Future Financial Economics of Health Professional Education Proceedings of a Workshop (2017) / Chapter Skim
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2 Matching the Health Workforce to Population Needs
2 Matching the Health Workforce to Population Needs
Pages 9-38
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• Recognizing the importance of market forces within health labor and education markets is an essential step to aligning education investments to health systems' goals. (Araujo)
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The report explores the interactions between the markets for health care and for health workers, as well as the health professionals' education choices in the context of low- and middle-income countries. Araujo described the market forces that exist within the health labor market, describing the factors influencing the demand for and the supply of health workers (see Figure 2-1)
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Health systems performance FIGURE 2-1 Framework for analysis of health workers labor market dynamics. NOTE: ATP = ability to pay; HRH = human resources for health; HW = health worker; WTP = willingness to pay.
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He began to describe the conflicts, tensions, and imbalances between health care needs and demand, health professional training and supply, and demand and supply. FIGURE 2-2 The interaction between education and labor markets for health workers.
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. This report also projects a global demand shortage of 15 million health workers by 2030, maintaining the current patterns of demand and production of health workers (Liua et al., 2016)
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. Population Health Needs and Demand for Health Workers Araujo stated that owing to the market failures discussed, unregulated health labor markets are unlikely to move to an equilibrium, or a situation where needs, demands, and supply are matched.
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Araujo explained that in Brazil, the growth of private health insurance in the late 2000s boosted the demand for health workers in the country. Given the government's inability to expand the production of health workers quickly, there was a large expansion of private medical and nursing schools in the country (Scheffer and Dal Poz, 2015)
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He also pointed out that the spending is not focused where it needs to be in order to meet population health needs, as there are problems with student debt, cost of application, and faculty salaries. Health Workforce Supply and Health Workers' Training The production of health professionals is influenced by the availability of resources and the rate of return to education, as well as models of training, regulation, prestige, and quality of life.
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Looking at public and private education, it appears that the public education sector has not been able to meet the increased demand for health workers. The private education sector is growing, but it is still unable to meet the increasing demand, said Araujo.
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The growing size of student loans results in students more likely to seek jobs with higher salaries in order to pay back their loans. The Health Labor Market Imbalances Revisiting Figure 2-2, Araujo described the results of health labor market imbalances; specifically, imbalances between population health need and population health demand, between population health demand and health workforce supply, and between health workforce supply and health worker's training and careers (see Figure 2-4)
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The figure shows the FIGURE 2-5 Elements that affect the health workforce supply and demand. NOTE: This is an adaptation of an original work by the World Bank.
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Costs and Financing of HPE Araujo then turned to the financing of health professional education. He first noted that examining the cost and financing of health professional education is difficult because the data are not available in many countries (though the United States is in a privileged position in terms of data availability)
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. Araujo challenged participants to look forward to what the health labor market would look like in a situation with universal health coverage, and what changes in the health workforce and in HPE would be required.
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At the time of the study 1 Ghanaian cedi was equivalent to $1. The cost calculation is based on an average cost coming from the Ghana preinvestment study, coupled with the capital investment budget data from the Ministry of Education (National Council on Higher Education)
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• Step ladder career opportunities • Payment based on outcomes for career development to incentivize team-based • Competency-based curricula service delivery RESULTS IN… UHC WORKFORCE …a workforce that is adequate in number, appropriate in skill mix, evenly distributed and performing well FIGURE 2-7 Demand and supply of health workers with universal health coverage. NOTES: PHC = primary health care; UHC = universal health coverage.
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. • There should be concentrated efforts to generate more data on health workers' compensation, costs of training, and career choices.
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As shown in Figure 2-8, meeting the needs of the population is on one side of the model and health professions education is on the other. Between them are the supply and demand market forces described fully by Araujo.
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FIGURE 2-9 A detailed look at a model for financing HPE. NOTE: HCW = health care workforce; ROI = return on investment.
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Guiding Principles Fraher then called the participants' attention to the one-page document found in Appendix B of this Proceedings of a Workshop. As a contributing author, she recapped the guiding principles in the document that represent what the authors believe is an ideal for what a well-designed health professions educational system would be founded on.
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Such constrained resources are forcing health system leaders, employers, and governments to rethink their social and financial returns on investments for financing health professional education. This, said Fraher, is shifting the cost burden from the public sector
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As Araujo mentioned, the world invests less than 2 percent in health professional education (Frenk et al., 2010)
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While financially advantageous, they may be contributing to the oversupply of health workers. This statement led to a related observation by another participant on the issue of duplication within HPE that is unnecessarily driving up costs.
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EXPLICATING A MODEL FOR FINANCING HPE Warren Newton, American Board of Family Medicine Newton began by directing the audience back to the model in Figure 2-8 that asks whether and how the health labor market mediates the translation of population health needs to the actual health professions workforce and career choices. He then turned to the guiding principles in Box 2-1 and in
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Are these the correct guiding principles of the health professional education finance system? If not, what should be added and deleted, and why?
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MATCHING THE HEALTH WORKFORCE TO POPULATION NEEDS 33 TABLE 2-2 Continued Respondent Affiliation Comments Mary Beth Bigley Health Resources • Being responsive to society's needs and Services involves offering cost-effective care so Administration the principles should consider who can provide a function at the lowest cost • Missing from the list is interprofessional practice that emphasizes team-based care models Zohray Talib The George • Change from passive thinking with Washington the word responsive to a more active University concept like accountable to society • Diversity in the community or society is missing from the guiding principles • The guiding principles should include flexibility so they are adaptable, that differs from nimbleness, indicating the rapidity of change Susan Scrimshaw The Sage Colleges • Who speaks for society? The guiding principles need to include the community voice as well as the analytics from a macrolevel to better understand the full breadth of society's needs Joanne Spetz University of • Being responsive to society means California, San knowing what society wants, which Francisco will vary depending on the context • Countries or health systems where health care is a human right will drive different guiding principles than in places where health care is not a human right but part of a business model • Include sustainable as a principle for financing*
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Respondent Affiliation Comments Mary Barger American College of • Add commercial lenders, Nurse-Midwives philanthropists, and policy makers • Include policy makers who can influence loan repayment programs Mary Beth Bigley Health Resources • Breakdown the list of employers and and Services specify pharmaceutical companies who, Administration as major drivers of the system, send signals to learners and health workers • Callout additional groups such as the U.S. Department of Defense and the U.S.
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MATCHING THE HEALTH WORKFORCE TO POPULATION NEEDS 35 TABLE 2-3 Continued Respondent Affiliation Comments Robert Smith Health Education • Differentiate between the HPE faculty England and members and the leadership, because they have a different set of drivers and personal investments • Separate patients from communities • Consider the wider business community and their reliance on the health system as well as the families of the learners Joanne Spetz University of • Disaggregate communities that are made California, San up of many different groups that have Francisco very different needs from patients • Include a wide range of educational institutions from the private, for-profit colleges to faith-based to prestigious universities, all of which have different influences on the system • Use the term political players rather than policy makers, meaning that what is said by a politician may be different from what a government agency or ministry had in mind • Think in an international context -- learners are often crossing international boundaries to pursue education, and employers may look internationally for locating a business • Include employers who at times fund education of their workers and the delivery of health care Zohray Talib The George • Unpack the learner group to specify Washington potential learners, future learners, and University existing learners • Include an investors' category that brings out various types of investors like entrepreneurs, impact investors, lenders, insurance companies, and local cooperatives of community-based health financers Workshop participant Unknown • Include the public as an actor to move away from a disease-based approach, and be inclusive of those people that are healthy
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2016. Addressing the challenges of health professional education: Opportunities to accelerate progress towards universal health coverage.
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2013. Cost and value in healthcare professional education -- why the slow pace of change?
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