Building the bridge: Can we afford it?
Building the bridge: Can we afford it?
On face value, it would seem certain that a 22 to 29 percent shortage of healthcare workers in developed countries would signal that healthcare systems are set to suffer from a massive shortfall of qualified healthcare professionals. However, while these numbers seem threatening, there are a number of potential policy measures available that could increase the number of professionals and significantly close the gap.
The most obvious relates to the setting of retirement ages and the number of hours worked per year which differs greatly among OECD countries. Indeed, if all countries shared Japan’s high retirement age and Greece’s work hours, OECD countries could, in theory, enjoy a 35 percent gain in total labor capacity (see Figure 3). Another policy-level measure that could help close the gap lies in increasing female participation rates. Differences between OECD countries are substantial, and could represent a 10 percent labor capacity gain if the average OECD country achieved Northern European standards on female participation.
Significant variances between OECD countries also emerge when comparing the size of the total healthcare workforce as a share of total employment. While the average rate for the OECD countries is currently 10 percent, there are significant differences across the board: Greece has one of the lowest participation rates with just five percent of the total workforce employed in the healthcare field, whereas in Norway, 20 percent of total workers are healthcare employees. If all OECD countries would achieve the rates of Norway, we would see a 100 percent capacity increase as participation rates move from 10 to 20 percent. As can be seen in Figure 4, the combination of these policy measures could result in an almost 300 percent increase in the healthcare workforce.
The point here is not to argue that a 300 percent increase in healthcare workforce is realistically possible. We cannot maximize all policy levers at the same time (even if we wanted to): Greece’s long working hours, for example, are partly caused by low female participation in the Greek economy. In addition, maximizing all these levers may not work wonders on the productivity of the overall workforce available. The point here, however, is that in the light of this, overcoming the potential gap of 22 to 29 percent is not unfeasible. The core question is whether we can afford it.
While a dramatic shortage of healthcare professionals may not fully materialize, it is clear that health systems cannot afford to keep throwing money at the problem. This will force a radical change in the way we approach ‘the workforce challenge’. In the developing world, the problem is even more severe; the WHO estimates that some 60 African and Asian countries will face a critical shortage of healthcare workers but will not have the economies to allow them to spend their way out.
The simple truth is that to meet this challenge there really is only one solution: to make substantial improvements in the productivity and capacity of the healthcare workforce. This is, in our opinion, the only way that countries can simultaneously reduce the cost of healthcare and the need for more healthcare workers. In our global search for best practices, we found a number of providers that have been able to increase the productivity of their professionals, while also improving the quality of care and the attractiveness of the work. By broadly applying the lessons provided by these (sometimes surprising but equally inspiring) examples from around the world, we believe healthcare systems can develop a truly sustainable route to addressing the global workforce challenge.
Labor shortages: demography is not destiny
Most experts agree that the labor market is dynamic, involving dozens of moving pieces that interact together to affect economic growth and the labor supply. It is far from a simple equation that measures the number of available jobs against the available workforce. Indeed, by focusing solely on the number of jobs and the number of workers, one risks ignoring important complexities, such as the changing levels of immigration, the retirement age and productivity. Simply put, demography is not destiny and the number of potential workers in each age bracket is only one potential factor in the complex equation that determines the supply of available labor.
Labor shortages in developing countries
Our research shows that the predicted shortages of healthcare professionals will probably not materialize in OECD countries, assuming they have the funds to ‘spend their way out’. However, according to estimates by the World Health Organization (WHO), many developing countries now face severe shortages of healthcare professionals and, as a result, the provision of essential health services is at risk. Clearly, funding is a major challenge and, while increasing the productivity of the existing workforce will be a key objective for those countries, even more imaginative solutions are going to be needed if the developing world hopes to bridge the potential workforce gap.
Importing workforce from overseas
Although the quantity of personnel available in any given country is largely dependent on national labor market conditions, there are a number of examples of countries importing large numbers of healthcare professionals from other countries to close the workforce gap. However, if one were to examine global healthcare labor markets, it seems clear that importing healthcare personnel is not the most desirable way to deal with a national labor shortage (Crisp 2010). Importing healthcare professionals only relocates the potential labor shortage in healthcare, often to less developed countries where wages are lower. Importing personnel from less developed countries also means taking highly educated people away from countries that may have struggled to pay for their education in the first place.