HEALTH LABOUR MARKET TRENDS IN OECD COUNTRIES Michael Schoenstein, OECD Health Division 3 rd Global Health Workforce Alliance Forum Recife, 11 November 2013
Main health labour market issues in OECD countries since 2008 The crisis had a rapid impact on health workers and policy priorities. Human resource allocation is the most salient topic in OECD countries. A labour productivity agenda will need to address skills mismatch. 2
Crisis-related adjustment in the health sector has fallen on wages 10.0% 8.0% 6.0% Hungary GPs Specialists Average wage 8.0% 7.0% 6.0% 5.0% Denmark Doctors (GPs and specialists) Average wage 4.0% 2.0% 4.0% 3.0% 2.0% 0.0% -2.0% 2005 2006 2007 2008 2009 2010 2011 1.0% 0.0% -1.0% 2005 2006 2007 2008 2009 2010 2011-4.0% -2.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% -1.0% -2.0% France GPs Specialists Average wage 2005 2006 2007 2008 2009 2010 2011 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% -2.0% Belgium GPs Specialists Average wage 2005 2006 2007 2008 2009 2010 2011 3
Employment held up well: more doctors and nurses than before the crisis USA Japan 150 150 140 140 130 130 120 110 Doctors 120 110 Doctors 100 100 90 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 90 2002 2003 2004 2005 2006 2007 2008 2009 2010 France Italy 150 150 140 140 130 130 120 110 Doctors 120 110 Doctors 100 100 90 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 90 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Source: OECD Health Data 2013 4
The increase in HR supply is driven by increasing graduate numbers Number of medical graduates, selected countries, 1990 to 2011 Index (1990=100) 300 Australia Japan Canada United States Index (1990=100) 300 Denmark Netherlands Italy United Kingdom 250 250 200 200 150 150 100 100 50 50 Source: OECD Health Statistics 2013, http://dx.doi.org/10.1787/health-data-en 5
and in many countries by improved retention, e.g. doctors delaying retirement Share of doctors aged 55 or older, OECD countries, 2000 vs. 2010 60.0 50.0 40.0 30.0 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 39.5 41.3 42.2 48.4 20.0 12.9 10.0 0.0 2010 or nearest year 2000 Source: OECD Health Data 2012 6
Policy priorities have changed to issues about allocation of human resources 30 25 20 15 10 5 0 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 Source: OECD Health System Characteristics Survey 2012-13 No particular issue : Netherlands 7
32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 0 All OECD countries consider geographic maldistribution of MDs a key challenge Doctors per 1 000 inhabitants, TL2 regions, 2011 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 Lisboa Brussels Vienna Prague Bratislava 0 2 4 6 8 10 Physicians density (per 1 000 population) 8
Distribution across specialties is considered inadequate in many countries 60 Share of generalist doctors, selected countries, 1995 to 2010 55 50 45 40 35 30 25 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Australia France Germany Netherlands United Kingdom Note: Generalists include general practitioners ( family doctors ) and other generalist (non-specialist) medical practitioners. Source: OECD Health Data 2012 9
Changing team composition is a fastmoving target for many OECD countries Increase in NP/PA, relative to MD, USA, 2000 to 2010 20000 20000 15000 15000 10000 10000 NP PA MD 5000 5000 0 2000 2005 2010 0 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 10
Task reallocation will require tackling skills mismatch in among current HR 60% Do you feel that you need further training in order to cope well with your present duties? 50% 40% 30% 20% 10% 0% Physicians Other health professionals Others Notes: Preliminary data. Others = other technical and professional occupations (ISCO 2 and 3) Source: PIAAC 2013 11
Main health labour market issues in OECD countries since 2008 The crisis had an immediate impact on health workers and policy priorities. Human resource allocation is the most salient topic in OECD countries. A labour productivity agenda will need to address skills mismatch. 12
More information michael.schoenstein@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 6x forthcoming in December Geographic imbalances in physician supply and policy responses, WP 6x forthcoming in December 13
HEALTH LABOUR MARKET TRENDS IN OECD COUNTRIES Michael Schoenstein, OECD Health Division 3 rd Global Health Workforce Alliance Forum Recife, 11 November 2013