Changes in the hospital care environment impacting on nurses workforce conditions a European perspective Reinhard Busse, Prof. Dr. med.

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1 Changes in the hospital care environment impacting on nurses workforce conditions a European perspective Reinhard Busse, Prof. Dr. med. MPH FFPH Dept. Health Care Management, Technische Universität Berlin, (WHO Collaborating Centre for Health Systems Research and Management) & European Observatory on Health Systems and Policies

2 How has the hospital care environment changed in the last 10 or 20 years? inpatient outpatient treatment in community, as day care etc. fewer hospitals with fewer beds hospitals used for severely ill and/or high-technology patients over short time spans in addition, case-based payments contributes to this development very different work environment for nurses and other health professionals What can we see and learn from European data? 2

3 How can we learn from data? 1. Single parameter in (e.g. number of hospital beds) does not tell us anything as we do not know whether number is appropriate! 2. Single parameter in one country over time better but still of little use (e.g.: More hospital beds better or worse?) 3. Comparison of that parameter with other countries at one point in time and over time even better 4. Correlations between different parameters, e.g. hospital beds and number of nurses, in different countries most useful but still many pitfalls Context information always important! 3

4 1400 Hospital beds per only few data around European average

5 1100 Acute care hospital beds per better data around European average 5

6 30 In-patient care admissions per PL = exception 50% increase

7 Age standardized admission rate per 1000 population Different numbers of inpatients different epidemiology or differences in treatment style? Here: hospitalisations for breast cancer Belgium Croatia Cyprus Czech Republic Denmark Hungary Iceland Israel Italy Lithuania Luxembourg Malta Norway Slovenia Spain Switzerland 7 United Kingdom

8 % of day-cases to all admissions (2008) United Kingdom (2008) (2008) Italy (2006) Denmark (2009) Spain (2005) (2008) Malta (2009) (2008) Belgium (2007) Israel (2008) Luxembourg (2007) (2008) Switzerland (2008) Norway (2009) Cyprus (2008) Slovenia (2007) (2008) Hungary (2008) (2008) Lithuania (2009) Czech Republic (2008) (2008) Inguinal hernia repair: % as day cases

9 % of day-cases to all admissions Belgium Croatia Cyprus Czech Republic Denmark Hungary Israel Italy Lithuania Luxembourg Malta Norway Slovenia Spain Switzerland 9 United Kingdom

10 20 Average length of stay, all hospitals %; now 3 days below European average 10

11 500 Physicians per PL = exception no increase

12 1700 Nurses (PP) per Rate below European average and no increase!

13 150 Nurses graduated per Increase from very low level; but still below European average 13

14 200 Y Nurses newly graduated per population Y = X+9.2 Today (i.e. latest avalaible year) ALB Rate above replacement LAT PT SK PL FR SWE NL GER FIN IRL Rate below replacement X - Nurses (PP) per , Last available Y - Nurses graduated per , Last available Nurses per population X 14

15 500 Y Physicians per population Y = X : 1 Few nurses, few physicians PT LAT ALB 3 : 1 2 : 1 AT FR SK 2.2 : 1 PL European average GER NL SWE European average IRL FIN 6.5 : 1 Many nurses, few physicians X - Nurses (PP) per , Y - Physicians per , 2000 X Nurses 15 per population

16 Y Physicians per population Y = X Today (i.e. latest avalaible year) Few nurses, many physicians 1.4 : 1 LAT 2.3 : 1 ALB PT European average European average X - Nurses (PP) per , Last available Y - Physicians per , Last available Nurses 16 Few nurses, very few physicians SK PL 3.4 : 1 AT 2.4 : 1 NL FR SWE GER IRL FIN 6 : 1 High nurse : physician ratio X per population

17 1000 Y Acute care hospital beds per population Y = X Few nurses, many beds PT Few nurses, few beds LAT 1 : : 1 PL ALB AT FR European average SK GER 3 : : 1 NL SWE 1.5 : 1 European average 6 : 1 FIN High nurse : bed ratio IRL X - Nurses (PP) per , 2000 Y - Acute care hospital beds per , 2000 X Nurses 17 per population

18 1500 Acute care hospital beds per population Few nurses, many beds 1 : 1 LAT ALB European average AT PL SK FR PT 2 : 1 2 : 1 GER 1 : : 1 NL SWE 8 : 1 European average IRL FIN Today (i.e. latest avalaible year) High nurse : bed ratio Few nurses, few beds X X - Nurses (PP) per , Last available Y - Acute care hospital beds per , Last available Nurses 18 per population

19 30 25 High 20patient : nurse ratio Y Inpatient admissions per 100 population 50 : 1 PT LAT 30 : 1 PL ALB Y = X AT SK European average 25 : 1 GER SWE NL 10 : 1 FIN 20 : 1 European average IRL Low patient : nurse ratio X - Nurses (PP) per , 2000 Y - In-patient care admissions per 100, 2000 X 2000 Nurses 19 per population

20 50 Inpatient admissions per 100 population 40 High patient : nurse ratio : 1 LAT ALB 40 : 1 PL AT SK PT 40 : 1 = European average FR 22 : 1 GER NL SWE 10 : 1 = FIN 15 : 1 European average IRL 9 : 1 Low patient : nurse ratio X - Nurses (PP) per , Last available Y - In-patient care admissions per 100, Last available X Today (i.e. latest avalaible year) Nurses 20 per population

21 Costs and cost components by country: Hip replacement

22 Costs and reimbursement by hospital within country: Hip replacement Reimbursement (Euros) and Hungary Denmark England Hungary Italy Spain Total cost (Euros) 22

23 395, , , , , , , , ,22 308,88 592, , , ,53 483, , , , , , , , , , , , ,21 0, , , , , , , , , , ,00 Hungary (N=2) (N=5) Spain (N=5) Denmark (N=3) (N=13) England (N=3) (N=3) (N=6) Italy (N=5) in 23 Acute myocardial infarction 23

24 Acute myocardial infarction Working conditions likely to change a lot in future! 24

25 Impact of DRGs: felt or real? Hospital CEOs Medical controllers Physicians Nurses improved unchanged worsened

26 Conclusions It s worth looking at other countries if only to learn more about ourselves and expected future changes ( ambulatory treatment, new technologies ). 26

27 Thank you for your attention Analysing Health Systems and Policies

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