USING EVIDENCE IN HRH POLICY MAKING IN OECD COUNTRIESMark PearsonHead, OECD Health Division

2

• The crisis has turned policy concerns upside down.

• Decision support tools and processes

are mostly not fit for purpose• The health sector needs a

productivity agenda

Main health labour market issues in OECD countries since 2008

3

THE CRISIS IMPACT ON HEALTH LABOUR MARKETS

4

Crisis-related adjustment in the health sector has fallen on wages…

-4.0%

-2.0%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

2005 2006 2007 2008 2009 2010 2011

HungaryNurses

GPs

Specialists

Average wage

-2.0%

-1.0%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

2005 2006 2007 2008 2009 2010 2011

DenmarkNurses

Doctors (GPs and specialists)Average wage

-2.0%

-1.0%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

2005 2006 2007 2008 2009 2010 2011

FranceNurses

GPs

Specialists

Average wage

-2.0%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

2005 2006 2007 2008 2009 2010 2011

BelgiumNurses

GPs

Specialists

Average wage

5

Employment held up well: more doctors and nurses than before the crisis

Source: OECD Health Data 2013

90

100

110

120

130

140

150

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

USA

Doctors

Nurses

90

100

110

120

130

140

150

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Italy

Doctors

Nurses

90

100

110

120

130

140

150

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

France

Doctors

Nurses

90

100

110

120

130

140

150

2002 2003 2004 2005 2006 2007 2008 2009 2010

Japan

Doctors

Nurses

6

The increase in HR supply is driven by increasing graduate numbers…

50

100

150

200

250

300

Australia Canada

Japan United StatesIndex (1990=100)

50

100

150

200

250

300

Denmark Italy

Netherlands United KingdomIndex (1990=100)

Number of medical graduates, selected countries, 1990 to 2011

Source: OECD Health Statistics 2013, http://dx.doi.org/10.1787/health-data-en

7

…and in many countries by improved retention, e.g. doctors delaying retirement

12.9

22.2 22.7 23.0 23.2 24.1

30.5 31.0 31.0 31.6 31.7 31.8 32.8 33.5 33.5

38.0 39.1 39.541.3 42.2

48.4

0.0

10.0

20.0

30.0

40.0

50.0

60.0

2010 or nearest year 2000

Source: OECD Health Data 2012

Share of doctors aged 55 or older, OECD countries, 2000 vs. 2010

8

• Spain: 75% increase in doctors emigrating from 2011 to 2012

• Ireland: Five-fold drop in foreign nurse recruits from 2007 to 2009

• Brazil:Planning to recruit up to 5,000 doctors from EU crisis countries

Migration flows have reacted to the crisis in a number of hard-hit countries

9

(POST-)CRISIS POLICY CONCERNS

Policy priorities have changed to issues about allocation of human resources

0

5

10

15

20

25

30

No particular issue

Maintaining the current level of

physician suppply

Meeting increasing

demand

Maintaining the current share of

GPs

Identified shortage in some

specialties

Mal-distribution of physician

supply

10Source: OECD Health System Characteristics Survey 2012-13“No particular issue”: Netherlands

11

OECD countries consider geographic maldistribution of MDs a key challenge

Source: OECD Regions at a Glance (forthcoming)

Australia

Austria

Belgium

Canada

Czech Republic

Denmark

Estonia

Finland

France

Germany

Greece

Hungary

Iceland

Ireland

Israel

Italy

Japan

Korea

Luxembourg

Mexico

Netherlands

New Zealand

Norway

Poland

Portugal

Slovak Republic

Slovenia

Spain

Sweden

Switzerland Turkey

United Kingdom

United States

Vienna

Brussels

Prague

Lisboa

Bratislava

0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

0 2 4 6 8 10

Physicians density (per 1 000 population)

Doctors per 1 000 inhabitants, TL2 regions, 2011

12

Distribution across specialties is considered inadequate in many countries

Note: Generalists include general practitioners (‘family doctors’) and other generalist (non-specialist) medical practitioners.Source: OECD Health Data 2012

Share of generalist doctors, selected countries, 1995 to 2010

25

30

35

40

45

50

55

60

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Australia France Germany Netherlands United Kingdom

13

Changing team composition is a fast-moving target for many OECD countries

0

5000

10000

15000

20000

0

5000

10000

15000

20000

2000 2005 2010

NP

PA

MD

Sources: OECD Health Data 2013, US National Commission on Certification of Physician Assistants “Certified Physician Assistant

Population Trends (PA-Cs)”, American Association of Colleges of Nursing 2000-2010 Annual Surveys

Increase in NP/PA, relative to MD, USA, 2000 to 2010

14

DECISION SUPPORT IS NOT FIT FOR PURPOSE

15

Health workforce planning aims at the long term…

16

Different approaches to projections especially on the demand side…

Country/Institution Population size

Constant utilization

Needs-based

Health service delivery reforms

GDP/health expenditure

growthAustralia, Health Workforce Australia (2012) x xCanada, Ontario Ministry of Health and Long-Term Care and Ontario Medical Association (2010)

x x

France, Ministry of Social Affairs and Health (2009 for MD, 2011 for nurse) xNetherlands, Advisory Committee on Medical Manpower Planning (2010) x x x x

United Kingdom, Centre for Workforce Intelligence (2012) x x x xUSA, University of North Carolina, Cecil G. Sheps Center (2012) x x x

17

• Working hours (FTE) • Outflows

Stocks & Flows

• Measurement?• Sources?Productivity

• Indicators?• Current balance?Shortages

But many countries struggle with more basic data inputs as well…

18

Data

• Investing in data collection: EU Joint Action, national agencies

Structure

• “Agencification”: the rise of the workforce planning agency in NL, UK, AUS, NZ

Policy

• Linking better to policy and frontline: include stakeholders at all stages of planning (NL)

What are countries doing to improve health workforce planning?

19

WE NEED A PRODUCTIVITY AGENDA

Productivity development in the health sector has been lacklustre

Changes in UK Health Care Productivity, 1995-2010

Source: Nuffield Trust 2013

21

There are large variations in the number of doctor per (1 000 population)…

Greec

e¹

Austri

a

Portu

gal²

Germ

any

Spain

Czech

Rep

.

Denm

ark

Franc

e¹

Estonia

Israe

l

Nethe

rland

s¹

Belgium

Luxe

mbo

urg

New Z

ealan

d

United

Sta

tes

Japa

n

Poland

Brazil

Chile²

South

Afri

ca

Indo

nesia

0

1

2

3

4

5

6

7

6.1

5.0

4.8

4.1

4.0

3.9

3.8

3.8

3.8

3.7

3.6

3.5

3.5

3.3

3.3

3.3

3.3

3.3 3

.3

3.2

3.0

3.0

2.9

2.8

2.8

2.7

2.6

2.5

2.5

2.4

2.2

2.2

2.2

2.0

1.8

1.7

1.6

1.5

0.8

0.7

0.2

Per 1 000 population

22

…and nurses (per 1000 population)

0

5

10

15

20

16.6

15.415.414.8

12.9

12.211.8

11.411.311.111.1

10.310.110.010.0

9.38.88.78.68.3

8.08.07.8

6.36.26.26.15.95.5

5.24.84.7

4.2

3.3

2.7

1.71.71.51.11.00.9

23

And they report considerable mismatch between their skills and tasks…

Physicians Nurses Other health professionals

Others-10%

0%

10%

20%

30%

40%

50%

60%

Do you feel that you need further training in order to cope well with your present duties?

Notes: Preliminary data. “Others” = other technical and professional occupations (ISCO 2 and 3)Source: PIAAC 2013

24

• The crisis has turned policy concerns upside down.

• Decision support tools and processes

are mostly not fit for purpose• The health sector needs a

productivity agenda

Main health labour market issues in OECD countries since 2008

25

mark.pearson@oecd.org

www.oecd.org/health: • Health at a Glance 2013 – 21 November• Health workforce planning in OECD

countries – WP 62• The crisis impact on health markets, WP

– forthcoming in December• Geographic imbalances in physician supply

and policy responses, WP – forthcoming in December

More information

USING EVIDENCE IN HRH POLICY MAKING IN OECD COUNTRIESMark PearsonHead, OECD Health Division