Time trends in the geographical distribution of physicians, nurses and midwives in Europe

Abstract

Abstract Background Data on the supply of health professionals show large variations in the health workforce density among European countries based on national-level data. However, little attention has been paid to the comparison of health professional density at the regional level. This study aimed to analyse the density of physicians, nurses and midwives at regional level, using a cross-country comparative design and examine time trends. Methods Descriptive analysis of Eurostat data on the rate of health professionals per population at national and regional levels (NUTS 2 regions) for 2017 and time trends (2005-2017) and comparison to population density. To improve the cross-country comparability of data a set of criteria was applied, resulting in 15 European countries covered on physicians and eight for nurses and midwives. Changes over time in the regional distribution were analysed, using percentage change and compound annual growth rate (CAGR). Results We found a 2.4-fold difference in the physician density between the highest and lowest density countries (Austria: 513, Poland 241.6 per 100.000) and a 3.5-fold difference among nurses (Denmark: 1702.5, Bulgaria: 483). Differences by regions across Europe were higher and varied up to 4.5-fold both for physicians and nurses/midwives and did not improve over time. Results show that in all countries physician density levels are highest in densely populated regions, with capitals and/or major cities, while density of nurses and midwives tends to be higher in less populated areas. Overall, physician rates grew at a faster rate than the density levels of nurses and midwives. Conclusions International data should not only cover supply indicators at national level, but routinely collect regional data on the number of health professionals to demonstrate regional differences in workforce supply and to improve monitoring and workforce planning at regional levels. Key messages Despite increases in the density levels of physicians, nurses and midwives, time trends over a ten-year period showed no improvement in the geographical distribution within countries. The study is the first of its kind to descriptively analyse geographical density levels and time trends among health professionals across a selection of European countries using Eurostat data.