Comparing health care workforce in circumpolar regions: patterns, trends and challenges

T Kue Young,Natalia Fedkina,Susan Chatwood,Peter Bjerregaard

doi:10.1080/22423982.2018.1492825

Abstract

ABSTRACTBackground: The eight Arctic States exhibit substantial health disparities between their remote northernmost regions and the rest of the country. This study reports on the trends and patterns in the supply and distribution of physicians, dentists and nurses in these 8 countries and 25 regions and addresses issues of comparability, data gaps and policy implicationsMethods: We accessed publicly available databases and performed three types of comparisons: (1) among the 8 Arctic States; (2) within each Arctic State, between the northern regions and the rest of the country; (3) among the 25 northern regions. The unit of comparison was density of health workers per 100,000 inhabitants, and the means of three 5-year periods from 2000 to 2014 were computed.Results: The Nordic countries consistently exceed North America in the density of all three categories of health professionals, whereas Russia reports the highest density of physicians but among the lowest in terms of dentists and nurses.The largest disparities between “north” and “south” are observed in the Northwest Territories and Nunavut of Canada for physicians, and in Greenland for all three categories. The disparity is much less pronounced in the northern regions of Nordic countries, while Arctic Russia tends to be oversupplied in all categories.Conclusions: Despite efforts and standardisation of definitions by international organisations such as OECD, it is difficult to obtain an accurate and comparable estimate of the health workforce even in the basic categories of physicians, dentists and nurses . The use of head counts is particularly problematic in jurisdictions that rely on short-term visiting staff. Comparing statistics also needs to take into account the health care system, especially where primary health care is nurse-based.List of Abbreviations ADA: American Dental Association; AHRF: Area Health Resource File; AMA: American Medical Association; AO: Autonomous Okrug; AVI: Aluehallintovirasto; CHA: Community Health Aide; CHR: Community Health Representative; CHW: Community Health Worker; CIHI: Canadian Institute for Health Information; DO: Doctor of Osteopathic Medicine; FTE: Full Time Equivalent; HPDB: Health Personnel Database; MD: Doctor of Medicine; NOMESCO: Nordic Medico-Statistical Committee; NOSOSCO: Nordic Social Statistical Committee; NOWBASE: Nordic Welfare Database; NWT: Northwest Territories; OECD: Organization for Economic Co-operation and Development; RN: Registered Nurse; SMDB: Scott’s Medical Database; WHO: World Health Organization

Highlights

The health workforce is an important and critical “building block” of any health system
International comparisons of the size and distribution of the health workforce are beset by serious methodological challenges
We performed three types of comparisons: (1) comparing the eight Arctic States based on OECD data; (2) within each Arctic State, comparing its northern regions with the rest of the country using national data sources, with some exceptions explained below; and (3) comparing the northern regions

Summary

Introduction

The health workforce is an important and critical “building block” of any health system. A recent OECD review of health workforce policies found a continuing need to focus on addressing shortages, maldistribution and suboptimal skill mix [2] Within countries, even those at a highly developed state of economic development, rural and remote communities tend to experience reduced access to health services. Even those at a highly developed state of economic development, rural and remote communities tend to experience reduced access to health services Redressing such inequality would require special health workforce policies that target these vulnerable populations [3]. This study reports on the trends and patterns in the supply and distribution of physicians, dentists and nurses in these 8 countries and 25 regions and addresses issues of comparability, data gaps and policy implications Methods: We accessed publicly available databases and performed three types of comparisons: (1) among the 8 Arctic States; (2) within each Arctic State, between the northern regions and the rest of the country; (3) among the 25 northern regions. For within-country, interregional comparisons, substantial variations in how the health workforce is deployed, employed and regulated offer additional obstacles

Methods

Results

Conclusion