1. NEUJOBS WP12 Health care, goods and services for an ageing population Impact of demographic change on health care workforce Presentation at the 2nd NEUJOBS Validation Event Employment 2025: How will multiple transitions affect the European labor market? 9th April 2014 at IZA Bonn Dr. Erika Schulz, DIW

2. OBJECTIVES Analyse the impact of socio-ecological transition, in particular the ageing of the population, on employment in health care sector taking into account the  framework assumptions defined in the two scenarios tough and friendly (WP1: SET),  results of the NEMESIS model for employment and growth in total and in non-market services (WP9: Economic and employment development)  two demographic scenarios tough and friendly (WP10) Detailed analyses have been carried out for five countries: Denmark, Germany, Italy, Poland, and Slovakia

3. Participants DIW Berlin DR. ERIKA SCHULZ AND DR. JOHANNES GEYER responsible for DE and DK SAVBADR. MAREK RADVANSKÝ AND GABRIELA DOVÁĽOVÁ responsible for SK CASEProf. DR. STANISŁAWA GOLINOWSKA, DR. EWA KOCOT, AND DR. AGNIESZKA SOWA, responsible for PL CeRPDR. FLAVIA CODA MOSCAROLA (subcontract CeRP) responsible for IT

4. Health care - Tasks  A Current employment situation in EU countries and detailed analyses in selected countries (DE, DK, PL, SK, IT)  B Impact of ageing on the demand for health care services and its workforce (status-quo-projection for selected countries)  C Impact of changes in health workforce supply (selected countries)  D Employment and expected gap in the health care labour market (selected countries)

5. Share of employment in sector Q ‚human health and social work‘ (%) 2011: 23 mio. in EU27 - 10.4% of total employment 2000 – 2011: 5 mio. new jobs, thereof 1.5 million during the crisis (2008 - 2011). Source: EU LFS

6. Human health and social work (Q) Human health (Q86) Residential care (Q87) Social work activities without accommodation (Q88) Hospital activities Medical and dental practice activities Other human health activities Overview sector Q

7. Share of subsectors Q86, Q87, and Q88 (%) 12.4 mio. (EU27), 5.1 mio. (selected countries) employed in human health 75% female employment 32% elderly employment (50+); 18 % (55+) Source: EU LFS 2011

8.  More than half of health care workforce is employed in hospitals Institutional and ambulatory health care 2010  High share of elderly employment in ambulatory care (22%) Alarming signal: share of elderly practising physicians (55+) in DK 31.8%, DE 39.5%, IT 42.2% and SK 33.5%

9. Changes in population size and age-structure Increase in the number of elderly and oldest old Decline in working-age population Impact on the demand for services + employees I mpact on the supply of health care workforce Impact of demographic change

10. Demand Preferred Methods Supply Utilisation approach -Hospital admissions, length of stay -Contacts to doctors -Other services -Combined with popu- lation projections (tough and friendly scenarios) Top down approach -Estimation of total labour force (WP10) -Estimation of employment and growth by sectors (WP9) -Calculation for subsectors Estimation of future demand and supply

11. Data on utilization of hospital services are available for all selected countries; limited availability of data on utilization of ambulatory care services. Data from population surveys or insurance funds. Data sources (demand)

12. Utilization of hospital services Utilization = number of patients and average length of stay by age-groups and gender Past trends: increase in inpatients, but decline in length of stay

13. Changes in hospital utilization – pure demographic effect Hospital care I

14. Changes in hospital utilization – trend extrapolation in prevalence and length of stay Hospital care II

15. Changes in hospital employment – constant utilization rates Hospital employment

16. Available utilization data on ambulatory care

17. Utilization of ambulatory services Changes in the number of doctor‘s and dentist‘s consultations between 2010 and 2025 in %

18. Demand for ambulatory health workforce Changes in the demand for workforce in offices of doctors and dentists between 2010 and 2025 in %

19. Health care workforce supply  Population in working age: based on demographic scenarios tough and friendly by education level  Changes in male and female activity rates by education level: based on EU LFS for males, females and age-groups by education level, time series 2000 to 2011.  Changes in total labour supply: population combined with (a) constant and (b) increasing activity rates  Comparison with the NEMESIS results for labour supply – problem different accounting methods between NA and LFS  NEMESIS results for employment in non-market services, own calculation of the development in health care employment using constant share of sector Q86, Q87+88 in non-market services

20. Changes in total labour force – comparing own calculations and NEMESIS results Labour supply

21. Employment by sectors – changes 2025/2010 in %

22. Estimated changes in the demand and supply of health care workforce 2025/2010 in % Comparing demand and supply I

23. Comparing demand and supply II

24. Summary and conclusions The pure demographic effect is expected to lead to high imbalances on the health care market in particular in Germany, Italy, and Slovakia in the tough scenario, and in Italy also in the friendly scenario. Other factors influencing demand which could not be taken into account: New medical and pharmaceutical treatments Changes in health status, e.g. due to socio-ecological transition Changes in health behaviour Factors influencing the health workforce supply: Intensifying international recruitment strategies Changing working conditions Changes in health care organisation (patient-centred care)