1. Human resources in health care system in Estonia – opportunities and challenges Pille Saar Ministry of Social Affairs of Estonia

2. MAIN TOPICS  Current situation and statistical figures  New HRP model  Migration

3. CURRENT HEALTH CARE WORKFORCE SITUATION IN ESTONIA  5085 registered doctors (3.2 doctors per 1000) including 935 general medical practitioners working in the primary care  9784 registered general nurses (6,9 nurses per 1000) including 673 registered primary health care nurses working in the primary care and 106 registered school nurses working in the primary care

5. Number of registered and employed health care workers in August, 2005 PhysiciansDentistNursesMidwives Registered 508513079772481 working in health care sector 442011878099116 not working in health care sector in ESTTOTAL6651201673116 working abroad18215902 64 y or older185 318 working outside health care sector2961051287114

6. Averaged monthly gross wages of the nurses, compared with the overall average monthly gross wage in Estonia in 2002-2005 (EEK) 7

7. THE NEED FOR HEALTH CARE WORKFORCE IN ESTONIA The need for health care workforce in Estonia 3,2 doctors per 1000 6.6 dentists per 1000 8-10nurses per 1000 5,5 midwives per 1000 Number of doctors needed by the year 2015 is 4051 Number of nurses needed by the year 2015 is 12153 Expected nurses and doctors ratio:nursesdoctors 1:281024051 1:3121534051 1:4162044051

8. HEALTH CARE WORKFORCE PLANNING POLICY The number of state commissioned education study places for health care workforce doctors130admitted students specialist training (residency)110 admitted students nurses for general care290 admitted students midwives 40 admitted students MoSa worked out the new health care workforce planning model in 2005 Assumptions  Provided health care services in 2003 and health service prognosis in 2015  Expected annual migration is 1.3 %  All 65 y.o. doctors and nurses will be retired

9. Family physicians 200420052006200720082009201020112012201320142015 Number of registered family phys. 916 877867872876874864857842819803790 Need for 2015 840 Expected annual migration 1,3 % 2611 10 Retirement 13108171113111927202337 Admitted students before 2005 1125175 Amount of study places 15 20 lack or oversupply 372732363424172-21-37-50

10. 200420052006200720082009201020112012201320142015 3,5 year study Number of registered nurses 9597 89448966889591489475956796499720972797209697 Need for 2015 9597 Expected annual migration 1,3%125989998101104105106107 Retirement52810614510993103113123186200216211 Admitted students before 2005 226173170230 Amount of study places 290300 320 lack or oversupply -653-631-702-449-122-3052123130123100

12. THE MAIN REASONS FOR MIGRATION

13. POLICY ALTERNATIVES 1.Increase 10-20% of the state commissioned educations study places for health workforce 2.Increase the salary - the main reasons for migration - it is not relevant to increase the salary of health care workers who have made the final decision to migrate (better solution is to increase the salaries of young workers and medical residents) - erase the tuition bank loan 3.Improve working conditions, including attitude 4.Use internal resources - decrease falling out from the system - professional counselling 5. Agreements with other countries concerning to avoid the active enlisting

14. MIGRATIONS COSTS AND BENEFITS BENEFITS  Increase of professional experiences COSTS  Increase of the state commissioned educations study places for health workforce  Increase of the waiting list for treatment  Drop of the quality of health care services  Ineffective use of the government resources

15. CONCLUSIONS The international migration is not the biggest problem in the Estonian Health Care sector. The major problem is that 6 % of registered doctors and 13 % of registered nurses do not actually work in the health care sector. The number of really migrated health care workers is about 3 % from the whole number of registered health care workers.

16. Thank you for your attention!