1. Demands and challenges for Health Human Resources in Lithuania Liudvika Starkienė, PhD Assistant to the Minister of Health, Ministry of Health of the Republic of Lithuania Researcher, Kaunas University of Medicine September 26, 2005

2. Structure of the presentation: Supply of HHR The main problems of HHR Overview of planning approaches Response to challenges

3. Supply of HHR in 2004: Lithuania, Latvia, Estonia and EU

4. The main problems of HHR in Lithuania Lack of timely and precise information Migration Retention Unfinished undergraduate studies Retirement Geographic maldistribution

5. The main problems of HHR: Lack of timely and precise information Data sourcePhysi- cians NursesDentistsPharma- cists PH spe- cialists License Registry at the MoH + 1999 + 2003 + 1999 -- Database of the State Medicines Control Agency ---+- LHIC database+++++ SSF database+ 1999 ---- Archives of the Universities +++++ No one database or registry of HHR in Lithuania can provide all the needed information in a timely manner. Databases are not linked.

6. The main problems of HHR: Migration

7. Reasons for leaving (physicians and pharmacists): Higher salary->70% Higher quality of life ->50% Better carrier possibilities ->40% Countries of destination: Nordic countries (Denmark, Norway, Sweden); UK; Germany The main problems of HHR: Migration

8. The main problems of HHR: Retention

9. The main problems of HHR: Unfinished undergraduate studies

10. The main problems of HHR: Retirement (physicians older than 60 years)

11. The main problems of HHR: Maldistribution of physicians by county, 2004

12. The main problems of HHR: Maldistribution of nurses by county, 2004

13. The main problems of HHR: Maldistribution of dentists by county, 2004

14. Overview of planning approaches

15. Overview of planning approaches: Supply VariablesData source Current supplyLithuanian Health Information Center Mortality rateDepartment of Statistics, weighted average of mortality in the 25-64 year age group adjusted by gender (84.9% or 68% of women) Drop out due to retirementLicense register at MoH Drop out due to migrationMoH, migration studies Drop out from undergraduate studies Cohort studies Drop out from residency studies Cohort studies

16. Overview of planning approaches: Planning of physician and GP supply until 2015 VariablesPhysiciansGPs Duration of studies10 years3 years Mortality rate0.7%0.47% Drop out due to retirement (71 or 66 years) 1.7% or 2.5%0.4% or 1.2% Drop out due to migration1%, 2% or 3%0.6%, 1.1% or 2.2% Drop out from undergraduate studies 17.3%NA Drop out from residency studies 1%, 1.5% or 2% Annual enrolment to undergraduate studies 360, 400 or 44030, 38, 46

17. Overview of planning approaches: Requirement according to Delphi method Performed in 2000 (for physicians and GPs) Performed in 2005 (for pharmacists, nurses, public health specialists and dentists) Target recipients were representatives of the Universities, members of the NBH, chief physicians of the counties and municipalities, directors of the TSF and the SSF, representatives of the MoH and of the WHO Liaison Office.

18. Overview of planning approaches: Requirement according to Delphi method

19. Overview of planning approaches: Utilization-based requirement, GPs Population by age and gender in 2003 Population visits to GPs by age and gender in 2003 Number of visits per 1 GP in 2003 Projected population by age and gender in 2015 Projected number of population visits to GPs in 2015 (adjusted with growth of services) Projected requirement for GPs in 2015

20. Overview of planning approaches: Utilization-based requirement, GPs Gender, age group Population in 2003 (in thousands) Number of visits in 2003 (in thousands) Projected population in 2015 (in thousands) Projected number of visits in 2015 (in thousands) Projected number of visits in 2015, adjusted with 18.7% increase (in thousands) Males: 0-18438.5736.3336.5565.0670.7 19-44650.5537.6597.1493.5585.8 45-64353.1496.1409.5575.5683.0 >65175.2401.2183.4419.8498.4 Totally, males1617.32171.21526.52053.82437.9 Females: 0-18418.8720.9320.0550.0653.9 19-44660.5734.6602.5670.0795.3 45-64431.5863.2473.1946.51123.6 >65334.5933.3355.3991.51176.9 Totally, females1845.33252.01750.93158.03749.7 Totally3462.65423.23277.45212.86187.6

21. Overview of planning approaches: Gap between supply and requirement, physicians

22. Overview of planning approaches: Gap between supply and requirement, GPs

23. Response to challenges

24. Response to challenges: Enrollment to study programs As a result of planning projections, enrollment to medical studies in 2002 was increased from 250 to 400 Recommendations for the Universities were delivered in 2005 regarding enrolment to residency programs

25. Response to challenges: Salaries Salaries of HHR in Lithuania have been traditionally low In 2004 average salary of physician was 463 euros per month and salary of nurse was 319 euros Salaries of HHR in 2004 were by 20% lower than the national average Gradual increase of salaries until 2015 As a result of this long-term commitment salaries of HHR should grow by 3.8-4.6 times until 2015

26. Response to challenges: Restructuring of the health care institutions (2003-2008) Objectives: Development of outpatient services, especially in primary health care Optimization of inpatient services and development of alternative types of activities Development of medical nursing and long-term care During the first stage of the reform 50,000 m 2 of hospital areas were renovated and supplied with new medical equipment Almost 1,000 offices for family physicians were established until 2004 and over 500 new offices will be established and appropriately equipped in 2006-2008. Improved distribution of services: growth of outpatient services, day care hospital services, day surgery, etc. Growing number of GPs

27. Response to challenges: Project e-health Will be implemented until 2008 The main strategic aims are improved quality and access to health care services and health information, improved competence and efficiency of health professionals, and improved management and planning possibilities for executives and administrators Will ensure linkage and communication of existing HHR registers and classifiers and improve quality of data Will ensure better working conditions for physicians (filling of documentation will take 30% less time, e- registration of patients, feedback, better and faster exchange of information between different providers of health services, etc.)

28. Conclusion Achieving a balance between the supply and the requirements of HHR is very complex, but important task in order to ensure the appropriate and efficient functioning of the health care system in the future Successful implementation of the ongoing reforms in the health sector will ensure that HHR in Lithuania will not face severe shortages in coming years