using evidence in hrh policy making in oecd countries mark pearson head, oecd health division
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USING EVIDENCE IN HRH POLICY MAKING IN OECD COUNTRIESMark PearsonHead, OECD Health Division
2
• The crisis has turned policy concerns upside down.
• Decision support tools and processes
are mostly not fit for purpose• The health sector needs a
productivity agenda
Main health labour market issues in OECD countries since 2008
3
THE CRISIS IMPACT ON HEALTH LABOUR MARKETS
4
Crisis-related adjustment in the health sector has fallen on wages…
-4.0%
-2.0%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
2005 2006 2007 2008 2009 2010 2011
HungaryNurses
GPs
Specialists
Average wage
-2.0%
-1.0%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
2005 2006 2007 2008 2009 2010 2011
DenmarkNurses
Doctors (GPs and specialists)Average wage
-2.0%
-1.0%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
2005 2006 2007 2008 2009 2010 2011
FranceNurses
GPs
Specialists
Average wage
-2.0%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
2005 2006 2007 2008 2009 2010 2011
BelgiumNurses
GPs
Specialists
Average wage
5
Employment held up well: more doctors and nurses than before the crisis
Source: OECD Health Data 2013
90
100
110
120
130
140
150
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
USA
Doctors
Nurses
90
100
110
120
130
140
150
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Italy
Doctors
Nurses
90
100
110
120
130
140
150
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
France
Doctors
Nurses
90
100
110
120
130
140
150
2002 2003 2004 2005 2006 2007 2008 2009 2010
Japan
Doctors
Nurses
6
The increase in HR supply is driven by increasing graduate numbers…
50
100
150
200
250
300
Australia Canada
Japan United StatesIndex (1990=100)
50
100
150
200
250
300
Denmark Italy
Netherlands United KingdomIndex (1990=100)
Number of medical graduates, selected countries, 1990 to 2011
Source: OECD Health Statistics 2013, http://dx.doi.org/10.1787/health-data-en
7
…and in many countries by improved retention, e.g. doctors delaying retirement
12.9
22.2 22.7 23.0 23.2 24.1
30.5 31.0 31.0 31.6 31.7 31.8 32.8 33.5 33.5
38.0 39.1 39.541.3 42.2
48.4
0.0
10.0
20.0
30.0
40.0
50.0
60.0
2010 or nearest year 2000
Source: OECD Health Data 2012
Share of doctors aged 55 or older, OECD countries, 2000 vs. 2010
8
• Spain: 75% increase in doctors emigrating from 2011 to 2012
• Ireland: Five-fold drop in foreign nurse recruits from 2007 to 2009
• Brazil:Planning to recruit up to 5,000 doctors from EU crisis countries
Migration flows have reacted to the crisis in a number of hard-hit countries
9
(POST-)CRISIS POLICY CONCERNS
Policy priorities have changed to issues about allocation of human resources
0
5
10
15
20
25
30
No particular issue
Maintaining the current level of
physician suppply
Meeting increasing
demand
Maintaining the current share of
GPs
Identified shortage in some
specialties
Mal-distribution of physician
supply
10Source: OECD Health System Characteristics Survey 2012-13“No particular issue”: Netherlands
11
OECD countries consider geographic maldistribution of MDs a key challenge
Source: OECD Regions at a Glance (forthcoming)
Australia
Austria
Belgium
Canada
Czech Republic
Denmark
Estonia
Finland
France
Germany
Greece
Hungary
Iceland
Ireland
Israel
Italy
Japan
Korea
Luxembourg
Mexico
Netherlands
New Zealand
Norway
Poland
Portugal
Slovak Republic
Slovenia
Spain
Sweden
Switzerland Turkey
United Kingdom
United States
Vienna
Brussels
Prague
Lisboa
Bratislava
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
0 2 4 6 8 10
Physicians density (per 1 000 population)
Doctors per 1 000 inhabitants, TL2 regions, 2011
12
Distribution across specialties is considered inadequate in many countries
Note: Generalists include general practitioners (‘family doctors’) and other generalist (non-specialist) medical practitioners.Source: OECD Health Data 2012
Share of generalist doctors, selected countries, 1995 to 2010
25
30
35
40
45
50
55
60
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Australia France Germany Netherlands United Kingdom
13
Changing team composition is a fast-moving target for many OECD countries
0
5000
10000
15000
20000
0
5000
10000
15000
20000
2000 2005 2010
NP
PA
MD
Sources: OECD Health Data 2013, US National Commission on Certification of Physician Assistants “Certified Physician Assistant
Population Trends (PA-Cs)”, American Association of Colleges of Nursing 2000-2010 Annual Surveys
Increase in NP/PA, relative to MD, USA, 2000 to 2010
14
DECISION SUPPORT IS NOT FIT FOR PURPOSE
15
Health workforce planning aims at the long term…
16
Different approaches to projections especially on the demand side…
Country/Institution Population size
Constant utilization
Needs-based
Health service delivery reforms
GDP/health expenditure
growthAustralia, Health Workforce Australia (2012) x xCanada, Ontario Ministry of Health and Long-Term Care and Ontario Medical Association (2010)
x x
France, Ministry of Social Affairs and Health (2009 for MD, 2011 for nurse) xNetherlands, Advisory Committee on Medical Manpower Planning (2010) x x x x
United Kingdom, Centre for Workforce Intelligence (2012) x x x xUSA, University of North Carolina, Cecil G. Sheps Center (2012) x x x
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• Working hours (FTE) • Outflows
Stocks & Flows
• Measurement?• Sources?Productivity
• Indicators?• Current balance?Shortages
But many countries struggle with more basic data inputs as well…
18
Data
• Investing in data collection: EU Joint Action, national agencies
Structure
• “Agencification”: the rise of the workforce planning agency in NL, UK, AUS, NZ
Policy
• Linking better to policy and frontline: include stakeholders at all stages of planning (NL)
What are countries doing to improve health workforce planning?
19
WE NEED A PRODUCTIVITY AGENDA
Productivity development in the health sector has been lacklustre
Changes in UK Health Care Productivity, 1995-2010
Source: Nuffield Trust 2013
21
There are large variations in the number of doctor per (1 000 population)…
Greec
e¹
Austri
a
Portu
gal²
Germ
any
Spain
Czech
Rep
.
Denm
ark
Franc
e¹
Estonia
Israe
l
Nethe
rland
s¹
Belgium
Luxe
mbo
urg
New Z
ealan
d
United
Sta
tes
Japa
n
Poland
Brazil
Chile²
South
Afri
ca
Indo
nesia
0
1
2
3
4
5
6
7
6.1
5.0
4.8
4.1
4.0
3.9
3.8
3.8
3.8
3.7
3.6
3.5
3.5
3.3
3.3
3.3
3.3
3.3 3
.3
3.2
3.0
3.0
2.9
2.8
2.8
2.7
2.6
2.5
2.5
2.4
2.2
2.2
2.2
2.0
1.8
1.7
1.6
1.5
0.8
0.7
0.2
Per 1 000 population
22
…and nurses (per 1000 population)
0
5
10
15
20
16.6
15.415.414.8
12.9
12.211.8
11.411.311.111.1
10.310.110.010.0
9.38.88.78.68.3
8.08.07.8
6.36.26.26.15.95.5
5.24.84.7
4.2
3.3
2.7
1.71.71.51.11.00.9
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And they report considerable mismatch between their skills and tasks…
Physicians Nurses Other health professionals
Others-10%
0%
10%
20%
30%
40%
50%
60%
Do you feel that you need further training in order to cope well with your present duties?
Notes: Preliminary data. “Others” = other technical and professional occupations (ISCO 2 and 3)Source: PIAAC 2013
24
• The crisis has turned policy concerns upside down.
• Decision support tools and processes
are mostly not fit for purpose• The health sector needs a
productivity agenda
Main health labour market issues in OECD countries since 2008
25
www.oecd.org/health: • Health at a Glance 2013 – 21 November• Health workforce planning in OECD
countries – WP 62• The crisis impact on health markets, WP
– forthcoming in December• Geographic imbalances in physician supply
and policy responses, WP – forthcoming in December
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USING EVIDENCE IN HRH POLICY MAKING IN OECD COUNTRIESMark PearsonHead, OECD Health Division