TRENDS IN HEALTH WORKFORCE IN EUROPE Gaétan Lafortune, OECD Health Division Conference, Brussels, 17 November 2017
Health and social workers account for a growing share of total employment in nearly all EU countries % 20 15 18 17 16 16 14 13 13 12 12 2015 2000 10 5 10 10 10 8 8 7 7 7 6 6 6 6 6 5 5 0 Note: The EU average is unweighted. Source: OECD National Accounts.
A simple framework for analysing the supply of health workers (basic inflows/outflows model) Source: Health Workforce Policies in OECD Countries - Right Jobs, Right Skills, Right Places, OECD (2016)
A more complex framework for analysing the supply and demand for health workers Source: Health Workforce Policies in OECD Countries - Right Jobs, Right Skills, Right Places, OECD (2016)
1. In Greece and Portugal, the data refer to all doctors licensed to practice (resulting in a large over-estimation of practising doctors). 2. In France and the Slovak Republic, the data include not only doctors providing care for patients, but also those working as managers, researchers, etc. (resulting in an over-estimation of practising doctors by 5-10%). 3. In Belgium, a minimum threshold of activities is used to define practising doctors (leading to an under-estimation). Source: OECD Health Statistics 2017 (based on OECD/Eurostat/WHO-Europe Joint Questionnaire). The number of doctors per capita has increased in most EU countries, except in Belgium and France Per 1 000 population 7 6 5 4 3 2 1 0 6,3 5,1 4,6 4,3 4,2 4,1 4,0 2015 2000 3,9 3,8 3,8 3,7 3,7 3,6 3,6 3,5 3,5 3,4 3,3 3,2 3,2 3,2 3,1 3,0 2,9 2,9 2,8 2,8 2,8 2,3
Source: OECD Health Statistics 2017 (based on OECD/Eurostat/WHO-Europe Joint Questionnaire). The number of doctors has grown more rapidly in the UK and Netherlands than Belgium and France Index (2000=100) 160 150 140 United Kingdom Netherlands 130 120 Germany Belgium 110 France 100
Countries are using a range of policy levers to address current or future shortages of doctors Number of OECD countries (based on 29 responses) 20 15 10 5 0 No particular policy Prolong working time for physicians Targeted immigration policy Introduction or expansion of non-physician practitioner Incentives to foster the takeup of specialties where shortages exist Incentives to foster the takeup of general practice Financial incentives to correct geographic maldistribution Increase in training capacity Source: OECD Health System Characteristics Survey 2016
Belgium and neighbour countries are using some policy levers to address current or future shortages of doctors Belgium France Germany Netherlands United Kingdom Increase in training capacity Yes Yes Yes Prolong working time for physicians No Yes Targeted immigration policy No Yes Incentives to foster the take-up of general practice Yes Yes Incentives to foster the take-up of specialties where shortages exist or are expected No Yes Introduction or expansion of non-physician practitioner roles No Financial incentives to correct perceived geographic misdistribution Yes (only for GP) Yes Yes Yes Yes Source: OECD Health System Characteristics Survey 2016
The share of generalists has decreased over time in Belgium and in other countries % 50 Share of generalists as % of all physicians 45 40 France Netherlands Germany Belgium 35 30 25 United Kingdom 2000 2002 2004 2006 2008 2010 2012 2014 2016 Source: OECD Health Statistics 2017 (based on OECD/Eurostat/WHO-Europe Joint Questionnaire). 9
But a big concern is about the ageing of doctors Almost 50% of doctors in Belgium and France are aged 55+ Belgium (2015) Netherlands (2015) France (2015) United Kingdom (2015) Source: OECD Health Statistics 2017 (based on OECD/Eurostat/WHO-Europe Joint Questionnaire). 10
But let s keep in mind that the supply of doctors is driven by both inflows and outflows Source: Health Workforce Policies in OECD Countries - Right Jobs, Right Skills, Right Places, OECD (2016) 11
Will the projected number of doctors who will retire exceed the inflows of new doctors? Doctors by age group (in 2015) Rising number of new medical graduates (each year) Belgium % 65+ % 55-64 17% 5619 28% 9502 1600 1200 800 400 1289 1180 1176 1614 1359 0% 10% 20% 30% 40% 0 2000 2005 2010 2015 France % 65+ 12% 25691 % 55-64 35% 77859 0% 10% 20% 30% 40% Source: OECD Health Statistics 6000 5000 4000 3000 2000 1000 0 5040 4384 4717 6025 5365 2000 2005 2010 2015 12
Another growing source of doctors in Belgium and France has been foreign-trained doctors % foreign-trained doctors 35 30 25 United Kingdom 20 15 10 5 0 Belgium France Germany Netherlands The number of foreign-trained doctors in Belgium has increased from less than 2000 in 2000 to over 7000 in 2016 Source: OECD Health Statistics
A growing number of foreign-trained doctors in Belgium have come from Romania since 2007 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Total number of doctors 49695 50502 51389 52303 53418 54851 56363 57623 59070 60138 61899 Domestically-trained doctors 47059 47460 47899 48418 49038 49818 50655 51439 52338 53249 54529 Foreign-trained doctors 2636 3042 3490 3885 4380 5033 5708 6184 6732 6889 7370 % of foreign-trained doctors 5.3% 6.0% 6.8% 7.4% 8.2% 9.2% 10.1% 10.7% 11.4% 11.5% 11.9% France 530 603 660 711 764 860 1003 1078 1147 1219 1312 Romania 9 135 267 420 566 744 866 975 1064 1172 1247 Netherlands 473 537 607 649 682 739 807 872 940 1037 1112 Italy 186 216 238 275 306 367 425 490 605 687 768 Germany 228 248 283 302 321 357 375 396 416 435 447 Greece 65 86 115 138 154 181 222 236 258 279 301 Spain 163 172 175 180 185 202 219 232 260 280 291 Bulgaria 1 8 19 28 38 50 61 73 78 84 94 Portugal 2 2 4 7 12 15 21 32 49 73 88 Poland 17 26 34 39 41 47 53 60 66 70 76 United Kingdom 33 38 42 45 47 49 52 55 61 67 71 Hungary 11 16 20 24 28 30 34 36 42 46 55 South Africa 30 33 36 36 36 37 42 43 47 51 54 Switzerland 3 11 16 18 18 23 27 29 35 40 48 Czech Republic 9 12 15 18 21 25 30 32 36 42 47 Lithuania 1 3 5 7 12 21 24 30 32 33 Algeria 1 1 22 40 56 61 66 27 31 Austria 1 4 6 8 9 12 15 17 23 25 Note: This table only shows the top 18 countries of origin of foreign-trained doctors in Belgium. Source: OECD Health Statistics
Source: OECD Health Statistics A sizeable number of doctors trained in Belgium also work in other EU and OECD countries 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Austria 1 2 2 3 4 5 4 4 4 4 Canada 124 127 127 130 125 126 124 120 117 117 Chile 7 9 Finland 4 4 4 5 France 1748 1746 1773 1773 1773 Germany 195 193 201 211 221 233 247 246 242 244 Ireland 15 14 15 15 16 Israel 60 63 61 61 60 53 49 48 47 45 Netherlands 427 455 477 519 578 616 522 523 562 New Zealand 5 5 8 12 13 12 14 19 21 16 Norway 53 56 53 51 50 45 42 43 Poland 2 2 Spain 58 Switzerland 101 97 101 112 130 Turkey 2 2 2 2 2 2 2 2 2 2 United Kingdom 133 149 133 134 128 131 137 132 United States 985 959 925 901 891 898 909 816 770 # countries reporting data 8 8 11 11 12 15 14 12 14 13 TOTAL 1799 1806 2090 1244 2195 4060 3933 3835 3787 3173 But the number of doctors trained in Belgium who migrate to other countries is smaller than the number of foreign-trained doctors working in Belgium
NURSES
The number of nurses per capita also increased in most EU countries, including Belgium and France Per 1 000 population 18 16,7 2015 2000 15 12 14,7 13,3 11,9 11,9 11,1 10,8 10,5 9,9 9 8,8 8,2 8,1 8,0 7,9 7,9 7,7 6 3 0 6,5 6,4 6,3 6,0 5,8 5,7 5,4 5,3 5,2 5,2 4,7 4,4 3,2 1. The data include not only nurses providing direct care to patients, but also those working as managers, researchers, etc. 2. Austria and Greece report only nurses employed in hospital. Source: OECD Health Statistics 2017 (based on OECD/Eurostat/WHO-Europe Joint Questionnaire).
Source: OECD Health Statistics 2017 (based on OECD/Eurostat/WHO-Europe Joint Questionnaire). The number of nurses in Belgium has grown by nearly 40% since 2004; in France, by nearly 50% Index (2004=100) 150 France 140 Belgium 130 120 110 Germany Netherlands 100
But the growth in full-time equivalent nurses has been slightly slower than in headcounts 90000 HC (left axis) FTE (left axis) FTE/HC (right axis) Belgium 1,0 400000 80000 70000 60000 50000 2000 2005 2010 2015 France 1,1 600000 Germany 0,9 0,8 0,7 0,6 0,9 350000 1,0 500000 0,8 300000 0,9 400000 0,7 250000 0,8 2000 2005 2010 2015 300000 0,6 2000 2005 2010 2015 Source: OECD Health Statistics 2017 (based on OECD/Eurostat/WHO-Europe Joint Questionnaire).
OPPORTUNITIES TO CHANGE THE ROLES AND RESPONSIBILITIES OF HEALTH PROFESSIONALS
Low number of doctors and high number of nurses may provide opportunities for greater task sharing Note: The number of doctors in Greece (EL) and Portugal (PT) is over-estimated as it includes all doctors licensed to practice. The number of nurses in Austria and Greece is under-estimated as it only includes those working in hospital. Source: Eurostat Database
Development of more advanced roles for nurses: Example of nurse practitioners in some countries Country Year introduced Total number of Nurse Practitioners (NPs) (2015) NPs as % of all RNs (2015) United States (NP) Canada (NP) United Kingdom (Advanced NP, NP) Netherlands (Nurse specialist) Australia (NP) New Zealand (NP) Ireland (Advanced NP) 1965 174,943 5.6% 1967 4,090 1.4% 1983 n/a (because title not regulated) n/a 1997 2,749 1.5% 2000 1,214 0.5% 2001 142 0.3% 2001 141 0.2% Source: Maier et al., OECD Health Working Paper (2017) 22
Key messages Number of doctors & nurses The number of doctors and nurses per capita has increased in most EU countries since 2000, except in Belgium and France for doctors Composition (GPs/specialists) The share of GPs has declined in most countries (including in Belgium), but remains higher in France and Netherlands Migration flows Changing roles & responsibilities The migration of doctors is generally a two-way street, although immigration flows have been larger than emigration in Belgium and other Western European countries The demand for doctors may be reduced by expanding the scope of practice of other mid-level providers (e.g. nurse practitioners, but also pharmacists and other professionals)
For more information Contact: gaetan.lafortune@oecd.org Website Twitter Newsletter http://www.oecd.org/health/workforce.htm @OECD_Social http://www.oecd.org/els/health-systems/oecd-health-update.htm