Mobility Data Mapping Work Package 4 Survey The objective of the Survey is to support the Mobility Data Mapping activities of Work Package 4. This Survey was partly based on a 2011 research by the Swedish Board of Health and 1 Welfare. An important and relevant remark from the final Swedish research report should be emphasized also for the current Survey: There must be an aim and objective for collecting the variables that is useful for comparison, analyses and evaluation of the health care systems between countries. It is also important for countries to know why different variables are to be collected. It would also be an advantage if the Member States themselves have a benefit of the variables collected for national analyses. 2 You may send any inquiries concerning the Survey on Terminology Gap Analysis to Zoltan Aszalos: zoltan.aszalos@emk.sote.hu Mobility Data Mapping to Edit Eke: edit.eke@emk.sote.hu Deadline for submission: 10 December 2013 Please send the completed survey to euhwforcewp4@emk.sote.hu Name of person(s) completing this Survey Organisation Contact e-mail Person(s) contributing to the completion of the Survey Organisation Contact e-mail For each person contributing to the survey please insert another row. This Survey has two main sections. Please fill in BOTH sections: Section 1. - Terminology/Data Source Gap Analysis Section 2. - Mobility Data Mapping 1 The key contact point from this research is Kristina Stig, Programme Officer, The National Board of Health and Welfare (Socialstyrelsen), Department of Statistics, Monitoring and Evaluation 2 Evaluation on the Joint Questionnaire on Non-Monetary Healthcare statistic, Eurostat project ESSnet Public statistics. Final report. The Swedish National Board of Health and Welfare, 2011-04-30 1
Section 1. Terminology/Data Source Gap Analysis In this section we would like to have a thorough understanding on the contents of the data your country supplies to the OECD-WHO-Eurostat non-monetary healthcare Joint Questionnaire - the JQ. However, we would also like to collect information on HWF data available in your country based on other definitions. To fill in the Survey, you will need to work together with the National Focal Point of the OECD-WHO-Eurostat Joint Questionnaire. If you are not aware of who your National Focal Point is, please send a message to Zoltan (zoltan.aszalos@emk.sote.hu) and he will send you the contact details. you will need to understand the structure of the Joint Questionnaire Excel Template, which is sent to you in the same e-mail as this Survey. The results of the 2013 Questionnaire are sent to you in attachment as well. 3 you should understand the contents of the 2008 ISCO Codes: http://www.ilo.org/public/english/bureau/stat/isco/docs/health.pdf This Survey focuses on the following 5 harmonised professions: Doctors Nurses Dentists Pharmacists Midwives The JQ collects data for the above mentioned 5 harmonised professions in the following three categories: Licensed to practice: entitled to practice as health professionals Practicing: health care professionals directly providing services to patients Professionally active: the practicing category plus other health professionals working in administration and research who are not directly providing services to patients but for whom their medical education is a prerequisite for the execution of the job 3 Please note, that the full information is available from OECD on the 2013 Survey at http://dx.doi.org/10.1787/health-data-en. 2
1. A. Data reported to the Joint Questionnaire 1.A.1. Availability of Joint Questionnaire data Please tick ( ) in the cells to indicate where your country produced data for the Joint Questionnaire in 2013. Please note that this information is available from the OECD 2013 report on the JQ. You need to know this information in order to start doing the national level data gap analysis in the next question. As mentioned in the Introduction, you will need to understand the structure of the Joint Questionnaire Excel Template, which is sent to you in the same e-mail as this Survey. The results of the 2013 Questionnaire are sent to you in attachment as well. 4 Professional category + ISCO code(s) Licensed to practice Practicing Professionally active Doctors: 221, 2211, 2212 Nurses: 2221, 3221 Dentists: 2261 Pharmacists: 2262 Midwives: 2222, 3222 For the categories your country does not provide information, can you give a reason why that data is not available? Please fill in the cell matching the given category. (Reasons may include lack of data, or data collected according to different definitions, etc.) Detailed answers By category Explanation on the lack of reporting 4 Please note, that the full information is available from OECD on the 2013 Survey at http://dx.doi.org/10.1787/health-data-en. 3
1.A.2. Gap analysis For the categories your country does provide information, please make a gap analysis whether data supplied fully matches the ISCO codes and the three Joint Questionnaire categories (Licensed to Practice, Practicing, Professionally active) as defined in the JQ Template. The gap can be explained for example by the fact that the data is based on an estimation or on a sample, or data is based on job categories other than ISCO code: professions are defined by the contents of jobs, but the classification in use doesn t fit ISCO codes data based on qualifications according to 2005/36 directive: professions are defined by qualifications under the 2005/36 directive only data based on other qualifications: data are based on qualifications, but not on qualifications under 2005/36 directive (e.g. nurses trained in an other, older training system) compilation of various data sources: Data from different sources is compiled and an approximate number is provided - please describe this process. Please indicate what sources you use for such reporting, e.g. data based on the 2005/36 Directive or on other national definition any other special conditions - please explain Professional category and status Gap analysis Doctors - Licensed to practice Doctors - practicing Doctors - professionally active Nurses - Licensed to practice Nurses - practicing Nurses - professionally active Dentists - Licensed to practice Dentists - practicing 4
Dentists - professionally active Pharmacists - Licensed to practice Pharmacists - practicing Pharmacists - professionally active Midwives - Licensed to practice Midwives - practicing Midwives - professionally active What method(s) do you use to separate public providers from private ones? provide a short reference to the relevance of the private sector in your country. 5 Please (Please add your response here) 1.A.3. Special focus on Nurses The Joint Questionnaire includes two ISCO categories of nurses (professional nurses and associate professional nurses). According to the ISCO, there are other health professions similar to nurses, such as Medical assistants (3256), Ambulance workers (3258 ) and Health 6 care assistants (5321). In order to identify the possible gaps in reporting, we put a special emphasis on finding out who you report as nurse for the Joint Questionnaire. Here below you can find a list of different healthcare professionals. In case of every item please choose the category where it is reported (or not reported at all). Please, tick ( ) the cells accordingly. 5 The 2011 Swedish report on the Joint Questionnaire found that out of the 33 countries involved in their survey, only five countries had data only on public providers, 15 countries could separate public providers from private providers while 11 cannot. 6 The description of the professions are in the Occupations in Health ISCO Codes document: (http://www.ilo.org/public/english/bureau/stat/isco/docs/health.pdf) 5
We are aware that job contents, qualifications and registration procedure may vary according to countries. If a profession doesn t exist in your country s health system, please indicate not applicable. Categories Professi onal Nurse Associate Professio nal Nurse Not reported for JQ, as Classified under different ISCO Code Not applicable Classification depends on the following condition(s) - specify (e.g. degree) + Comments Nurses working in hospitals (with qualification nurse according to 2005/36 directive) Nurses working in hospitals (with other types of qualification than nurse according to 2005/36 directive) Specialist nurses working in hospitals Nursing aids working in hospitals Clinical nurse consultants Specialist nurses working in ambulatory care Nurses working in ambulatory care Medical assistants working in ambulatory care Nurses in primary care (GP practices) Mother and child community nurse (health visitor) Dental assistants Medical imaging (radiographic, ultrasound) assistants Medical laboratory technicians Assistants working at gynaecology ambulances 6
Endoscopic assistants Emergency care practitioners (paramedic) Emergency care assistants Intensive care assistants Home-based personal care workers You may add in the below rows any additional HWF categories related to nursing where reporting to the JQ is not evident in your country. 7
1.B. JQ and ISCO definitions applied in national data collection for better HWF planning This section focuses on the practical issues with the Joint Questionnaire definitions and data. In order to fill this section out you may need to consult the organisation(s) and the 7 experts in charge of national HWF planning. How much do you agree with the following statements? Please, indicate your level of agreement from 1-10 (where 1= absolutely disagree, 10= absolutely agree) and provide your written explanation. 1. The JQ categories match well the national composition of the 5 harmonised professions (doctors, nurses, pharmacists, dentists and midwives) 1 10 (You may also add an explanation here) 2. The reporting to the Joint Questionnaire raises no issues for our data collection system 1 10 (You may also add an explanation here) 3. The Joint Questionnaire provides an excellent resource to benchmark national data with data from other countries. 1 10 (You may also add an explanation here) 4. The Joint Questionnaire provides an excellent resource to contribute to national health workforce planning 1 10 (You may also add an explanation here) 7 Please, note, if there is no definitive HWF Planning process yet in your country, consider those steps and elements that represent similar and appropriate activities. 8
Section 2. Mobility Data Mapping In this section we are collecting information on the relevance of HWF mobility; the availability, interpretation and use of mobility data; and the objectives of mobility data collection in your country. We also aim to map your view on the comparability of your mobility data and gather information of the use of the currently available European Union databases, processes and recommendations. Last, but not least, we also want to ask for your recommendations on any further EU level steps on mobility data issues. You find the questions in three sections: 2.A. Relevance of HWF mobility at national level 2.B. Definition(s), availability and contents of HWF mobility data at national level 2.C. Validation and comparability of HWF mobility data, use of international data sources, recommendations Before you start filling in this part, please note the following clarifications to have a 8 common understanding of the term mobility in this survey : The term mobility is used for geographical, international cross-border mobility (inflow and outflow) both across European countries (between countries of the European Union) and from and to non European countries. The term HWF stands for the practicing health workforce of your country. 8 We follow the interpretations the European Comission Feasibility Study uses, please have more information in details in it, section 5.0, http://www.euhwforce.eu/web_documents/health_workforce_study_2012_report_en_1_.pdf 9
2.A. Relevance of HWF mobility at national level 2.A.1. Please, rate the relevance of mobility: inflow and outflow, separately, on the number, composition and sustainability of the total HWF, and according to the listed professions, respectively. Please, tick ( ) the cells according to your rating. Please, indicate with NR (No Rate) in any of the cells, if and where the relevance cannot be 9 rated. Mobility: Inflow HWF categories Absolutely high (crucial relevance) Absolutely low (no relevance at all) 1 2 3 4 5 6 7 8 9 10 Total HWF Doctors Dentists Nurses Pharmacists Midwives Mobility: Outflow HWF categories Absolutely high (crucial relevance) Absolutely low (no relevance at all) 1 2 3 4 5 6 7 8 9 10 Total HWF Doctors Dentists Nurses Pharmacists Midwives (Please add your comments here) 9 Please, in each case consider, if mobility of health professionals influence/define significantly the number, composition and sustainability of practicing health workers of the listed category, thus the provision of health services in your country. 10
2.A.2. Please define and explain any other aspects of relevance of mobility issues in your country. (Please add your response here) 2.A.3. Provide reference, if possible, that justify the relevance of HWF mobility in your country, preferably in English (e.g., website with mobility relating information, high level policy meeting/discussion documents, national guideline/ agreement, etc.) (Please add your comments here) 2.B. Definition(s), availability and contents of HWF mobility data at national level 2.B.1. What definition(s) of HWF mobility and what indicator(s) on HWF mobility are used in your country at national level? 10 (Please add your response here) 2.B.2. For which health professions and/or professional categories do you track HWF 11 mobility: stock data, inflow and/or outflow data? Please, tick ( ) the relevant cells and indicate with NA (non available), if no data is available. HWF categories Stock data Inflow data Outflow data How frequently is it updated?* Total HWF Doctors Dentists Nurses 10 Please, note, that we do want to explore any HWF mobility definition(s) and indicator(s) that may differ from the ones the European Commission Feasibility Study has, and are used at national level. 11 Please, consider, if, and how the number/proportion of foreign health professionals is represented in your stock data. 11
Pharmacists Midwives *please indicate frequency in months (Please, add your comments, and explain whether you can separate these data by public/private sector.) 2.B.3. Indicators(s) Please, tick ( ) the cells according to the mobility definition(s) you use. Please, indicate with NA (non applicable), if the indicator cannot be interpreted in the given category (for instance because no data are available). IHWF categori es foreigntrained foreignborn foreign-n ationality other (please specify below) stock data inflow data stock data inflow data stock data inflow data stock data inflow data Total HWF Doctors Dentists Nurses Pharmac ists Midwives (Please add your comments here. Please, specify and explain shorty also here any other indicator(s) you use.) 12
2.B.4. What are the main data sources of mobility data you use in your country? Please, list the data sources by name, and give the year when data collection started. Please, indicate with NA (non applicable) in any cell, if information cannot be interpreted. HWF categories Data source(s), starting year of data collection Data source(s), starting year of data collection Data source(s). starting year of data collection Stock data Inflow data Outflow data Total HWF Doctors Dentists Nurses Pharmacists Midwives (Please add your comments here) 2.B.5. What is the objective(s) of mobility data review in your country? How do you use and/or plan to use your mobility data to achieve that objective(s)? Please, tick ( ) the relevant cells, and shortly explain. Please, indicate with NA (non applicable), if no answer can be given (for example because no mobility data are available). Objectives YES How do you use your mobility data to achieve that objective(s) at present How do you plan to use your mobility data to achieve that objective(s) in the future NO Reasons for that (no use) in your view? HWF monitoring HWF planning HWF forecasting Other health 13
policy aim(s) (Please add your comments and detailed explanation here) 2.B.6. How do you keep contact with authorities of other nations to map/follow mobility of your HWF? contact and communication 1. we do not have any contacts 2. we do have formal contacts but not frequently 3. we do have contact frequently 4. we do have good contact in following international mobility regularly 5. Any other Please, tick ( ) Shortly explain. Please, explain how the process of international level information sharing on HWF mobility works in general in your country, and how it could be facilitated by EU regulations. (Please add your response here) 14
2.C. Validation and comparability of HWF mobility data, use of international data sources, recommendations 2.C.1. Validation and comparability of your HWF mobility at national and international level Please, tick ( ) the relevant cells, and shortly explain. Issue YES NO Shortly explain HWF mobility data can be cross-validated (triangulation): a) with other national data sources? b) with other international data sources? HWF mobility a) data used at national level comparable with international data? b) indicators used at national level comparable with international indicators? 2.C.2. What currently available EU processes can be used and/or work well to support HWF mobility relating information share in your view? (Please add your response here) 2.C.3. Which international HWF databases do you supply information to? Do you also use information/data for HWF monitoring, planning and forecasting, or any other purpose (please, define) from any of these databases? Please, provide information on DG Markt database anyway. (Please add your response here) 15
2.C.4. How EU level actions relating to mobility could support your HWF monitoring, planning and forecasting, or any other HWF relating (please, define) processes the best in the future? (Please add your response here) 2.C.5. What recommendations do you have regarding the use/inclusion of HWF mobility information into the JQ, and its utilization and use for HWF Planning in your country and at European level? (Please add your response here) 16
Background information The timing of the the Survey and the Deliverables W - Workshop, D - Deliverable As the above GANTT chart shows, the timing of the Survey is between September and December 2013 (in red) and the Terminology gap analysis final report is to be submitted in June 2014 and the Mobility data mapping report in March 2015 (also in red). Your contribution to the Survey All Associated Partners of WP4 are to contribute 3 days to fill out the Survey. These countries are: UK, Italy, Spain, Portugal, Greece, Poland, Iceland, Germany, Finland, Slovakia, Belgium, Netherlands. Some Collaborating Partners are also filling out the Survey. Countries with additional Mandays allocated to the two Activities as well as the two international organisations represented in WP4, the Union of European Medical Specialists and the European Federation of Nurses are to contribute to the analysis of the results of the Survey. The Manday distribution of the two Activities: 17
18
Detailed research description - not to be included in the Guidelines WP4 research activities The ultimate goal of the research activities of Work Package 4. is to provide a better understanding of the contents of health workforce data at national level in countries participating in this Work Package, and to examine and improve comparability of national health workforce data In order to serve this goal, two focal areas with a high impact on HWF data management have been selected for WP4: 1. Terminology issues related to the definitions of health care professions 2. Availability of data concerning the mobility of healthcare professionals Within each of these these two broad categories a specific area has been selected for closer analysis: 1. Terminology: Availability of comparative international HWF data in European countries - from the perspective of the ISCO codes applied also by the OECD-WHO-Eurostat Joint Questionnaire 12 2. Mobility Data: data on the geographical, international cross-border mobility (inflow and outflow) across European countries and from and to non-european countries as essential information for HWF planning. The WP4 Survey, together with expert interviews, workshop discussions and the review of relevant literature, are to contribute to the publication of two key reports: Terminology Gap Analysis and the Mobility Data Mapping in June 2014 and March 2015 respectively. These documents are to present feasible and simple policy level recommendations that countries may apply in order to improve their health workforce planning. The questions included in the WP4 Survey reflect this purpose as in addition to mapping current HWF data contents, they also intend to identify best practices in data collection and structuring. Countries participating at the Joint Action are at different levels of HWF data collection, therefore the implementation phase of these recommendations will be different from country to country. The pace of implementation will also depend strongly on the resources allocated to national HWF planning efforts. Various policy documents have been already published in these areas, and the WP4 research activities, including the Survey are built on these materials, including the Feasibility Study of the Joint Action. The timing of the the Survey and the Deliverables W - Workshop, D - Deliverable 12 Having comparative international data on the basic categories of HWF is a first step towards HWF planning. Obviously without other comparable data on other HWF categories, such as caring personnel, or on demographical trends and availability of technical equipment, the international comparison is not complete. 19
As the above GANTT chart shows, the timing of the Survey is between September and December 2013 (in red) and the Terminology gap analysis final report is to be submitted in June 2014 and the Mobility data mapping report in March 2015 (also in red). April-May 2013: Preliminary discussion on the contents of WP4 survey with key experts from OECD, WHO and the Swedish National Board of Health and Welfare 13-14 June 2013: First introduction of the basic features of the survey to WP4 Partners at the Budapest Workshop July-September 2013: With the involvement of the Partners and the advisory board of WP4, a finalisation of the survey, including a pilot 30 September 2013: Sending out of the template to countries and organisations involved in WP4 10 December 2013: deadline for the Partners to submit survey January-February 2014: analysis of surveys submitted by the Partners February 2014: during 2nd overall WP4 workshop presentation of the analysis of the results and discussion February-June 2014: results of the Survey built in the Terminology Gap Report February 2014 - March 2015: result of the Survey built in the Mobility Data Mapping Report The contribution of the WP4 Partners to the Survey Partners of Work Package 4 are expected to fill out the Survey and submit it before the 10 December deadline. A major objective of this Survey is to identify best practices, methods in order to facilitate the better collection and management of data required for health workforce planning. While some countries participating in WP4 have an established data collection system built on the requirements of HWF planning, some other countries have recently started or will start in the future the setting up of their comprehensive data and workforce planning system. This also means that the contribution of some countries will be based on a deeper knowledge and experience base, and other countries will fill out the survey based on current strategic plans rather than concrete operation. In all, countries will be required to 20
pay a special focus on questions where they have a special solution or methodology, which can be shared. As an additional benefit of this survey, Partners of WP4 will be more aware of HWF data collection in their countries, that later on will enable them to introduce policy recommendations at national level. All Associated Partners of WP4 are to contribute 3 days to fill out the Survey. These countries are: UK, Italy, Spain, Portugal, Greece, Poland, Iceland, Germany, Finland, Slovakia, Belgium, Netherlands. Some Collaborating Partners are also filling out the Survey. Countries with additional Mandays allocated to the two Activities as well as the two international organisations represented in WP4, the Union of European Medical Specialists and the European Federation of Nurses are to contribute to the analysis of the results of the Survey. The Manday distribution of the two Activities: Terminology Gap Analysis Valid and available health workforce data is key to health workforce planning. Terminology issues related to HWF data With few exceptions European countries collect data on physicians, nurses, midwives, dentists, pharmacists and physiotherapists. Many countries collect data outside these categories in other licensed professions and even administrative healthcare staff. The granularity as well as the type of data collected varies from country to country. 13 14 As the Commission Feasibility Study underlines, in Europe one of the key common 13 The Commission Feasibility Study offers a description of the type of data collected by European countries. 3.2.2. National Data Collection. 14 This paragraph includes statements in the Executive Summary of the Feasibility Study. 21
challenges of HWF monitoring data collection is the lack of clarity with regard to professions and roles included in or excluded from the different professional categories. Common definitions systems would greatly support the EU-wide health workforce problems, while a European-level health workforce planning model should be partly based on, the international data sources, primarily those obtaining their data from the WHO-OECD-Eurostat Joint Questionnaire. The Joint Questionnaire The OECD-WHO-Eurostat Joint Questionnaire on Non-Monetary Health Statistics is an important tool to collect comprehensive data on health workforce. The key definitions and key indicators applied by this questionnaire have, in case of some countries, even influenced national data collection methodologies. The Joint Questionnaire data collection in Europe does not cover all types of data needed for health workforce planning, and in fact few countries apply the JQ comparative data for HWF planning for the time being. At the same time, the Joint Questionnaire data provide an excellent tool for mapping and benchmarking national data sets against a common international set of definitions. The Joint Questionnaire applies the definitions of ISCO (International Standard Classification of Occupations). ISCO codes are to cover professions from countries across the World, and therefore they are of quite general nature. European countries have now moved towards more standardised definitions for professions, still the ISCO codes provide an excellent international dataset on HWF. On top of the ISCO codes, the Joint Questionnaire applies the definitions Licensed to Practice, Practicing and Professionally Active. Definitions of HWF ISCO National definitions 2005/36 Directive Swedish research on the JQ in 2011 This Survey was partly based on a 2011 research by the Swedish Board of Health and 15 Welfare. That research was focusing on the collection of data for the Joint Questionnaire in different European states. This research helps to put in context the.- although there have been important amendments to the JQ since 2011. An important remark concerning the JQ in the final research report: 16 15 The key contact point from this research is Kristina Stig, Programme Officer, The National Board of Health and Welfare (Socialstyrelsen), Department of Statistics, Monitoring and Evaluation 16 Evaluation on the Joint Questionnaire on Non-Monetary Healthcare statistic, Eurostat project ESSnet Public statistics. Final report. The Swedish National Board of Health and 22
There must be an aim and objective for collecting the variables that is useful for comparison, analyses and evaluation of the health care systems between countries. It is also important for countries to know why different variables are to be collected. It would also be an advantage if the Member States themselves have a benefit of the variables collected for national analyses. In view of budget restriction in Member States further improvements and developments of the JQNMHC must be in tune with the possibility for the Member States to provide data. Mobility data mapping The Minimum Data Set on International Flows European Commission Feasibility Study 5.0. Mobility Trends Various research have focused in the past on the mobility of European health workforce, including the Mobility of Health Professionals (MoHProf) research and the Health Professional Mobility in the European Union (Health Prometheus) Study. The Health Professional Mobility project (Health Prometheus), launched in 2009 has targeted the research of the scale, relevance and reasons behind health professionals mobility in the European Union. One of the key finding of this research was that in order to improve health workforce planning in many European countries, it must be ensured that mobility data are also considered. This section is to be further elaborated. Future use of the information submitted in this Survey Welfare, 2011-04-30 23