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Lessons from the GFC for health workforce planning and policy

Jennifer Doggett reports from Adelaide:

The complexity and limitations of health workforce planning were clearly demonstrated in a presentation at the Health Workforce Australia Conference 2013 by Mark Pearson, Head of the Health Division at the Organisation for Economic Co-operation and Development (OECD).

The OECD has access to more comprehensive health workforce data than perhaps any other organisation and works across developed countries globally to provide internationally comparable data, state-of-the-art analysis and evidence-based policy recommendations.

Yet even the OECD got it wrong when predicting a major crisis in the global health workforce in a research paper in 2008, titled The Looming Crisis in the Health Workforce: How can OECD Countries respond?

The paper provided a robust range of data, including migration patterns of health professionals, workforce patterns and education policies of the various countries, to support its argument that there was a growing gap between supply and demand for health care workers globally.

On this basis, the OECD urged member countries to implement urgent policy reforms to increase their workforce supply and avert the looming crisis.

Yet, despite this evidenced-based prediction, as Mark Pearson pointed out in his presentation, the predicted crisis did not occur.

In fact, during this period many countries have experienced the opposite – an oversupply in some areas of the health workforce. The reason for this unexpected outcome was an event that no-one at the OECD (or anywhere else) had predicted – the global financial crisis (GFC).

The GFC had a profound impact on the health workforce across the OECD.  As Mark Pearson demonstrated, the effects were felt across the spectrum of the health sector with a profound impact on all professions with the possible exception of medical specialists.

Effects of the GFC on the health workforce included a significant reduction in the income of health workers (again with the exception of specialists) and a drop in the value of their pensions/retirement funds. This led to many health workers delaying retirement and/or working longer hours, thus increasing overall supply.

Another factor noted by the OECD was the effect of the GFC on the migration patterns of health workers as the flow from countries most affected to those least affected increased, thus boosting workforce supply in those areas.

The OECD experience is a lesson for all policy makers and those responsible for health workforce planning that even with the best data in the world, predictions about future workforce needs can still be way off base.

Clearly, this is not an argument against evidence-based workforce policies.

In fact, Pearson argues that we should use the current environment of lower overall pressure on the supply of health professionals to increase systematic data collection and workforce planning processes.

“It is a valuable opportunity to move away from one-off crisis-driven workforce planning towards a more sustainable process for the future,” he says.

However, the OECD experience with the GFC does highlight the need to address as many possible influencing factors – both inside and outside the health sector – when making predictions about future health workforce needs.

It also emphasises the importance of communicating the limitations of the data, something that often gets lost when trying to sell a key message to Health Ministers, the media and other stakeholders.

Another useful learning is the need for workforce planners to focus on current rather than future workforce policies.

Pearson notes that a common flaw in analyses of future workforce needs is the assumption that we are using our current health workforce at its maximum capacity.

He says the starting point for workforce planning needs to be a plan to harness the potential of the existing workforce, rather than simply a focus on increasing future supply.

A number of presentations at Health Workforce Australia Conference 2013 have provided glimpses of a very different future for health care education, training and service delivery.

From Joshua Tepper’s description of an entire simulated hospital built in Israel for training purposes, to extended scope paramedics, and emotionally engaging robots, it is clear that our health system of the future could look very different to that of today.

As the OECD experience makes clear, incorporating these sometimes radical and unexpected changes into workforce planning and policy making will continue to pose a challenge.

• You can track Croakey’s coverage of the conference here or follow the Twitter stream at #HWA2013.


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