Abstract
This article examines issues facing the future health care workforce in Australia in light of factors such as population ageing. It has been argued that population ageing in Australia is affecting the supply of health care professionals as the health workforce ages and at the same time increasing the demand for health care services and the health care workforce.However, the picture is not that simple. The health workforce market in Australia is influenced by a wide range of factors; on the demand side by increasing levels of income and wealth, emergence of new technologies, changing disease profiles, changing public health priorities and a focus on the prevention of chronic disease. While a strong correlation is observed between age and use of health care services (and thus health care workforce), this is mediated through illness, as typified by the consistent finding of higher health care costs in the months preceding death.On the supply side, the health workforce is highly influenced by policy drivers; both national policies (eg funded education and training places) and local policies (eg work place-based retention policies). Population ageing and ageing of the health workforce is not a dominant influence. In recent years, the Australian health care workforce has grown in excess of overall workforce growth, despite an ageing health workforce. We also note that current levels of workforce supply compare favourably with many OECD countries. The future of the health workforce will be shaped by a number of complex interacting factors.Market failure, a key feature of the market for health care services which is also observed in the health care labour market – means that imbalances between demand and supply can develop and persist, and suggests a role for health workforce planning to improve efficiency in the health services sector. Current approaches to health workforce planning, especially on the demand side, tend to be highly simplistic. These include historical allocation methods, such as the personnel-to-population ratios which are essentially circular in their rationale rather than evidence-based. This article highlights the importance of evidence-based demand modelling for those seeking to plan for the future Australian health care workforce. A model based on population health status and best practice protocols for health care is briefly outlined.
Highlights
The challenges facing Australia's health workforce have been the subject of recent intense public interest, with perceptions of widespread and increasing workforce shortages that could impact upon patient care [1,2,3,4]
This mirrors concerns about health workforce shortages internationally, for example as expressed by the World Health Organization – for WHO critical shortages are identified with sub-Saharan Africa and Asia [5]
The Productivity Commission in its 2005 report on Australia's health workforce, details shortages in the health workforce "in general practice, various medical specialty areas, dentistry, nursing and some key allied health areas." [6]. It suggested shortfalls of 800 to 1300 GPs in 2002 (~5% of the GP workforce), and an anticipated shortfall of 10–12,000 nurses (~5% of the nursing workforce) in 2006 and 12–13,000 in 2010; citing the 2004 Australian Health Workforce Advisory Committee (AHWAC) 2003– 2004 annual report, [8] (This was in turn based on research by Access Economics (2004) [9], Preston [10], Shah and Burke [11] and Karmel and Li [12].) Other commentators have voiced similar concerns about existing and impending health workforce shortages [13]
Summary
The challenges facing Australia's health workforce have been the subject of recent intense public interest, with perceptions of widespread and increasing workforce shortages that could impact upon patient care [1,2,3,4]. The United Kingdom, for example, has increased the size of the health care workforce in a short time period, with an appropriately targeted policy mix; including new funding for additional consultants, GPs, and nurses within the NHS, an increase in medical school places and hospitalbased reforms to improve the work environment [30] These initiatives have seen in the UK National Health Service a growth in the number of GPs by 20.1%, of qualified nurses by 26.8% and of allied health professionals by 35.7% in the period 1997 to 2005 [30]. O'Brien-Pallas & colleagues in their international review of various health workforce models [48] are most critical of the ratio-based methods of service provision and the associated increase in workforce numbers in line with aggregate population levels This hardly fits in with the evidence-based approach increasingly demanded in other aspects of health care or health services research. It is important as noted by the World Health Organization [5] that health workforce planning consider the need for managers/health planners/researchers as well as the clinical workforce
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