Workforce Shortage and Wage Bill Forecasts: Effect of Skill Mix Changes (Lecture B2) Richard M. Scheffler, PhD Distinguished Professor of Health Economics & Public Policy Director, Global Center for Health Economics and Policy Research School of Public Health University of California, Berkeley
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Workforce Shortage and Wage Bill Forecasts: Effect of Skill Mix Changes (Lecture B2)
Workforce Shortage and Wage Bill Forecasts: Effect of Skill Mix Changes (Lecture B2). Richard M. Scheffler, PhD Distinguished Professor of Health Economics & Public Policy Director, Global Center for Health Economics and Policy Research School of Public Health - PowerPoint PPT Presentation
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Workforce Shortage and Wage Bill Forecasts: Effect of Skill Mix Changes
(Lecture B2)
Richard M. Scheffler, PhD Distinguished Professor of Health Economics & Public PolicyDirector, Global Center for Health Economics and Policy ResearchSchool of Public HealthUniversity of California, Berkeley
2University of
California, Berkeley
Learning Objectives
Forecast workforce shortages and surpluses Estimate economic demand Forecast supply using a trendline Estimate requirements using different utilization
measures and controlling for country-level factors Estimate scaling-up costs
Wage bill Training Non-wage bill
Illustrate workforce and wage bill shortages under different skill mixes
3University of
California, Berkeley
Overview
Forecast workforce shortages and surpluses
Estimate scaling-up costsIllustrate workforce and wage bill
shortages under different skill mixes
4University of
California, Berkeley
Two types of shortages
Need-based shortage:
Need – Supply = Shortage
Economic demand-based shortage:
Economic Demand – Supply = Shortage
5University of
California, Berkeley
6University of
California, Berkeley
WHR 2006 found 2.28 workers per 1,000 population are required to achieve 80% coverage of births
Time period: 2015Estimate need for doctors versus nurses
and midwives separatelyEstimate economic demand for doctorsNeeds-based extensions
Use different needs-based health utilization measures
Use additional co-variates
9University of
California, Berkeley
Conceptual Framework
0
1
2
3
4
5
6
1 2 3 4 5 6 7 8 9 10
Time period
Phys
icia
ns p
er 1
,000
Need
Supply
Surplus Shortage
Demand
Scheffler, RM, Liu, JX, Kinfu, Y, Dal Poz, MR. “Forecasting the Global Shortages of Physicians: An Economic- and Needs-based Approach.” April 2008, The Bulletin of the World Health Organization. Available at: http://www.who.int/bulletin/volumes/86/7/07-046474.pdf
εi,t : Random disturbance termScheffler, RM, Liu, JX, Kinfu, Y, Dal Poz, MR. “Forecasting the Global Shortages of Physicians: An Economic- and Needs-based Approach.” April 2008, The Bulletin of the World Health Organization. Available at: http://www.who.int/bulletin/volumes/86/7/07-046474.pdf
11University of
California, Berkeley
Demand-based model projection
ln(physicians per 1,000 populationi,t) =γ0 + γ1*ln(GNP per capitai,t-5)+ γ2*IncomeDummyi + μi +ηt + εi,t
WhereIncomeDummyi: low-income and middle-income
dummiesμi : country fixed effectsηt : Time fixed effectsεi,t : random disturbance term
Scheffler, RM, Liu, JX, Kinfu, Y, Dal Poz, MR. “Forecasting the Global Shortages of Physicians: An Economic- and Needs-based Approach.” April 2008, The Bulletin of the World Health Organization. Available at: http://www.who.int/bulletin/volumes/86/7/07-046474.pdf
12University of
California, BerkeleySource: Scheffler et al., 2008 The Bulletin of the World Health Organization
Needs-based and demand-based regression modeling results
13University of
California, Berkeley
Found 0.55 doctors per 1,000 population are required to achieve 80% coverage of births
14University of
California, Berkeley
Supply projection
ln(doctors per 1,000 populationt) =α0 + α1*Yeart + εt
Wheret = index {1980,…,2001}Yeart: year dummy variables
εt random disturbance term
Scheffler, RM, Liu, JX, Kinfu, Y, Dal Poz, MR. “Forecasting the Global Shortages of Physicians: An Economic- and Needs-based Approach.” April 2008, The Bulletin of the World Health Organization. Available at: http://www.who.int/bulletin/volumes/86/7/07-046474.pdf
15University of
California, Berkeley
Number of countries with projected shortages of doctors in 2015
Scheffler, RM, Liu, JX, Kinfu, Y, Dal Poz, MR. “Forecasting the Global Shortages of Physicians: An Economic- and Needs-based Approach.” April 2008, The Bulletin of the World Health Organization. Available at: http://www.who.int/bulletin/volumes/86/7/07-046474.pdf
Note: A country was defined to have a shortage if the projected supply of doctors met less than 80% of the projected demand or need.
16University of
California, BerkeleySource: Scheffler et al., 2008 The Bulletin of the World Health Organization
Significant doctor shortages projected for Africa and Asia in 2015
17University of
California, Berkeley
Summary of Findings for Africa
Over 30 countries with projected doctor shortages in 2015
Scheffler, RM, Liu, JX, Kinfu, Y, Dal Poz, MR. “Forecasting the Global Shortages of Physicians: An Economic- and Needs-based Approach.” April 2008, The Bulletin of the World Health Organization. Available at: http://www.who.int/bulletin/volumes/86/7/07-046474.pdf
California, BerkeleyScheffler, RM, Liu, JX, Kinfu, Y, Dal Poz, MR. “Forecasting the Global Shortages of Physicians: An Economic- and Needs-based Approach.” April 2008, The Bulletin of the World Health Organization. Available at: http://www.who.int/bulletin/volumes/86/7/07-046474.pdf
Doctor Shortages in Africa in 2015 (cont.)
Countries with no doctor shortages: Botswana, Congo, Namibia, Mauritius, South Africa and Algeria
Forecast workforce shortages and surplusesEstimate requirements using different
utilization measures and controlling for country-level factors
Estimate scaling-up costsIllustrate workforce and wage bill
shortages under different skill mixes
21University of
California, Berkeley
World Health Survey (WHS) 2002
53 countries used for this analysis, including 18 in Africa
Approximately 4,000 adults per country surveyed
Household and individual surveys
21
22University of
California, Berkeley
Descriptive Statistics for Africa (n=18)Variable Mean Std. Dev.Health Care Services
1. Birth attended by health worker 0.74 0.232. Received healthcare when needed it 0.94 0.04
Women's Health Care3. Pelvic examination <3 years 0.17 0.144. Pap smear test <3 years 0.44 0.145. Mammography <3 years 0.05 0.046. HIV testing offered when pregnant 0.19 0.16
Child vaccinations and supplements7. Received any vaccination 0.76 0.118. Received DPT vaccination 0.93 0.059. Received measles vaccination 0.82 0.1010. Received vitamin A capsule or similar supplement 0.61 0.21
Health Outcomes11. Health rating 0.64 0.1112. Health satisfaction 0.59 0.14
Health WorkforceDoctors per 1,000 population 0.21 0.27Nurses and midwives per 1,000 population 1.52 1.68Health workers per 1,000 population 1.73 1.85
Population DistributionLand (square km) per capita 0.08 0.12Urban (% of total population) 38.01 21.33
23University of
California, Berkeley
Extended needs-based model
percent of need met =β0 + β1* log(health care professionals per 1,000 population) +x + ε
Where:percent of need met: is for a particular health
care utilization measurex: country-level factors (land area per capita,
percent population that is urban)ε: Random error term
24University of
California, Berkeley
Number of Required Workers Varies Based on Health Utilization Measure
0
20
40
60
80
100 % receiving health services
0 5 10 15 Health workers per 1,000 population
Birth attended by HW (A) Received health care when needed (B) Pap smear test (C) HIV testing offered (D) Pelvic examination (E) Mammography (F)
A B C D E F
2.28*
*WHO Threshold
2.28*
*WHO Threshold
Source: Fulton and Scheffler, forthcoming. Do not cite or distribute.
25University of
California, Berkeley
Number of Required Workers Varies Based on Countries’ Geographic Characteristics
Source: Fulton and Scheffler, forthcoming. Do not cite or distribute.
0.0
1.0
2.0
3.0
4.0
5.0
Con
go, R
epub
lic
Cot
e d'
Ivoi
re
Sou
th A
frica
Sen
egal
Mau
ritiu
s
Gha
na
Zim
babw
e
Com
oros
Ave
rage
Zam
bia
Sw
azila
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Ken
ya
Bur
kina
Fas
o
WH
O
Eth
iopi
a
Mal
i
Mal
awi
Cha
d
Mau
ritan
ia
Nam
ibia
Est
imat
ed N
umbe
r of H
ealth
Wor
kers
per
1,0
00 P
opul
atio
n R
equi
red
to A
chie
ve 8
0 P
erce
nt B
irth
Cov
erag
e
26University of
California, Berkeley
Overview
Forecast workforce shortages and surpluses
Estimate scaling-up costsIllustrate workforce and wage bill
shortages under different skill mixes
27University of
California, Berkeley
Components of scaling-up Human resources
Wage bill for health care professionals Wage bill for support staff Training
Other inputs Facilities Equipment Supplies Pharmaceuticals
28University of
California, Berkeley
Annual wage bill required to remove health worker shortage in Africa for 2015
Note: Numbers are based on rounded numbers.
Source: Scheffler et al., 2009 Health Affairs
Doctors($ billions)
Nurses & Midwives($ billions)
Total($ billions)
Need 1.3 2.3 3.6Supply 0.2 0.8 1.0
Incremental Costof additional workers 1.1 1.5 2.6
29University of
California, Berkeley
Annual wage bill required to remove health worker shortage in Africa for 2015 (millions $US 2007)
Changing the skill mix has the potential to reduce the wage bill costs
Notes: based on 12 non-African low- and middle-income countries with projected shortages in 2015; $1.8bn (USD 2007) shortfall. Preliminary results. Do not cite.
A
43University of
California, Berkeley
0%
5%
10%
15%
20%
25%
0% 50% 100% 150% 200%
Nurse:Doctor Ratio Increase
Red
uctio
n in
Wag
e Bi
ll Sh
orta
ge
0.9 0.8 0.7One nurse equals this number of doctors:
Wage bill reduction depends on relative productivity of workers
B
Notes: based on 12 non-African low- and middle-income countries with projected shortages in 2015; $1.8bn (USD 2007) shortfall. Preliminary results. Do not cite.
44University of
California, Berkeley
0%
5%
10%
15%
20%
25%
0% 50% 100% 150% 200%
Nurse:Doctor Ratio Increase
Red
uctio
n in
Wag
e B
ill S
horta
ge0% 10% 20%Percentage of Needed Nurses Replaced with CHW:
Adding CHW to the skill mix has an even greater potential to reduce wage bill
C
Notes: based on 12 non-African low- and middle-income countries with projected shortages in 2015; $1.8bn (USD 2007) shortfall. Assumes one nurse equals 0.8 doctors. Preliminary results. Do not cite.
45University of
California, Berkeley
Wage bill shortage is reduced under new skill mix, but varies by country (2007 $USD million)
Country Original New ReductionNepal 88 80 8.3%Djibouti 36 32 12.1%Yemen 119 107 9.7%Papua New Guinea 121 102 15.7%Haiti 26 23 11.0%Solomon Islands 2 2 10.5%Bangladesh 376 342 9.1%Vanuatu 1 1 12.5%Sudan 507 467 8.1%Samoa 3 2 14.4%Indonesia 544 391 28.1%Fiji 4 2 43.9% Total 1,827 1,552 15.1%
Assumes one nurse equals 0.8 doctors, nurse:doctor ratio increases 50%, and 20% of nurses are replaced with CHW. Preliminary results. Do not cite.
46University of
California, Berkeley
Implications of adjusting the skill mix
Substitute lower skilled workers for higher skilled
Reduce wage billReduce training costsReduce time to scale upNeed to maintain quality
47University of
California, Berkeley
Learning Objectives
Forecast workforce shortages and surpluses Estimate economic demand Forecast supply using a trendline Estimate requirements using different utilization
measures and controlling for country-level factors Estimate scaling-up costs
Wage bill Training Non-wage bill
Illustrate workforce and wage bill shortages under different skill mixes
48University of
California, Berkeley
Global Center for Health Economics and Policy Research (UC Berkeley) publications
Scheffler RM, Liu JX, Kinfu Y, Dal Poz MR. “Forecasting the Global Shortages of Physicians: An Economic- and Needs-based Approach.” The Bulletin of the World Health Organization 86, 2008:516-523. Available at: http://www.who.int/bulletin/volumes/86/7/07-046474.pdf
Scheffler, RM. Is There a Doctor in the House? Market Signals and Tomorrow’s Supply of Doctors. Palo Alto, Calif.: Stanford University Press, 2008.
Scheffler RM, Mahoney CB, Fulton BD, Dal Poz MR, Preker AS. “Estimates of Sub-Saharan Africa Health Care Professional Shortages by 2015,” Health Affairs 28, 2009: w849-w862.
Fulton BD, Scheffler RM, “Health Care Professional Shortages and Skill-Mix Options Using Community Health Workers: New Estimates for 2015,” forthcoming chapter in a book being published from papers selected from The Performance of National Health Workforce Conference, sponsored by World Health Organization, Neuchatel, Switzerland, October 2009.
Scheffler RM, Fulton BD, “Needs-Based Health Workforce Analysis: Methods and Empirical Estimates in Selected African Countries,” forthcoming chapter in HRH in Africa: A New Look at the Crisis, Washington, DC: The World Bank.
Questions?
End of Presentation
Back Up Slides
51University of
California, Berkeley
Millennium Development GoalsTargets for 2015
1. Halve extreme poverty and hunger2. Achieve universal primary education3. Eliminate gender education disparity4. Reduce child mortality by 2/35. Improve maternal health by 3/46. Halt and reverse the spread of HIV/AIDS7. Adopt national environmental sustainability
policies8. Develop and global partnership for development
52University of
California, Berkeley
Sample calculations for increasing nurse+midwife:doctor ratio