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
Workforce innovations for better performing health systems in Europe, 4th May
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
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Workforce innovations for better performing health systems in Europe, 4th May
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
Workforce innovations for better performing health systems in Europe, 4th May 5
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
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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
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3. Results – technical component
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
Workforce innovations for better performing health systems in Europe, 4th May 8
3. Results – technical component
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
Workforce innovations for better performing health systems in Europe, 4th May 9
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
Workforce innovations for better performing health systems in Europe, 4th May 10
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) Retirements
3. Impact on the numerus clausus
1 704
1 658
46 228
Exits (estimates)
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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
3. Impact on the numerus clausus
Exits (estimates)
Physicians (estimates)
Workforce innovations for better performing health systems in Europe, 4th May 12
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
3. Impact on the numerus clausus
Exits (estimates)
Physicians (estimates)Medical graduates (real)Medical graduates (estimates)
Medical graduates (estimates based on NC)
Workforce innovations for better performing health systems in Europe, 4th May 13
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 Numerus clausus (estimative)
3. Impact on the numerus clausus
1 704
683
1 658
Physicians (estimates)Medical graduates (real)Medical graduates (estimates)Numerus clausus (estimates)
Exits (estimates)Medical graduates (estimates based on NC)
Workforce innovations for better performing health systems in Europe, 4th May
Physicians NC (Med. School)
2014 2040 2014 2034
Real Estimate Real Estimate
46 227 42 334 1 704 683
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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
Workforce innovations for better performing health systems in Europe, 4th May
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
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Workforce innovations for better performing health systems in Europe, 4th May
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
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Training needs (NC): 683(2034)
Medical training capacity: 1500
Workforce innovations for better performing health systems in Europe, 4th May
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
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Workforce innovations for better performing health systems in Europe, 4th May
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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.
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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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Workforce innovations for better performing health systems in Europe, 4th May
Thank you!
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