Objectives
The aim of the SEPEN mapping study was to provide a general overview, a detailed description and an updated summary of the health workforce planning systems and policies in the 28 EU Member States (MS), including the United Kingdom . The report provides 28 country fiches of national health policies and health workforce of the MS, including a summary of the health workforce planning systems, a list of health workforce policies in place, health workforce data and the top three major challenges for the future.
Methods
In the first phase of the mapping study, a literature review was conducted based on the scientific and grey literature, policy reports and information available on the internet. Also the international data sources were screened. The results provided a basis to generate pre-filled health workforce country fiches and define a set of policy questions to be discussed in the next stage with the identified key country informants. Three countries, namely Belgium, Hungary and Italy served as pilot cases for the mapping study. The country profiles were filled with the latest available information and data on health workforce stock and replacement data, mobility data and the number of practising physicians, nurses and midwives by NUTS2 region in the EU Member States. Eight different health policies were discussed with the key country
informants: (1) to measure the stock, the shortages and the maldistribution of skills, (2) to address performance, (3) to address mobility, (4) to address the education and the attractiveness of the profession, (5) the capacities of education the health workforce, (6) the system of continuous professional development, (7) to regulate the private sector and (8) to support appropriate working conditions.
| Age groups | A division of the population according to age, in a predetermined range, used to distinguish differences among populations. Examples: 0-4; 5-9; 10-14; …. 55-64; 65+. |
| Advanced practice nurse (APN) | A registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is authorised to practise. A master’s degree is recommended for entry level. |
| Continuous professional development (CPD) | The systematic maintenance, improvement and continuous acquisition and/or reinforcement of the lifelong knowledge, skills and competences of health professionals. It is pivotal to meeting patient, health service delivery and individual professional learning needs. The term acknowledges not only the wide-ranging competences needed to practise high-quality care delivery but also the multi-disciplinary context of patient care. (For example, this might include technical, scientific, regulatory and ethical developments, as well as research, management, administration and patient relationship skills. Activities can be categorised as formal/informal and mandatory/voluntary.) |
| Demand (of HWF) | The number of health professionals required to respond to the planning objectives. It should ideally be expressed in both headcount and full-time equivalent (FTE), depending on the forecasting purpose. |
| Density (of HWF) | HWF density is the number of health workforce per unit of population (e.g. per 10,000/100,000 inhabitants). |
| Dentists | Dental practitioner is one of the sectoral health professions in the EU defined by the Directive EC/2005/36 (see section 4 for details of training requirements, activities and rights). |
| Emigration (outflow) | The act of leaving one’s current country, in this context with the intention to permanently practise a profession abroad. |
| Forecasting model (quantitative) | A quantitative forecasting model is a set of formal statements about variables and relationships among variables. The scope is to estimate future data as a function of past data (time series, cross-sectional or longitudinal data) on the basis of specific assumptions. Accordingly, it is appropriate when past data are available. Quantitative forecasting models are usually applied to short- or intermediate-range decisions. On the other hand, qualitative forecasting models (in which estimates are based on the opinion and judgement of experts, stakeholders or users) are appropriate when past data are not available and they are usually applied to intermediate- or long-range decisions. A combination of both models supports the definition of quantitative assumptions through a qualitative assessment process. |
| Full-time equivalent (FTE) | Unit used to measure employed persons to make them comparable, as they work a different number of hours per week, in different sectors. The unit is obtained by comparing an employee’s average number of hours worked to the average number of hours of a full-time worker of the same kind. A full-time worker is therefore counted as one FTE, while a part-time worker gets a score in proportion to the hours he or she works or studies. For example, a part-time worker employed for 24 hours a week where full-time work consists of 48 hours, is counted as 0.5 FTE. |
| Graduate | A graduate is someone who has successfully completed a first degree at a university or college. |
| Health professionals | Individuals working in the provision of health services, whether as individual practitioners or as an employee of a health institution or programme. Health professionals are often defined by law through their sets of activities reserved under provision of an agreement based on training prerequisites or equivalents. Health professionals can be characterised by different health profession categories (e.g. see the sectoral professions in the Directive EC/2005/36). |
| Health professions | Health and care professions defined by the national legal framework and subject to recognition of skills through the mechanisms are defined by the Directive 2005/36/EC of the European Parliament and of the Council on the recognition of professional qualifications. Within this definition, nurses, midwives, doctors (general practitioners and specialists), dental practitioners, pharmacists, architects and veterinary surgeons are the sectoral professions (see beneath). |
| Health workforce (HWF) | The overarching term for the body of health professionals working in a healthcare system. We differentiate licensed to practise, professionally active and practising professionals by activity status. |
| Health workforce planning | Strategies that address the adequacy of the supply and distribution of the health workforce, according to policy objectives and the consequential demand for health labour (Feasibility study on EU-level collaboration on forecasting health workforce needs, workforce planning and health workforce trends, 2012). |
| Key country informants | Key informants are the knowledge brokers from the EU-28. They provide and summarise the current health workforce planning and policy information at national level, listing key stakeholders at national level, providing sources, and validating the data and information of the country profiles and appendixes. |
| Licensing | Licensing has been defined as the process of authorisation or authenticating the right of a physician to engage in medical practice, its monitoring (regulation) and renewal or extension. Often used with registration interchangeably (Kovacs et al., 2014). |
| Maldistribution | The geographical maldistribution or imbalance due to the aggregation of health workers in urban and suburban areas, leaving large populations, especially members of minority groups and rural residents, underserved. |
| Midwives | Midwives represent one of the sectoral health professions in the EU defined by the Directive EC/2005/36 (see section 6 for details of training requirements, activities and rights). |
| Migration (inflow) | The act of (either temporarily or permanently) moving into a country, in this context in order to practise a profession. |
| Mobility (of HWF) | All processes in which persons cross borders between countries with the purpose or result of working as (qualified) health professionals in the country to which they move. |
| Nurses | Nurses responsible for general care is one of the sectoral health professions in the EU defined by the Directive EC/2005/36 (see section 3 for details of training requirements, activities and rights). |
| NUTS 2 | Represents basic regions for the application of regional policies e.g. “Provincies/Provinces” in Belgium. |
| Pharmacists | Pharmacists are one of the sectoral health professions in the EU defined by the Directive EC/2005/36 (see section 7 for details of training requirements, activities and rights). |
| Physicians | Doctors of medicine represent one of the sectoral health professions in the EU defined by the Directive EC/2005/36 (see section 2 for details of training requirements, activities and rights). |
| Planning system | Strategies that address the adequacy of the supply and distribution of the healthcare workforce in relation to policy objectives and the consequential demand for health labour force. Strategies contain the following: right attitude, commitment, doing the right work at the right cost and at the right productivity rate. Basic planning can be considered as: recognising the major imbalances of HWF and analysing the imbalances. Therefore, the following health workforce planning activities shape the planning systems: supply forecasting, demand forecasting, forecasting requirements, estimating future conditions and action planning. |
| Population | Number of inhabitants in the Country or Region considered at the reference date. |
| Population health and care needs | The requirements at the individual, family, community and population level of care and services to achieve physical, cognitive, emotional and social well-being, taking the broad determinants of health into account. |
| Positions | Defined employment, roles and responsibilities in the healthcare system. |
| Productivity | Labour productivity represents the total volume of output (measured in terms of Gross Domestic Product, GDP) produced per unit of labour (measured in terms of the number of employed persons) during a given time reference period. The indicator allows data users to assess GDP-to-labour input levels and growth rates over time, thus providing general information about the efficiency and quality of human capital in the production process for a given economic and social context, including other complementary inputs and innovations used in production (ILOSTAT, 2019). |
| Projection | A mathematical estimate, prognosis or forecast of a future situation based on a study of present and past trends, often steered by scenarios that apply to modelling factors (EC, 2012). |
| Recognition activity | Carrying out the recognition process of healthcare qualifications obtained in a foreign country, and the procedure of issuing certificates for recognition in a foreign country concerning healthcare qualifications obtained, or recognised, in certain countries. |
| Registration | Registration is defined as all the processes associated with the issuing of licences/authorisations to practise medicine and ensuring that the professional activities carried out under this authority maintain the professional standards on which it is based. Often used with licensing interchangeably (Kovacs et al., 2014). |
| Retirement | Annual number of professionals retiring, thus exiting the labour market. |
| Revalidation | The process through which registered health professionals demonstrate periodically that their knowledge is up-to-date and their continuing fitness to practise. It can be a tool for showing that CPD activities undertaken are appropriate for supporting and enhancing professional practice. It may be a prerequisite for re-licensing and re-registration, and can be tied to professional appraisals. |
| Sectoral Health Professions | The professional qualifications of physicians, nurses, midwives, pharmacists, and dentists, as included in the Directive 2005/36/EC of the European Parliament and of the Council. |
| Shortage | The gap in supply of human resources in health. The demand for healthcare is not covered by the available workforce. |
| Source country, also:
● Sending country ● Country of origin ● Donor country |
The home country of the mobile health professional,
● where he/she was born ● has his/her nationality from ● where he/she obtained his/her first medical diploma/ qualification AND was born there and/or has its nationality and/or has the language of the country as mother tongue |
| Stakeholder | Groups or individuals that have an interest in the organisation and delivery of healthcare, and who either deliver, sponsor, have an advisory role or benefit from healthcare. |
| Stock (of HWF) | Number of available practising and non-practising health professionals in a country, recorded in a registry or database. It should ideally be expressed in headcount and in full-time equivalent (FTE). |
| Supply (of HWF) | Number of newly graduated health professionals available to fill in open vacancies. It can be expressed in headcount or in full-time equivalent (FTE). |
| Target country, also:
● Country of destination ● Destination country ● Host country ● Recipient country ● Receiving country |
The country the mobile health professional intends to work in as a practising health professional. |
| Training | The process by which a person acquires the necessary knowledge, skills and competencies for delivering healthcare, possibly through postgraduate training programmes (in the framework of Continuous Professional Development) in addition to graduate training programmes. |
| Trend | An emerging pattern of change, likely to impact a system. |
| Underserved areas | A region or area that has a relative or absolute deficiency of healthcare personnel or healthcare resources. This deficiency could present itself in shortages of facilities/professionals/specialties/skills required to deliver health services. |
| Universal health coverage | A healthcare system that provides effective, high-quality and free of expense preventive, curative, rehabilitative and palliative health services to all citizens, regardless of socio-economic status, and without discrimination. |
| Variables | A characteristic, number or quantity that can increase or decrease over time, or take various values in different situations. |
| Workforce forecasting | Estimating the required health workforce to meet future health service requirements and the development of strategies to meet those requirements (Roberfroid et al, 2009; Stordeur and Leonard, 2010). |
OECD terminology is used unless otherwise noted. We refer to the OECD website for full definitions
https://stats.oecd.org/glossary/index.htm.
Due to different national definitions, there might be some deviations from the general definition. We refer to the information sheet of every country for more information.
General information on national definitions can be found here:
For OECD-data:
For Eurostat-data:
Below, non-OECD terminology can be found:
| Terminology | Definition |
| Allied health profession | Allied health professions are health care professions distinct from physicians, pharmacists, dentists, nurses and midwives. |
Symbols adapted from the Universal Symbols for Healthcare collection:
https://segd.org/healthcare-symbols
Eurostat:
Eurostat (2018), Health care resources
http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_rs_prsrg&lang=en
OECD:
OECD (2018), Country Statistical Profiles, OECD Statistics
https://stats.oecd.org/index.aspx?queryid=58290
OECD (2018), Health Care Resources, OECD Health
https://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_REAC
OECD (2018), Health Workforce Migration, OECD Health:
https://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_WFMI
Physicians (Eurostat uses “Medical doctors” as terminology):
http://ec.europa.eu/eurostat/
Nurses and midwives:
http://ec.europa.eu/eurostat/
Important notice:
The use of Eurostat and OECD-data does not mean that Eurostat and OECD participated in, approved, endorsed or otherwise supported this production.
The mapping study was carried out before Brexit, therefore contains information about the former 28 EU Member States.
The mapping exercise was conducted prior to the COVID-19 outbreak.
The country fiches are produced under the EU Health Programme 2014-2020 under a service contract with the Consumers, Health, Agriculture and Food Executive Agency (Chafea) acting under the mandate from the European Commission. The information and views set out in the country fiches are those of the author(s) and do not necessarily reflect the official opinion of the Commission/Executive Agency. The Commission/Executive Agency does not guarantee the accuracy of the data included in this study. Neither the Commission/Executive Agency nor any person acting on the Commission’s/Executive Agency’s behalf may be held responsible for the use which may be made of the information contained therein.
This website was produced under the EU Health Programme 2014-2020 under a service contract with the Consumers, Health, Agriculture and Food Executive Agency (Chafea) acting under the mandate from the European Commission. The information and views set out in this website are those of the author(s) and do not necessarily reflect the official opinion of the Commission/Executive Agency. The Commission/Executive Agency does not guarantee the accuracy of the data included in this website. Neither the Commission/Executive Agency nor any person acting on the Commission's / Executive Agency's behalf may be held responsible for the use which may be made of the information contained therein.