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The Health Care Workforce in Europe. Learning from Experience

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The Health Care Workforce in Europe. Learning from Experience European on Health Systems and Policies The Health Care Workforce in Europe Learning from experience Edited by Bernd Rechel Carl-Ardy Dubois Martin McKee The Health Care Workforce in Europe Learning from experience The European Observatory on Health Systems and Policies supports and promotes evidence- based health policy-making through comprehensive and rigorous analysis of health care systems in Europe. It brings together a wide range of policy-makers, academics and practitioners to analyse trends in health care reform, drawing on experience from across Europe to illuminate policy issues. The European Observatory on Health Systems and Policies is a partnership between the World Health Organization Regional Office for Europe, the Governments of Belgium, Finland, Greece, Norway, Spain and Sweden, the Veneto Region of Italy, the European Investment Bank, the Open Society Institute, the World Bank, CRP-Santé Luxembourg, the London School of Economics and Political Science and the London School of Hygiene & Tropical Medicine. The Health Care Workforce in Europe Learning from experience Edited by Bernd Rechel Research Fellow, London School of Hygiene & Tropical Medicine, United Kingdom Carl-Ardy Dubois Assistant Professor, Department of Nursing Sciences, University of Montreal, Canada Martin McKee Professor of European Public Health, London School of Hygiene & Tropical Medicine, and Research Director, European Observatory on Health Systems and Policies, London, United Kingdom Keywords: HEALTH OCCUPATIONS – trends HEALTH MANPOWER – trends DELIVERY OF HEALTH CARE COMPARATIVE STUDY FRANCE GERMANY LITHUANIA MALTA NORWAY POLAND RUSSIAN FEDERATION SPAIN UNITED KINGDOM EUROPE © World Health Organization 2006, on behalf of the European Observatory on Health Systems and Policies All rights reserved. The European Observatory on Health Systems and Policies welcomes requests for permission to reproduce or translate its publications, in part or in full. Please address requests to: Publications, WHO Regional Office for Europe, Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the WHO/Europe web site at http://www.euro.who.int/PubRequest The views expressed by authors or editors do not necessarily represent the decisions or the stated policies of the European Observatory on Health Systems and Policies or any of its partners. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the European Observatory on Health Systems and Policies or any of its partners concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Where the designation “country or area” appears in the headings of tables, it covers countries, territories, cities, or areas. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the European Observatory on Health Systems and Policies in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The European Observatory on Health Systems and Policies does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. ISBN 92-890-2297-3 Printed and bound in the United Kingdom by The Cromwell Press, Trowbridge, Wilts. Contents List of tables, figures and boxes vi About the authors vii Foreword ix Acknowledgements xi 1 Introduction: Critical challenges facing the health care workforce in Europe 1 Carl-Ardy Dubois, Martin McKee, Bernd Rechel 2 France 19 Suzanne Wait 3 Germany 33 Susanne Weinbrenner, Reinhard Busse 4 Lithuaniaˆ 47 Zilvinas Padaiga, Liudvika Starkiene,· Zeneta Logminiene, Jack Reamy 5 Malta 59 Natasha Azzopardi Muscat, Kenneth Grech 6 Norway 71 Are-Harald Brenne 7 Poland 87 Monika Strózik 8 Russian Federation 101 Kirill Danishevski 9 Spain 115 Beatriz González López-Valcárcel, Carmen Delia Dávila Quintana, Elena Rodríguez Socorro 10 United Kingdom 129 James Buchan, Alan Maynard Index 143 Tables, figures and boxes Tables Table 2.1 Distribution of human resources in the French health 22 care system (1998–2002) Table 2.2 Distribution of health care resources in the French health 22 care system (1998–2002) Table 2.3 Proportion of women according to medical specialization 23 and setting of care Table 3.1 Medical professionals 1991–2003 (per 100 000 population) 36 Table 3.2 Nursing workforce 1997–2002 (full-time equivalent, 38 in thousands) Table 6.1 Health professionals 1990–2002 (full-time equivalent) 72 Table 6.2 Trends in numbers qualifying as health professionals, 72 1990–2002 Table 7.1 Number of health care professionals in Poland per 89 1000 population Table 9.1 Members of professional associations in Spain, 1985–2000 117 Table 10.1 Number of NHS staff by selected occupation, NHS England, 132 1999 and 2002 (headcount) Table 10.2 Number of general practitioners per 1000 population 133 Table 10.3 Number of medical and dental staff in hospitals per 1000 133 population Table 10.4 Whole time equivalent in the NHS qualified nursing and 133 midwifery workforce, 1999–2002 Table 10.5 Number of qualified nurses and midwives, NHS England, 135 1999 and 2002 (headcount) Figures Figure 10.1 Admissions to the UKCC Register from EU Directive/non-EU 134 sources: 1993/1994–2001/2002 (initial registrations) Boxes Box 10.1 NHS Plan targets 131 About the authors Natasha Azzopardi Muscat is Director, EU and International Affairs, Ministry of Health, Malta, and Coordinator, Health Services Management Division, Institute of Health Care, University of Malta, G’Mangia, Malta. Are-Harald Brenne is a Master’s student at the Department of Economics, University of Bergen, Norway. James Buchan is Professor in the Faculty of Social Sciences and Health Care, Queen Margaret University College, Edinburgh, United Kingdom. Reinhard Busse is Professor and Head of the Department of Health Care Management at the Technical University of Berlin, and Associate Research Director of the European Observatory on Health Systems and Policies, Berlin, Germany. Kirill Danishevski is Research Fellow at the London School of Hygiene & Tropical Medicine, and Coordinator of Health System Development Research Programmes in the Russian Federation. He is also Assistant Lecturer in the School of Public Health and Health Management (postgraduate), Department of Public Health and Public Health Consultant, Open Health Institute, Moscow, Russian Federation. Carmen Delia Dávila Quintana is Professor in the Department of Quantitative Methods for Economics and Management, University of Las Palmas de GC, Spain. Carl-Ardy Dubois is Assistant Professor in the Faculty of Nursing Sciences, University of Montreal, Canada. Beatriz González López-Valcárcel is Professor in the Department of Quantitative Methods for Economics and Management, University of Las Palmas de GC, Spain. Kenneth Grech is Assistant Lecturer in Health Services Management, and Honorary Clinical Lecturer in Public Health in the Faculty of Medicine and Surgery, University of Malta, Malta. Zeneta Logminiene is Deputy in the Department of Expertise and Audit at the Vilnius Territorial Sickness Fund, Lithuania. Martin McKee is Professor of European Public Health at the London School of Hygiene & Tropical Medicine, and Research Director of the European Observatory on Health Systems and Policies, United Kingdom. viii About the authors Alan Maynard is Professor of Health Economics in the Department of Healthˆ Sciences, University of York, United Kingdom. Zilvinas Padaiga is Vice Rector for Studies and Professor of Preventive Medicine in the Faculty of Public Health, Department of Preventive Medicine, University of Medicine in Kaunas, Lithuania. Jack Reamy is Associate Professor at the Department of Health Services Administration at Xavier University, United States. Bernd Rechel is Research Fellow at the London School of Hygiene & Tropical Medicine, United Kingdom. Elena Rodríguez Socorro is Lecturer in the Department of Quantitative Methods for Economics and Management, University of Las Palmas de GC, Spain Liudvika Starkiene· is Adviser to the Minister in the Lithuanian Ministry of Health, Vilnius, Lithuania. Monika Strózik is Administration Supervisor for KPMG, Poland. Suzanne Wait is an independent health policy consultant, and Director of SHW Health Ltd. She is also Honorary Senior Research Fellow at UCL and Director of Research at the International Longevity Centre-UK, London, United Kingdom. Susanne Weinbrenner is Senior Research Fellow at the Department of Health Care Management, Institute for Public Health, Faculty of Economics and Management, Technical University of Berlin, Germany. Foreword Health care is changing. Ageing populations, new therapeutic possibilities and rising expectations have made the provision of health care much more complex than in the past. Many countries are responding to this challenge, introducing new ways of delivering health care. At the heart of these changes are the health professionals. They must acquire a range of new skills. Some are technical, such as how to get the most from new information
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