 1.5
Hungary
Slovak Republic
United Kingdom
France
Finland
Netherlands
Estonia
Slovenia
Norway
Italy
Czech Republic
Denmark
Japan
Ireland
Belgium
Canada ¹
Poland
Germany
Australia ¹
Spain
Greece
United States ¹
Israel
Luxembourg
Ratio to average wage of all workers in
each country
0.5
0.5
0.6
0.6
0.7
0.7
0.7
0.7
0.7
0.7
0.8
0.8
0.8
0.8
0.9
0.9
0.9
0.9
0.9
1.0
1.0
1.1
1.1
1.2
1.2
0.0 0.5 1.0 1.5
Hungary
Slovak Republic
Czech Republic
Netherlands
Italy
Germany
Poland
Ireland
Estonia
Norway
France
Slovenia
Finland
Denmark
United Kingdom
Canada ¹
Luxembourg
Belgium
United States ¹
Chile
Australia ¹
New Zealand
Spain
Israel
Greece
Ratio to average wage of tertiary-
educated workers in each country
• COMMENT on the possibility to fill data gaps and improve the comparability of data submitted;
• COMMENT on possible adjustments to national data submissions to improve comparability (along the lines of adjustments made in the Dutch report);
• COMMENT on the use of the average income of tertiary-educated workers only to compare the remuneration levels of doctors and nurses.
National Correspondents are invited to: