Transcript Using Evidence in HRH policy making in OECD

USING EVIDENCE IN
HRH POLICY MAKING
IN OECD COUNTRIES
Mark Pearson
Head, OECD Health Division
Main health labour market issues
in OECD countries since 2008
• 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
2
THE CRISIS IMPACT ON
HEALTH LABOUR MARKETS
3
Crisis-related adjustment in the
health sector has fallen on wages…
Hungary
10.0%
Nurses
GPs
8.0%
Nurses
7.0%
Specialists
Average wage
6.0%
Denmark
8.0%
Doctors (GPs
and specialists)
Average wage
6.0%
5.0%
4.0%
4.0%
3.0%
2.0%
2.0%
1.0%
0.0%
2005
2006
2007
2008
2009
2010
2011
-2.0%
0.0%
-1.0%
-4.0%
2005
2006
2007
2008
2009
2010
2011
-2.0%
France
6.0%
Nurses
5.0%
GPs
Belgium
12.0%
Nurses
GPs
10.0%
Specialists
4.0%
Average wage
3.0%
Specialists
8.0%
Average wage
6.0%
2.0%
4.0%
1.0%
2.0%
0.0%
-1.0%
2005
2006
2007
2008
2009
2010
2011
0.0%
2005
-2.0%
2006
2007
2008
2009
2010
2011
-2.0%
4
Employment held up well: more doctors
and nurses than before the crisis
USA
Japan
150
150
140
140
130
130
Doctors
120
Doctors
120
Nurses
Nurses
110
110
100
100
90
90
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2002
2011
2004
2005
2006
2007
2008
2009
2010
Italy
France
150
150
140
140
130
130
Doctors
120
2003
Doctors
120
Nurses
Nurses
110
110
100
100
90
90
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Source: OECD Health Data 2013
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
5
The increase in HR supply is driven
by increasing graduate numbers…
Number of medical graduates, selected countries, 1990 to 2011
Australia
Japan
Canada
United States
Denmark
Netherlands
Index (1990=100)
300
Index (1990=100)
300
250
250
200
200
150
150
100
100
50
50
Source: OECD Health Statistics 2013, http://dx.doi.org/10.1787/health-data-en
Italy
United Kingdom
6
…and in many countries by improved
retention, e.g. doctors delaying retirement
Share of doctors aged 55 or older, OECD countries, 2000 vs. 2010
60.0
48.4
50.0
39.5
38.0 39.1
40.0
41.3 42.2
32.8 33.5 33.5
30.5 31.0 31.0 31.6 31.7 31.8
30.0
24.1
22.2 22.7 23.0 23.2
20.0
12.9
10.0
0.0
2010 or nearest year
Source: OECD Health Data 2012
2000
7
Migration flows have reacted to the
crisis in a number of hard-hit countries
• 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
8
(POST-)CRISIS POLICY
CONCERNS
9
Policy priorities have changed to issues
about allocation of human resources
30
25
20
15
10
5
0
No particular
issue
Maintaining the
current level of
physician
suppply
Meeting
increasing
demand
Source: OECD Health System Characteristics Survey 2012-13
“No particular issue”: Netherlands
Maintaining the
Identified
Mal-distribution
current share of shortage in some of physician
GPs
specialties
supply
10
OECD countries consider geographic
maldistribution of MDs a key challenge
Australia
Doctors per 1 000
Austria
Belgium
inhabitants, TL2
Canada
Czech Republic
regions, 2011
Denmark
32
Vienna
31
Brussels
30
29
Prague
28
27
Estonia
26
Finland
25
France
24
Germany
23
Greece
22
Hungary
21
Iceland
20
Ireland
19
Israel
18
Italy
17
Japan
16
Korea
15
Luxembourg
14
Mexico
13
Netherlands
12
Lisboa
New Zealand
11
Norway
10
Bratislava
Poland
9
Portugal
8
Slovak Republic
7
Slovenia
6
Spain
5
Sweden
4
Switzerland
3
Turkey
2
United Kingdom
1
United States
0
Source: OECD Regions at a
Glance (forthcoming)
0
2
4
6
8
Physicians density (per 1 000 population)
10
11
Distribution across specialties is
considered inadequate in many countries
Share of generalist doctors, selected countries, 1995 to 2010
60
55
50
45
40
35
30
25
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Australia
France
Germany
Netherlands
United Kingdom
Note: Generalists include general practitioners (‘family doctors’) and other generalist (non-specialist) medical
practitioners.
Source: OECD Health Data 2012
12
Changing team composition is a fastmoving target for many OECD countries
Increase in NP/PA, relative to MD, USA, 2000 to 2010
20000
20000
15000
15000
NP
10000
10000
PA
MD
5000
5000
0
0
2000
2005
2010
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
13
DECISION SUPPORT IS NOT
FIT FOR PURPOSE
14
Health workforce planning
aims at the long term…
15
Different approaches to projections
especially on the demand side…
Country/Institution
Australia, Health Workforce Australia
(2012)
Canada, Ontario Ministry of Health
and Long-Term Care and Ontario
Medical Association (2010)
France, Ministry of Social Affairs and
Health (2009 for MD, 2011 for nurse)
Netherlands, Advisory Committee on
Medical Manpower Planning (2010)
United Kingdom, Centre for Workforce
Intelligence (2012)
USA, University of North Carolina,
Cecil G. Sheps Center (2012)
Population Constant Needssize
utilization based
x
Health service GDP/health
delivery
expenditure
reforms
growth
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
16
But many countries struggle with
more basic data inputs as well…
Stocks &
Flows
Productivity
Shortages
• Working hours (FTE)
• Outflows
• Measurement?
• Sources?
• Indicators?
• Current balance?
17
What are countries doing to improve
health workforce planning?
Data
• Investing in data collection:
EU Joint Action, national agencies
• “Agencification”: the rise of the workforce
planning agency in NL, UK, AUS, NZ
Structure
Policy
• Linking better to policy and frontline: include
stakeholders at all stages of planning (NL)
18
WE NEED A PRODUCTIVITY
AGENDA
19
Productivity development in the health
sector has been lacklustre
Changes in UK Health Care Productivity, 1995-2010
Source: Nuffield Trust 2013
0.2
0.7
0.8
1
1.5
1.6
1.7
2.2
2.2
2.8
2.8
2.6
2.5
2.5
3.6
3.5
3.3
3.3
3.3
3.3
3.3
3.8
3.8
3.8
3.7
3.5
3.3
3.2
3.0
2.9
2.7
2.4
2.2
2.0
1.8
2
3.0
3
4.1
3.9
4
4.0
5
4.8
5.0
6.1
There are large variations in the number
of doctor per (1 000 population)…
Per 1 000 population
7
6
0
21
Indonesia
India
South Africa
Brazil
China
Turkey¹
Mexico
Greece¹
Chile²
Korea
Israel
Poland
Spain
Slovak Republic¹
Portugal¹
Estonia
Hungary
Italy¹
Austria³
Russian Fed. (2006)
Czech Republic
Slovenia
United Kingdom
France¹
OECD34
Canada
New Zealand
Japan
Australia
Finland
Sweden
United States¹
Luxembourg
Germany
Netherlands¹
Ireland¹
Norway
Iceland¹
Belgium²
Denmark
Switzerland
…and nurses (per 1000 population)
20
16.6
15
15.415.4
14.8
12.9
12.2
11.8
11.4
11.111.111.3
10.3
10.010.010.1
10
7.8 8.0 8.0
5
4.2
0.9 1.0 1.1
4.7 4.8
5.2 5.5
8.7 8.8
8.3 8.6
9.3
6.3
5.9 6.1 6.2 6.2
2.7
3.3
1.5 1.7 1.7
0
22
And they report considerable mismatch
between their skills and tasks…
Do you feel that you need further training in order to cope
well with your present duties?
60%
50%
40%
30%
20%
10%
0%
Physicians
Nurses
Other health
professionals
Notes: Preliminary data. “Others” = other technical and professional occupations (ISCO 2 and 3)
Source: PIAAC 2013
Others
23
Main health labour market issues
in OECD countries since 2008
• 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
24
More information
[email protected]
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
25
USING EVIDENCE IN
HRH POLICY MAKING
IN OECD COUNTRIES
Mark Pearson
Head, OECD Health Division