Introduction
Literature search method
Keywords | Search queries |
---|---|
Health | Workforce planning |
Healthcare | Healthcare forecasting |
Workforce | Health human resources |
Manpower | Health manpower |
Physicians | Health planning |
Nurses | Healthcare planning |
Forecast | Health services |
Projection | Health supply |
Planning | Health demand |
… | Healthcare needs |
Healthcare providers | |
Physician forecasting | |
Nurse forecasting | |
Nursing staff | |
Manpower | |
Manpower planning | |
Workforce forecasting | |
Workforce projections | |
Workforce management | |
Staff levels | |
Health staffing levels | |
Shortage healthcare workers |
Step | Search method |
---|---|
1 | Identify common search terms from reviews, books and technical papers |
2 | Generate plausible combinations of terms to be used for search using the key search terms identified |
4 | Search for these terms on PubMed, MEDLINE, Embase, ProQuest, Healthstar, ABI/Inform, INSPEC, Google Scholar and Scopus |
5 | Select a base set for the results consisting of the 20 papers (10 most cited, 5 most recent and 5 randomly chosen) |
6 | Match the abstract and perform a forward and backward search to verify the relevance of the paper for the selected base set |
7 | Exclude papers that address none of the topics covered, that only make a brief reference to the subject at hand or that are not written in English |
Scope
Background
Supply
Field | Policy option |
---|---|
Education | Increase numbers of new students |
Recruit foreign graduates | |
Recognize previous learning | |
Improve curriculum content | |
Regulatory | Recognize overseas qualifications |
Introduce temporary employment regulations | |
Subsidized education for return of service | |
Enhanced scope of practice | |
Different types of health workers | |
Financial incentives | Increase trainee salaries |
Raise wages | |
Provide non-wage benefits | |
Introduce incentives for return of skilled migrants | |
Establish retirement policies | |
Employ lay health workers | |
Professional and personal support | Better living conditions |
Safe and supportive working environment | |
Career development programmes | |
Public recognition measures |
Methodologies for modelling supply
Demand
Methodologies for modelling demand
Evolution of the field
First phase: factor of production
Supply-based methodologies
Demand-based methodologies
Second phase: economic agent
Supply-based methodologies
Demand-based methodologies
Integrated methodologies
Third phase: fundamental resource
Integrated methodologies
Discussion
Methodology | Description | Assumptions | Advantages | Limitations | Overcoming limitations | Requirements | Documented usagea |
---|---|---|---|---|---|---|---|
Supply | |||||||
Training | Projects the availability of health-care professionals based on the current stock of clinicians, the training process (entries and dropouts), migration flows, attritions and retirement rates | Demand for medical services is assumed to remain constant and the projections are used to reduce the supply gap | Predictions for the future supply can be obtained in a fairly simple and immediate way | Demand for medical services is assumed to remain constant, which may not be true No critical assessment of the adequacy of current service levels | Incorporate a model of demand: economic or needs-based (or both)Evaluate current level of service through waiting lists, overtime hours,foreign workers, etc. | Accurate and up-to-date accounting of the current stock of physicians and nurses, migration rates, entry and drop out rates and expected retireesService usage levels from the health-care sector | Australia, Belgium,Canada, Chile,Denmark, Finland,France, Germany,Ireland, Israel, Japan,South Korea,Norway, Switzerla nd,The Netherlands,United Kingdom,USA |
Productivity | Reorganize services and/or economic incentives to promote higher productivity. Work harder or work smarter | Physicians and nurses act as rational agentsan d react to economic incentives like wage increases | Does not require a change in the quantity of human resources. Can be implementedimmediately | Productivity improvements may not be enough to accommodate large gaps in the supply of professionals | Do not preclude from evaluating the number of professiona ls necessary given differentproductivity levels | Operational indicators like the number of patients served with a given number of FTEs (or head counts) | Australia, Canada,Japan, Korea, Netherlands, N orway,Switzerland, UnitedKingdom, USA |
Skill mix | Delegate certain tasks to other health professionals. Substitution can be horizontal (betweenmedical professions) orvertical (betweenphysicians and nurses) | Professionals can assume new roles and perform new tasks | Does not require a change in the quantity of human resources. Can be implemented immediately | Enforcing such changes can be a political challange.Does not solve large gaps in the supply | Providing success stories to involved stakeholders, healthauthorities and medical associations | Education schools that can provide advanc ed education to the existing workforce | Netherlands, United Kingdom |
Worker-to-population ratios | Specifies desirable worker-to-population ratios based on direct comparison with another region of country | Regions and/or countries can be directly compared | Extremely easy to understand and apply Useful forproviding baseline comparisons | Does not take into account the intrinsic differences between regions a nd countries, the productivity and s kill mix of the avail able workforce | Does not take into account the intrinsic differences between regions and countries, the productivity and skill mix of the available workforce | Records of the current workforce to population ratios | Chile, France, Ireland, Israel, Switzerland,United Kingdom |
Demand | |||||||
Economic | Estimates future requirements by projecting the effect of demographic and socio-economic factors on the current level of service | Current level of service is adequate.Skill mix and distribution of health service is appropriateDemographic profile of the population and its effect on health-care demand can be accurately forecasted | Conceptually easy to understand and to apply Allows decoupling of the various components of demand and their influence on the overall aggregate demand | Tends to produce estimates of HHR demand that exceed practical limits No criticalassessment of the adequacy of current service levels Ignores the real demand,focusing instead onthe effective demand | Take financial constraints into considerationEvaluate current level of service through waiting lists, overtime hours, foreign workers, etc.Include a needs-basedevaluation | Accurate and long-term demographic estimates Service-usage levels from the health-care sector Macroeconomic indicators and stati stical data crossing income and usage | Australia, Belgium, Canada, Denmark, Finland, Germany, Japan, Norway, South Korea, Switzerland, The Netherlands, USA |
Needs | Considers the effect of epidemiology on the demand for health-care services Projects age- and gender-specific needs based on morbidity epidemiological trends | All health-care needs can and should be metResources are used in accordance to needs | Allows for a fine-gra inedanalysis of the requirements of each medical specialty Is independent of the current service-utilization ratios Easy to understand | Absence of ec onomic/efficiency considerations mayren der the projections unattainable Dependent on epidemiological projections which may not be obviousDoes not consider the current level of provision nor the capacity of the country to deliver health care | Consider an upper bound for a practical resultConsider projections of the most common he alth patterns Incorporate econo mic considerations in the model | Demographic esti mates that are accurate Service-usage levels from the health-care sector | Belgium, Canada, Germany, United Kingdom |
Service targets | Defines normative targets for the production of health-care services, which are then converted to HHR requirements | Assumes that established service targets are achievable in terms of financial and physical capital resources | Easy to d efine, interpret and understandFacilitates cost estimation Requires modest data and planning capabilities | May originate unrea listic assumptionsIgnores financial and other active constraints | Incorporate economic considerations in the model | Current level of service |
An integrated approach
Data requirements
Methodology | Indicators | Data requirements |
---|---|---|
Supply | Stock of licensed providers Baseline stock, age/sex distribution, growth projections | High |
Annual additions to licensed stocksGraduates, in-migration (foreign-trained, immigrantes, on temporary work permits), returned to profession | ||
Education/training programmesNumber of programmes and students enrolled, attrition rates, years to complete programme, number of graduates, costs | ||
Annual attritions to licensed stocksRetirements, mortality, career changes, emigration, abroad | ||
Productivity | Labour market Occupational participation rates, occupational employment rates, employment projections, vacancy rates, turnover rates, wage rates, productivity growth, cyclical factors, alternative career options | High |
Employment statusFull-time, part-time, casual, full-time equivalent (FTE), average hours worked, direct patient care hours, no longer practising, not licensed in jurisdiction | ||
Skill mix | Government policy variablesHHR education funding, alternative delivery modes, licencing regulations, professional roles/deployment, recruitment/retention strategies, immigration policy, remuneration rates/types, HHR capacity-building | High |
Worker-to-population ratios | Health labour workforce Number of active and employed physicians and nurses | Low |
Economic | Population demographicsTotal population, age/sex distribution, births/deaths, population projections | High |
Socio-economic variablesDisposable income, GDP growth projections, ethnic factors | ||
Needs | Population health statusAge/sex mortality, morbidity, acuity | High |
EpidemiologyIncidence and prevalence rates, hospital discharges, health patterns of the population | ||
Service targets | Utilization patternsNumber of occupied beds, number of inpatients and outpatients, number of surgeries/screenings/consultations performed, etc. | Low to high |