HEALTH LABOUR MARKET TRENDS IN OECD COUNTRIES Michael Schoenstein, OECD Health Division 3rd Global Health Workforce Alliance Forum Recife, 11 November 2013

• 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

Main health labour market issues

in OECD countries since 2008

Crisis-related adjustment in the

health sector has fallen on wages…

3

-4.0%

-2.0%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

2005 2006 2007 2008 2009 2010 2011

HungaryNurses

GPs

Specialists

Average wage

-2.0%

-1.0%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

2005 2006 2007 2008 2009 2010 2011

DenmarkNurses

Doctors (GPs and specialists)Average wage

-2.0%

-1.0%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

2005 2006 2007 2008 2009 2010 2011

FranceNurses

GPs

Specialists

Average wage

-2.0%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

2005 2006 2007 2008 2009 2010 2011

BelgiumNurses

GPs

Specialists

Average wage

Employment held up well: more doctors

and nurses than before the crisis

4 Source: OECD Health Data 2013

90

100

110

120

130

140

150

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

USA

Doctors

Nurses

90

100

110

120

130

140

150

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Italy

Doctors

Nurses

90

100

110

120

130

140

150

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

France

Doctors

Nurses

90

100

110

120

130

140

150

2002 2003 2004 2005 2006 2007 2008 2009 2010

Japan

Doctors

Nurses

5

The increase in HR supply is driven

by increasing graduate numbers…

50

100

150

200

250

300

Australia Canada

Japan United States

Index (1990=100)

50

100

150

200

250

300

Denmark Italy

Netherlands United Kingdom

Index (1990=100)

Number of medical graduates, selected countries, 1990 to 2011

Source: OECD Health Statistics 2013, http://dx.doi.org/10.1787/health-data-en

…and in many countries by improved

retention, e.g. doctors delaying retirement

12.9

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 39.541.3 42.2

48.4

0.0

10.0

20.0

30.0

40.0

50.0

60.0

2010 or nearest year 2000

6 Source: OECD Health Data 2012

Share of doctors aged 55 or older, OECD countries, 2000 vs. 2010

Policy priorities have changed to issues

about allocation of human resources

0

5

10

15

20

25

30

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

7

Source: OECD Health System Characteristics Survey 2012-13

“No particular issue”: Netherlands

8

All OECD countries consider geographic

maldistribution of MDs a key challenge

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

Vienna

Brussels

Prague

Lisboa

Bratislava

0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

0 2 4 6 8 10

Physicians density (per 1 000 population)

Doctors per 1 000 inhabitants, TL2 regions, 2011

Distribution across specialties is

considered inadequate in many countries

9

Note: Generalists include general practitioners (‘family doctors’) and other generalist (non-specialist) medical

practitioners.

Source: OECD Health Data 2012

Share of generalist doctors, selected countries, 1995 to 2010

25

30

35

40

45

50

55

60

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Australia France Germany Netherlands United Kingdom

Changing team composition is a fast-

moving target for many OECD countries

0

5000

10000

15000

20000

0

5000

10000

15000

20000

2000 2005 2010

NP

PA

MD

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

Increase in NP/PA, relative to MD, USA, 2000 to 2010

11

Task reallocation will require tackling skills mismatch in among current HR

0%

10%

20%

30%

40%

50%

60%

Physicians Nurses Other healthprofessionals

Others

Do you feel that you need further training in order to cope

well with your present duties?

Notes: Preliminary data. “Others” = other technical and professional occupations (ISCO 2 and 3)

Source: PIAAC 2013

• 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

Main health labour market issues

in OECD countries since 2008

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

More information

HEALTH LABOUR MARKET TRENDS IN OECD COUNTRIES Michael Schoenstein, OECD Health Division 3rd Global Health Workforce Alliance Forum Recife, 11 November 2013