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OECD/EUROSTAT/WHO JOINT QUESTIONNAIRE
2012
FOCUS ON DOCTORS
OECD Health Data National Correspondents Meeting 11-12 October 2012
Content of the Joint Questionnaire
• Physicians
• Midwives, nurses and caring personnel
• Dentists, pharmacists, physiotherapists
• Hospital employment
• Graduates
Health employment
and education
• Hospitals
• Hospital beds
• Beds in nursing and residential care facilities
• Medical equipment
Physical and technical resources
Only one change in 2012: Physicians by categories
2012 Round of Joint Questionnaire
• 61 countries involved in 2012 – 34 OECD countries (in Europe and outside Europe)
– 27 other European countries (EU members/candidates and other WHO-Europe members)
• Same timeline as for OECD Health Data questionnaire – Half of OECD countries met the deadline of end February
for returning the questionnaire
– Data validation process from March to June, implying a lot of exchanges between national correspondents and colleagues from international organisations
– Data from the JQ released on 28 June in OECD Health Data 2012 (and later in summer in WHO-Europe and Eurostat databases)
2012 Change
Nb % between
(96 series) 2012/11
Israel 90 94% 5%
Estonia 84 88% 1%
Denmark 83 86% -2%
Korea 80 83% 11%
Netherlands 80 83% 1%
Austria 77 80% 1%
Chile 77 80% 44%
Finland 77 80% 0%
Iceland 77 80% 0%
France 73 76% 2%
New Zealand 71 74% 5%
United States 71 74% 8%
Luxembourg 70 73% 28%
Germany 69 72% 1%
Italy 69 72% 1%
Slovenia 69 72% 12%
Spain 68 71% 7%
Hungary 67 70% -1%
Average 66 69% 5%
General improvement in data availability
2012 Change
Nb % between
(96 series) 2012/11
Average 66 69% 5%
Ireland 66 69% -6%
Czech Republic 65 68% -1%
Norway 65 68% 1%
Slovak Republic 65 68% 2%
Poland 64 67% 3%
Switzerland 64 67% 6%
Australia 62 65% 2%
Portugal 62 65% 6%
Greece 61 64% -2%
Canada 60 63% 1%
Belgium 56 58% 18%
Turkey 48 50% 0%
Japan 43 45% -3%
Sweden 39 41% 7%
United Kingdom 34 35% 1%
Mexico 32 33% 6%
Total number of physicians:
data availability
Concept Definition Number of countries available
Practising • Providing services directly to patients
27 (+2 since 2010: ITA, FRA)
Professionally active
• Practising • Working in the health system as administrators, managers, researchers, teachers, etc.
24 (+5 since 2010:
IRL, LUX, NLD, NOR, SWE)
Licensed to practice
• All physicians who are licensed to practice, including practising or non-practising (e.g. unemployed, retired, working abroad)
23 (+2 since 2010: CHL, NOR)
• The use of different sources for the three concepts reduces data consistency
• Data variability due to the use of surveys
Total number of physicians:
data issues (1)
2.5
3.0
3.5
4.0
4.5
5.0
1995 1997 1999 2001 2003 2005 2007 2009 2011
Practising Professionally active Licensed to practice
registry
Source: OECD Health Data 2012.
Physicians per 1000 population, Israel
LFS
registry
• Breaks in time series limit data analysis over time
Total number of physicians:
data issues (2)
2.0
2.5
3.0
3.5
4.0
4.5
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010
Hungary Norway Poland
B
B B
B
B
B
B B B
Practising physicians per 1000 population
Source: OECD Health Data 2012.
• Remaining data gaps, in particular for key concept “practising”
Total number of physicians:
data issues (3)
0
1
2
3
4
5
6
7
Gre
ece
Au
stri
a N
orw
ay
Ital
y Po
rtu
gal
Swit
zerl
and
Sw
eden
Sp
ain
G
erm
any
Icel
and
C
zech
Rep
ub
lic
Isra
el
Den
mar
k Sl
ova
k R
epu
blic
Fi
nla
nd
Fr
ance
Es
ton
ia
Irel
and
A
ust
ralia
B
elgi
um
N
eth
erla
nd
s H
un
gary
Lu
xem
bo
urg
U
nit
ed K
ingd
om
N
ew Z
eala
nd
U
nit
ed S
tate
s Sl
ove
nia
C
anad
a Ja
pan
Po
lan
d
Mex
ico
K
ore
a Tu
rkey
C
hile
Practising Professionally active Licenced to practice
Physicians per 1000 population, 2010
Source: OECD Health Data 2012.
Practising vs professionally active
physicians, 2010
0
1
2
3
4
5
Pe
r 1
00
0 p
op
ula
tio
n
Practising physicians Professionally active physicians
19% 2% 5% 7% 9% 11% 0% 7% 0% 7% 8% 5% 12% 13% 1% 5% 3% 3% 9%
On average: +7%
Source: OECD Health Data 2012.
Practising vs licensed physicians, 2010
0
1
2
3
4
5
6
7
Pe
r 1
00
0 p
op
ula
tio
n
Practising physicians Physicians licensed to practice
37% 56% 28% 44% 66% 88% 55% 29% 32% 23% 67% 69% 53% 60% 18% 31% 61% 23%
On average: +47%
Source: OECD Health Data 2012.
Approaches to fill data gaps for
“practising” concept
• Identify new potential data sources
• Use estimation methods Two examples: 1) First approach based on the average difference (7%) between practising and
professionally active physicians across other OECD countries. (For countries having data on “professionally active” and no data on “practising”).
2) Second approach based on the fact that the trends are usually very similar for practising and professionally active physicians. (For countries having time series on “professionally active” and at least one data point on “practising”, e.g. FIN, FRA, ITA, SVK and CHE).
2.0
2.5
3.0
3.5
4.0
4.5
2000 2002 2004 2006 2008 2010
Germany
Australia
USA
Practising Professionally active
Physicians per 1000 population, 2000-10
Source: OECD Health Data 2012.
Physicians by categories
Amendments to the 2012 questionnaire
Categories of physicians Extracts from definitions
1) Generalist medical practitioners (2211)
General practitioners • GPS, family doctors responsible for continuous care • Interns or residents specialising in general practice
Other generalist (non-specialist) medical practitioners
• Non-specialist physicians in hospital or elsewhere • Interns or residents without any area of specialisation yet
2) Specialist medical practitioners (2212)
• Specialists
• Interns or residents training for a specialty
General paediatricians
Obstetricians & gynaecologists
Psychiatrists
Medical group of specialists
Surgical group of specialists
Other specialists n.e.c.
3) Medical doctors not further defined (2210)
• Doctors who cannot be classified in other categories • Interns and residents who cannot be classified in other categories
• Generalists (total) and specialists (total and breakdown):
33 countries (all except JPN)
+ 5 countries since 2010 (CHL, HUN, LUX, ESP, SWE)
• Breakdown between GPs and other generalists/ non-specialists (requested for the first time in 2012):
15 countries
Physicians by categories:
data availability
• A number of countries have adjusted their data submission according to the new specifications
Physicians by categories:
improvement in data allocation
50 42
20 13 9 13 23
7 13 9
38 18
13
53
11
51 56
62
23
77
52 59
64
33
80
8 2
18
63
13 15
0
20
40
60
80
100
Generalists GPs Other generalists Specialists Doctors n.f.d.
2011 questionnaire 2012 questionnaire %
Source: OECD Health Data 2012.
Better identification of GPs
Less physicians in the “not further defined” category
Physicians by category, in % of total number of physicians, 2009
• Gaps in the split between GPs and other generalists/ non-specialists for about half of countries
• When Total generalists=GPs
Is it because there are no “other generalists”? (e.g. LUX, ESP)
Is it because it is not possible to distinguish “GPs” from “other generalists”? (e.g. FRA)
Physicians by categories:
data issues (1) Per 1000
pop
Total
generalists
GPs Other
generalists
Ireland 2.79 0.57 2.22
Norway 2.46 0.83 1.63
Portugal 1.99 0.50 1.49
France 1.59 (d) 1.59 ..
Austria 1.58 0.78 0.80
Germany 1.57 0.66 0.91
Australia 1.52 1.17 0.35
Netherlands 1.26 0.72 0.54
Finland 1.13 .. ..
Belgium 1.12 1.12 ..
Canada 1.12 1.12 ..
Italy 0.94 0.77 0.18
Chile 0.88 0.88 ..
Estonia 0.83 0.74 0.10
Luxembourg 0.82 0.82 0.00
Korea 0.80 0.44 0.35
United Kingdom 0.80 .. ..
New Zealand 0.75 .. ..
Spain 0.75 0.75 0.00
Mexico 0.74 0.74 ..
Denmark 0.73 .. ..
Czech Republic 0.70 .. ..
Israel 0.69 0.26 0.43
Sweden 0.63 0.63 ..
Switzerland 0.61 .. ..
Iceland 0.57 0.57 ..
Turkey 0.56 .. ..
Slovenia 0.51 0.44 0.07
Poland 0.46 0.21 0.25
Slovak Republic 0.41 .. ..
Hungary 0.34 .. ..
Greece 0.30 .. ..
United States 0.30 0.30 .. Source: OECD Health Data 2012.
• Still big variations in total number of generalists per capita (less variations in number of GPs)
Physicians by categories:
data issues (2)
0.6 0.8
0.5 0.8 0.7
1.2 0.7 0.8 0.7 0.8
0.4 0.8
0.3 0.4 0.2
2.8
2.5
2.0
1.6 1.6 1.6 1.5
1.3 1.1 1.1 1.1
1.0 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.8 0.7 0.7 0.7 0.7 0.6 0.6 0.6 0.6 0.5 0.5 0.4 0.3 0.3 0.3
0
1
2
3 Generalist medical practitioners General practitioners Other generalists (non-specialists)
Physicians by category, per 1000 population, 2010
Source: OECD Health Data 2012.
• Still high share of “physicians not further defined” in some countries
Physicians by categories:
data issues (3)
66 62 60 52 49 49 47 43 42 40 38 36 35 33 33 31 30 29 29 26 26 21 21 21 20 20 20 17 16 16 14 12 12
5
34 38 40 52 48 51 53 57 58 60 60 64
46
67
50 60
71 71
50 66
74
41
79 76 65 64
77
54 64 62
86 88
58 56
2 1
20 18 9
22 9
38
3 15
3
29 20 22
1
31 39
0
20
40
60
80
100
Generalist medical practitioners Specialist medical practitioners Medical doctors n.f.d. %
Source: OECD Health Data 2012.
Physicians by category, in % of total number of physicians, 2010
• The data do not add up for some countries
– Double-counting of physicians who have more than one specialty (AUT, IRL, PRT, GBR)
– Underreporting of specialists (ESP includes specialists working in hospital only)
Physicians by categories:
data issues (4)
GPs Other generalists
General paedia- tricians
Obstetric. & gynae- cologists
Psychia-trists
Medical group
Surgical group
Other specialists
Doctors not further defined
Sum
Austria 16.2 16.7 3.1 4.1 3.1 20.4 18.5 1.0 17.6 100.7
Ireland (2011)
17.6 48.8 2.6 1.9 5.1 17.3 11.3 1.4 0.0 106.0
Portugal 13.0 39.1 3.9 3.8 2.7 20.8 15.4 4.9 - 103.6
Spain 19.9 0.0 3.6 2.7 2.1 15.8 18.2 21.2 - 83.5
United Kingdom
29.6 5.5 4.3 7.1 23.1 26.9 4.0 - 100.4
Physicians by category, in % of total number of physicians, 2010
Source: OECD Health Data 2012.
• No change except the proposed move of “Occupational medicine”
2013 Joint Questionnaire
Physicians by categories
Generalist medical practitioners (2211)
- General practitioners - Other generalist (non-specialist) medical practitioners
Specialist medical practitioners (2212)
- General paediatricians - Obstetricians & gynaecologists - Psychiatrists - Medical group of specialists - Surgical group of specialists - Other specialists n.e.c.
Medical doctors not further defined (2210)
“Occupational medicine”
• Comment on the experience with filling the 2012 joint questionnaire on doctors, in particular any issues when allocating doctors by category
• Comment on the prospects of filling any persisting data gaps in reporting data on practising (and/or professionally active doctors), or indicate whether it may be acceptable to use some agreed-upon method to fill key persisting data gaps
• Agree on the reallocation of “occupational medicine” in the “medical group of specialists”
Discussion