Ontari s Apprach t Evidence Based Health Human Resurces Planning 15 th Internatinal Health Wrkfrce Cllabrative Cnference 2015 Technical Skills Wrkshp May 12, 2015 Denise Cle Assistant Deputy Minister Health Human Resurces Strategy Divisin Ontari Ministry f Health and Lng-Term Care
Overview Backgrund Ppulatin & Health Care in Ontari Ontari s Health Human Resurces Key Ontari Data Surces & Mdels Ontari Physician Human Resurces Data Centre Ontari s Health Prfessins Database Assessing Dctr Inventries & Net Flws Utilizatin Based Physician Mdel Ontari Ppulatin Needs-Based Physician Simulatin Mdel Limitatins f Physician Mdelling Summary f Our Physician Mdels Evidence: Driving Frward Using Evidence t Infrm Plicy & Planning Appendices Ontari s Health Wrkfrce, 2013 Prfessins Participating in the HPDB HPDB Minimum Data Set 2
Ppulatin & Health Care in Ontari Demgraphics & Gegraphy Mst ppulus jurisdictin in Canada: 38% f Canada s ppulatin at 13.5M in 2013. Number f Ontari senirs (65+ years) is expected t nearly duble t 4.1 millin by 2035. Majrity f Ontari s ppulatin lives in the suth with a large and sparsely ppulated nrthern area. The Ontari Ministry f Health and Lng-Term Care establishes the verall strategic directin and prvincial pririties fr the health system. Ontari is als divided int 14 Lcal Health Integratin Netwrks (LHINs) created in 2006 t plan, integrate and fund lcal services including: hspitals, cmmunity care access centres, cmmunity supprt services, lng-term care, mental health and addictin services, and cmmunity health centres. Health System Csts In 2015-16 the gvernment will be investing $50.8 billin in health care which means Ontari will spend 42 cents f every dllar n health care. Ontari Health Insurance Plan (OHIP) is Ontari s gvernment run health care plan. OHIP pays fr many health care services (e.g. payments t physicians fr visits). Under the 2015-16 budget cmpensatin fr physicians will nt increase. In 2014/15, 23% f the ttal health budget and 10% f gvernment spending was spend n physician services (i.e. payments t dctrs). 3
Ontari s Health Human Resurces (HHR) In 2006, there was a critical shrtage f health care prviders. In respnse, Ontari launched its HHR strategy t ensure that the peple f Ontari had access t the right number and mix f qualified health care prviders, nw and in the future. The strategy has been very successful: Increased the supply f health care prviders in the prvince: Example f Success: Stabilized the supply f physicians in Ontari - Between 2003 t 2013, the number f physicians in Ontari increased by 26% (frm 21,472 t 27,125) while the Ontari ppulatin grew by 12%. Created supprts t recruit and retain health care prviders: Example f Success: Develped the HealthFrceOntari Marketing and Recruitment Agency as a ne-stp shp t market Ontari as the emplyer f chice fr health prfessinals. Imprved access t care fr Ontarians: Example f Success: Made targeted investments in primary care mdels, hmecare agencies, public health units, lng-term care settings and emergency departments utilizing nurse practitiners t increase access t care. Enhanced evidence capacity t engage in better HHR planning: Example f Success: Fcus f this presentatin 4
Ontari Physician Human Resurces Data Centre The Ontari Physician Human Resurces Data Centre (OHPRDC) is funded by the Prvince and is a key resurce fr infrmatin n Ontari physicians in practice and in training. Since 1992, has maintained a registry f all licensed physicians practicing in Ontari, the Active Physician Registry: Ontari Physicians in Practice, 2013 Sex 27,125 physicians in ttal. Prduces numerus reprts and analyses, including an annual reprt, Physicians in Ontari, and special reprts. 62% Male 38% Female Average age was 51. Maintains the Ontari Pstgraduate Medical Trainee Registry: Ontari medical schls prvide data n pstgraduate trainees t this Registry fr analysis and reprting. 28% f physicians cmpleted their training utside f Canada. Prduces an annual reprt, Pstgraduate Medical Trainees in Ontari, and a variety f special reprts. 47% f physicians were family dctrs and 53% were specialists. 5
Ontari s Health Prfessins Database (HPDB) Since 2007, all health prfessin clleges regulated under the Regulated Health Prfessins Act, 1991 are mandated t cllect data n their members and reprt it t the ministry fr HHR planning purpses.* The HPDB was develped t huse this data. In 2013 there were ver 250,000 Prvince and health regulatry clleges cllabrated t develp the HPDB: Supply-side database that cllects standard, cnsistent and cmparable data acrss 24 regulated health prfessins in Ontari (excludes physicians as infrmatin n dctrs is cllected thrugh OPHRDC). Includes demgraphic, gegraphic, educatinal and emplyment data. Unique identifier assigned t each individual health prfessinal acrss clleges: Number is assigned at the pint f registratin. Allws us t see whether individuals are practising in mre than ne prfessin simultaneusly and whether individuals transitin frm ne health care prfessin t anther ver the curse f their career. nurses and allied health prfessinals registered with their respective regulatry Clleges in Ontari. *Nte: In Ontari, there are 27 regulated health prfessins gverned by 25 health regulated clleges. See Appendix fr details abut the health prfessins included in the HPDB. 6
Assessing Dctr Inventries & Net-Flws (ADIN) Since 2005, the Prvince has been using a physician supplybased mdel called ADIN. Stck-Flw mdel which tracks the prgressin f a physician frm pstgraduate training, t practice and then retirement. Used t prject the prvincial supply f physicians by specialty up t 19 years int the future. Uses multiple surces f data t prject the future supply f physicians in the prvince (see side bx): Fr example: Internatinal and interprvincial physicianin-practice migratin data supplied frm the Canadian Institute fr Health Infrmatin (CIHI). Was recently updated t prject physician supply up t 2030. DATA INCLUDES: First Year Residency Allcatins Canadian Resident Matching Service (CaRMS) First year pstgraduate psitins ffered by specialty and lcatin f medical degree Pstgraduate Migratin Data Canadian Pst M.D. Educatin Registry (CAPER) Inter-prvincial migratin after cmpletin f pstgraduate studies by specialty and sex Migratin Data CIHI Practice migratin by age, sex and specialty Pstgraduate Medical Trainees in ON OPHRDC Histrical averages f sub specializatin, level f training, specialty, sex, lcatin f medical degree Retirement Data OPHRDC Retirement by age, sex and specialty Prgram Length Ryal Cllege f Physicians and Surgens f Canada/Cllege f Family Physicians f Canada (RCPSC/CFPC) Prgram length by specialty 7
Utilizatin Based Physician Mdel (UM) Uses health insurance claims (OHIP) data t determine current utilizatin f physician services. Prjected number f physicians needed is cmpared t the prjected supply f physicians (using ADIN) t determine the prjected gap/surplus f physicians. Assumes the current supply and utilizatin f physician services is in balance. Current utilizatin is then applied t future ppulatin frecasts t estimate future utilizatin Estimated future utilizatin is cnverted t prject the number f physicians needed based n current patient/physician vlumes. Was recently updated with claims data frm 2012 t prject gaps/reserve in physician supply up t 2030. 8
Ontari Ppulatin Needs-Based Physician Simulatin Mdel (NBM) In 2007, the Prvince in partnership with the Ontari Medical Assciatin (OMA) hired the Cnference Bard f Canada t develp the NBM. NBM cnverts the future health needs f the ppulatin int need fr physician services, cmpares it with the future supply f physician services and calculates a gap by specialty and LHIN. Survey results and infrmatin frm expert panels were used t estimate physician prductivity and future incidence and prevalence f certain disease grups. Multiple surces f data were used t prject the future supply f physicians in the prvince: CAPER, OPHRDC, CaRMS, Statistics Canada, Canadian Cmmunity Health Survey, Canadian Medical Educatin Statistics etc. Last updated in 2010: In the prcess f updating this cmplex mdel and it is anticipated that these results will be available in 2016. 9
Limitatins f Physician Mdelling All mdels are planning tls. There are many imprtant variables t cnsider in HHR planning, but each mdel cannt quantify them all. Each mdel shuld be used in cnjunctin with ther evidence t develp a mre cmprehensive picture. Examples f mdelling limitatins include: ADIN: Like all supply mdels, ADIN des nt tell us whether physician supply will be sufficient t meet ppulatin need. Utilizatin Mdel: Assumes that current utilizatin is apprpriate and rates will remain cnsistent int the future. Des nt prvide infrmatin n ppulatin need. Needs Based Mdel: Was cnstructed at a macr level t help identify areas which require mre detailed examinatin and research. Any methd t determine need is an educated estimate as need is a cmplex variable that is difficult t define and measure. 10
Summary f Ontari s Physician Mdels Supply Mdel (ADIN) Estimates physician supply by tracking physicians frm pstgraduate training, t practice and then retirement Des nt infrm abut whether supply is sufficient t meet the demands r needs f the Ontari ppulatin Last updated in 2014 with mst up-t-date data (2012 & nwards) Utilizatin Mdel Estimates demand fr future physician services using health insurance claims and ppulatin prjectins Cmpares results t ADIN supply mdel prjectins t determine if supply meets demand Assumes the current supply f physicians meets patient demand Needs-Based Mdel Estimates future Ontari ppulatin need fr physicians Cmplex mdel; need is difficult t measure Last updated in 2010; updated results anticipated in 2016 Last updated in 2014 with 2012 claims data 11
Evidence: Wrk Underway Data Cllectin HPDB: Cllecting 2014 data fr ministry use. OPHRDC: Public reprts will cntinue t be prduced annually n physicians in-practice and in-training. Mdelling Develped a standardized schedule t update physician mdels bi-annually. Wrking n a nurse frecasting mdel that will examine the relatinship between supply, demand and need. The mdel is currently in the design stages. Natinal Planning A federal/prvincial/territrial Physician Resurce Planning Task Frce (Task Frce) established in 2013 t facilitate the cllabratin and crdinatin f pan-canadian physician human resurces planning in supprt f the Deputy Ministers f Health and the Deans f Medicine: Develping guiding principles that wuld supprt a cllabrative prcess t imprve physician planning. Finalizing cncepts fr a website t infrm thse pursuing medical educatin. Creating a pan-canadian planning tl (frecasting mdel). 12
Using Evidence t Infrm Plicy & Planning Evidence is used t supprt decisin making with ther areas f the prvincial gvernment, the federal gvernment, and system stakehlders. Example: Prvided data and analysis t the Ministry f Training Clleges and Universities (MTCU) t infrm decisins related t pssible new educatin prgrams. Example: Infrmed federal immigratin plicies (e.g. list f pririty health prfessins fr the Federal Skilled Wrker Prgram). Example: Guided decisins n planning and allcatin f physician residency psitins fr varius specialties t meet scietal needs. 13
APPENDICES 14
Overview f Ontari s Health Wrkfrce, 2013 Examples f Un-Regulated Health Prfessins Persnal Supprt Wrkers Physician Assistants Ultrasund Technlgists Addictin Wrkers Rehabilitatin Assistants Many, many mre All Health Care Prviders in Ontari 500,000+ Regulated Health Prfessins 2013 287,338 Registered Nurses 112,582 (39.2%) Nurse Practitiners 2,242 (0.8%) Nurses 156,820 (54.6%) Registered Practical Nurses 41,996 (14.6%) Denturists 620 (0.2%) Chirpdists 638 (0.2%) Audilgists 644 (0.2%) Midwives 607 (0.2%) Kinesilgists 1,298 (0.5%) Pharmacy Technicians 1,826 (0.6%) Dental Technlgists 521 (0.2%) Physicians 27,125 (9.4%) Pharmacists 13,881 (4.8%) Optmetrists 2,085 (0.7%) Traditinal Chinese Medicine Practitiners & Acupuncturists 2,217 (0.8%) Opticians 2,780 (1.0%) Dental Hygienists 12,084 (4.2%) Allied Health Prfessins 2013 103,393 (36.0%) Speech-Language Pathlgists 2,840 (1.0%) Family Physicians 12,635 (4.4%) Massage Therapists 11,224 (3.9%) Specialists 14,490 (5.0%) Dentists 9,194 (3.2%) Dietitians 3,545 (1.2%) Psychlgists 3,317 (1.2%) Respiratry Therapists 2,933 (1.0%) Physitherapists 7,527(2.6%) Medical Labratry Technlgists 7,470 (2.6%) Medical Radiatin Technlgists 6,852 (2.4%) Occupatinal Therapists 5,242 (1.8%) Chirpractrs 4,048 (1.4%) 15
Prfessins Participating in the HPDB Health Prfessins Currently Included in the HPDB Audilgists Midwives Chirpdists/Pdiatrists Nurses first submissin in 2011 Chirpractrs Dental Hygienists Dentists Dental Technlgists Occupatinal Therapists Opticians Optmetrists Pharmacists Denturists Pharmacy Technicians first submissin in 2013 Dietitians Kinesilgists first submissin in 2014 Massage Therapists Medical Labratry Technlgists Medical Radiatin Technlgists Health Prfessins t be Included in the HPDB Hmepaths Psychtherapists Physitherapists Psychlgists Respiratry Therapists Speech-Language Pathlgists Traditinal Chinese Medicine Practitiners & Acupuncturists first submissin in 2014 Naturpaths 16
HPDB Minimum Data Set Identifiers, Registratin and Demgraphics 1. Unique Identifier Number (de-identified) 2. Registratin Status 3. Registratin Inactive Status Reasn 4. Class f Registratin 5. Sex 6. Year f Birth 7. Languages f Care Gegraphy and Related 8. Primary Pstal Cde f Residence 9. Primary Prvince r Territry r State f Residence 10. Primary Cuntry f Residence 11. Prvince r Territry f Registratin (Default Value) 12. Year f Initial Registratin t Practise in Ontari 13. Cncurrent Prvince r Territry r State f Registratin 14. Cncurrent Cuntry f Registratin 15. Mst Recent Previus Prvince r Territry r State f Practice 16. Mst Recent Previus Cuntry f Practice 17. Last Year f Practice in Previus Prvince r Territry r State r Cuntry 18. Specialty Certificatin 19. Year f Specialty Certificatin Educatin 20. Bridging Prgram Cmpletin 21. Year f Cmpletin Bridging Prgram 22. Level f Educatin in Prfessin 23. Year f Graduatin frm Educatin in Prfessin 24. Canadian Educatinal Institutin f Educatin in Prfessin at Graduatin 25. Prvince r Territry r State at Graduatin frm Educatin in Prfessin 26. Cuntry f Graduatin frm Educatin in Prfessin 27. Highest Level f Educatin Outside f the Prfessin 28. Field f Study fr Highest Educatin Outside f the Prfessin 29. Year f Graduatin frm Educatin Outside f the Prfessin 30. Prvince r Territry r State f Graduatin frm Educatin Outside f Prfessin 31. Cuntry f Graduatin frm Educatin Outside f Prfessin Emplyment Histrical 32. Cuntry f First Time Practising in Prfessin 33. Prvince r Territry r State f First Time Practising in Prfessin 34. First Year f Practising in Prfessin 35. First Canadian Lcatin f Practice in Prfessin 36. Year f First Canadian Practice in Prfessin Current Emplyment Individual Based 37. Practice Status 38. Full Time/Part Time/Casual Wrk Preference 39. Agency Nurse 40. Ttal Number f Practice Weeks in the Past 12 Mnths 41. Average Number f Weekly Practice Hurs in the Past 12 Mnths 42. Average Number f Weekly On-Call Hurs in the Past 12 Mnths 43. Prprtin f Average Weekly Practice Hurs n Direct Prfessinal Services 44. Prprtin f Average Weekly Practice Hurs n Teaching 45. Prprtin f Average Weekly Practice Hurs n Clinical Educatin 46. Prprtin f Average Weekly Practice Hurs n Research 47. Prprtin f Average Weekly Practice Hurs n Administratin 48. Prprtin f Average Weekly Practice Hurs n All Other Activities Current Emplyment Site Based 49. Mre Than Three Practice Sites 50. Emplyment Categry 51. Full-Time/Part-Time/Casual Status 52. Practice Setting 53. Pstal Cde f Practice Site 54. Prvince r Territry r State f Practice Site 55. Cuntry f Practice Site 56. Primary Rle 57. Area f Practice Activity 58. Practice Specialty 59. Client Age Range 17
Denise Cle Assistant Deputy Minister Health Human Resurces Strategy Divisin Ontari Ministry f Health and Lng-Term Care 56 Wellesley Street West, 12 th Flr Trnt ON M5S 2S3 Canada 1-416-212-7688 Denise.Cle@ntari.ca 18