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Workforce innovations for better performing health systems in Europe, 4th May

Planning the health workforcein Portugal

Diana F. Lopes1

Eduardo de Castro1, Jorge Simões1,2

1GOVCOPP, DCSPT, Universidade de Aveiro2IHMT, Universidade Nova de Lisboa

Workforce innovations for better performing health systems in Europe


1. Context

Health professionals (HP) are the keystone of any health system

Given the time and cost involved in training new HP, the planning process is crucial by ensuring...

...the proper balance between the supply and demand of these HP

The planning process in Portugal has been conducted in a reactive way lacking a prospective vision based on an integrated and comprehensive analysis

2


Health 2040 project

Estimate the needs of physicians and nurses in Portugal, by specialities and by quinquennium until 2040

Identify the training needs of physicians and nurses, in medium and long term, until 2040

Estimate the number of students that must enter in medicine and nursing training system, each year, considering several specialities

2. Objectives

3

Workforce innovations for better performing health systems in Europe, 4th May 4

Organizational forms

EpidemiologyTechnological

EvolutionDemographic evolution of

HP

DEMAND

Demographic evolution of

the population

Population wages/GDP

SUPPLY

Wages

Health professionals’competencies

3. Driving forcesInteraction demography-economy

HP: Health professionals


3. Methodological basis

• The health workforce planning should follow an integrated perspective

…this project addresses physicians and nurses altogether

• There is a global evolution trend of the per capita number of professionals

• This evolution can be decomposed on specific benchmarks for each type of professionals depending on demography, GDP and technology

Panel data from OECD countries:Physicians p.c. and nurses p.c.GDP per capitaElderly populationFixed effects

Cluster analysis

Technicalcomponent

Social component

Delphi techniqueExperts’ opinionM

ODEL


3. Results – technical component

Physicians per 1 000 inhabitants

YearPhysicians/1000 inh.

2000 3,132005 3,4482010 3,8422014 4,4262020 4,5462025 4,5052030 4,3992035 4,2912040 4,242

0

0,5

1

1,5

2

2,5

3

3,5

4

4,5

5

2000

2002

2004

2006

2008

2010

2012

2014

2016

2018

2020

2022

2024

2026

2028

2030

2032

2034

2036

2038

2040

PHYS

ICIA

NS/

1 0

00 IN

HABI

TAN

TS



Nurses per 1 000 inhabitants

YearNurses

1000 inh.2000 3,542005 4,432010 5,682014 6,132020 6,7982025 7,1442030 7,3682035 7,5372040 7,718

0

1

2

3

4

5

6

7

8

9

2000

2002

2004

2006

2008

2010

2012

2014

2016

2018

2020

2022

2024

2026

2028

2030

2032

2034

2036

2038

2040

NU

RSES

PER

1 0

00 IN

HABI

TAN

TS



Ratio of nurses to physicians

Year Nurse/Phys.2000 1,1312005 1,2852010 1,4782014 1,3852020 1,4952025 1,5862030 1,6752035 1,7562040 1,820

00,20,40,60,8

11,21,41,61,8

2

2000

2002

2004

2006

2008

2010

2012

2014

2016

2018

2020

2022

2024

2026

2028

2030

2032

2034

2036

2038

2040

NU

RSES

TO

PHY

SICI

AN R

ATIO


0

500

1000

1500

2000

2500

3000

3500

4000

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

5000019

9619

9820

0020

0220

0420

0620

0820

1020

1220

1420

1620

1820

2020

2220

2420

2620

2820

3020

3220

3420

3620

3820

40

Physicians (real) Numerus clausus (real) Medical graduates (real)

3. Impact on the numerus clausus

1 704

1 658

46 228


0

500

1000

1500

2000

2500

3000

3500

4000

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

5000019

9619

9820

0020

0220

0420

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2020

2220

2420

2620

2820

3020

3220

3420

3620

3820

40

Physicians (real) Numerus clausus (real) Medical graduates (real) Retirements


1 704

1 658

46 228

Exits (estimates)


0

500

1000

1500

2000

2500

3000

3500

4000

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

5000019

9619

9820

0020

0220

0420

0620

0820

1020

1220

1420

1620

1820

2020

2220

2420

2620

2820

3020

3220

3420

3620

3820

40

Physicians (real) Physicians (estimative) Numerus clausus (real)

Medical graduates (real) Retirements


Exits (estimates)

Physicians (estimates)


0

500

1000

1500

2000

2500

3000

3500

4000

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

5000019

9619

9820

0020

0220

0420

0620

0820

1020

1220

1420

1620

1820

2020

2220

2420

2620

2820

3020

3220

3420

3620

3820

40

Physicians (real) Physicians (estimative)Numerus clausus (real) Medical graduates (real)Retirements Medical graduates (estimative)Medical graduates - estimative based on NC


Exits (estimates)

Physicians (estimates)Medical graduates (real)Medical graduates (estimates)

Medical graduates (estimates based on NC)


0

500

1000

1500

2000

2500

3000

3500

4000

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

5000019

9619

9820

0020

0220

0420

0620

0820

1020

1220

1420

1620

1820

2020

2220

2420

2620

2820

3020

3220

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3820

40

Physicians (real) Physicians (estimative)Numerus clausus (real) Medical graduates (real)Retirements Medical graduates (estimative)Medical graduates - estimative based on NC Numerus clausus (estimative)


1 704

683

1 658

Physicians (estimates)Medical graduates (real)Medical graduates (estimates)Numerus clausus (estimates)

Exits (estimates)Medical graduates (estimates based on NC)


Physicians NC (Med. School)

2014 2040 2014 2034

Real Estimate Real Estimate

46 227 42 334 1 704 683

14

3. Global overview

Nurses NC (Nursing School)

2014 2040 2014 2036

Real Estimate Real Estimate

64 893 77 031 2 823 2 121

-1 021

-702


Policy-makers increasingly recognise the need for a more integrated health workforce planning

Results show that Portugal will have a surplus of health professionals if nothing is done

Although this presentation is focused on the technical component, our methodology was complemented with:

• Experts’ opinion

• Scenario building

4. Conclusions

15


There is a need to:

• Improve the quality of the Portuguese health-related databases

• Smooth the wave form of the number of medical and nursing retirements

• Exploit methods to select the most effective policies to:

- Take advantage of our medical and nursing training capacities

- Attend population needs

4. Conclusions

16

Training needs (NC): 683(2034)

Medical training capacity: 1500


Exploit the spatial distribution of health professionals

Higher concentration of health personal in the metropolitan areas of the richer and more attractive countries/regions:• higher wages and better conditions to professional ambitions• greater employment opportunities (including the spouse/husband)

4. Further research

17


ReferencesBloor K, Maynard A. Planning human resources in health care: Towards an economic approach (an

international comparative review). Ottawa, Ontario: Canadian health Services research Foundation; 2003. Available

Carpenter BE, Neun SP. An analysis of the location decision of young primary care physicians. Atlantic Economic Journal. 1999;27(2):135-49.

Correia I, Veiga P. Geographic distribution of physicians in Portugal. European Journal of Health Economics. 2010;11:383-93.

Dayrit MM, Dolea C, Braichet JM. One piece of the puzzle to solve the human resources for health crisis. Bulletin of the World Health Organization. 2010;88(5):322.

Dussault G, Franceschini MC. Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce. Human Resources for Health. 2006;4:12Roberfroid D., Leonard C., et al. (2009). Physician supply forecast: better than peering in a crystal ball? Human Reources for Health 7(10): 1-13.

Hornby P. e Milicevic S. (2011). Human resources in health planning. Basics of health care system management. Health management guides, readings and references, Training in Health Service management in Serbia Belgrade: Ministry of Health of the Republic of Serbia.

OECD (2017), Health at a Glance 2017: OECD Indicators, OECD Publishing, Paris. http://dx.doi.org/10.1787/health_glance-2017-en

Santinha G. Cuidados de Saúde e Território: um debate em torno de uma abordagem integrada. Saúde e Sociedade. 2013;22(3):815-29.

WHO, 2010, Models and tools for health workforce planning and projections. Available at http://www.who.int/hrh/resources/observer/en/.

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http://www.who.int/hrh/resources/observer/en/


Thank you!

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