1. The challenge of the changing health labor market G ILLES D USSAULT EUREGIO III 3 RD M ASTER C LASS P ROGRAMME 23 M ARCH, 2011

2. Overview Why discuss health workforce issues (HW) now? What needs to be done to find the right balance?

3. Why discuss HW issues now? Needs change Demand changes Supply changes Many alerts: WHO reports, EU Green paper/Conclusions Time lag

5. Education pipeline Nationals trained abroad Immigration Contracting Stock/ supply of health workers Composition Distribution Statutory retiremen t Attrition Emigration Returners A simple model of health labour market dynamics (stock and flows) Socio-demographic, economic, organizational, legal determinants

6. Needs change Aging population Epidemiological profile (chronic diseases, mental health, re/emerging diseases) Values (religious requests, palliative care, euthanasia) New diagnosis/treatment tools and strategies

7. Aging in the WHO-EUROPE Region, EU and CIS

8. Demand changes EU Health Policy, Cross-border directive WHO renewed primary care policy New organizational strategies: team work, integration of services, ambulatory/home care. Telemedicine Medicalization of healthy life Better informed, more demanding users (average time of consultations)

9. Supply changes Aging: Average/nurses = 41-45 in Den., Isl., Nor., Swe., Fra. Scaling-up of general practice, of nursing (expanded functions) Values and expectations (work-life balance, non-financial incentives) Mobility: within countries, between countries, im/emigration (freedom of movement, Bologna process, Blue EU Labour Card)

10. GPs, Denmark

11. England 2010: 14,000 nurses (Mooney H, 2007) Netherlands: 7,000 nurses (Simoens et al 2005) Norway: 3,300 nurses (Askildsen et al 2003) Switzerland: 3000 nurses (Irving J 2001) USA – 500000 nurses (2025) (Buerhaus et al. in print) – 44000 (2025) family practitioners (Colwill 2008) Predicted shortages

12. 12 Estimated shortage of HRH (DG-SANCO)

13. Migratory flows: ‘push’ e ‘pull’ Compensation Working conditions Working environment Better career opportunities Access to specialized training More security and stability “Global Code of Practice on the International Recruitment of health personnel” Source: Buchan J et al 2003

14. % physicians and nurses with foreign nationality (OECD 2007)

15. Which workforce? First, need to answer a few tricky questions: – Where do we start from? – Future health needs? – Which services? How will they be organized? – Who will do what? – How will supply and labour market evolve? – How much are we prepared to spend?

16. Which workforce? What is the capacity of the country, of individual organizations? – To attract/recruit the right type of future health workers – To educate/train them – To employ them – To retain them

17. What countries can (should) do? HW policy in line with services and health policies Build the information base (numbers, availability, productivity, projections, expectations, multiple employment, private sector) Mobilize stakeholders in support of change Mobilize resources and capacity

18. Conclusions The toughest challenge: building the workforce of tomorrow A global approach is needed How to move from awareness to effective action ?