NEUJOBS WP12 Health care, goods and services for an ageing population

Impact of demographic change on health care workforce

Presentation at the 2nd NEUJOBS Validation Event Employment 2025: How will multiple transitions affect the European labor market?

9th April 2014 at IZA Bonn

Dr. Erika Schulz, DIW

OBJECTIVES

Analyse the impact of socio-ecological transition, in particular the ageing of the population, on employment in health care sector taking into account the

framework assumptions defined in the two scenarios tough and friendly (WP1: SET),

results of the NEMESIS model for employment and growth in total and in non-market services (WP9: Economic and employment development)

two demographic scenarios tough and friendly (WP10)

Detailed analyses have been carried out for five countries:

Denmark, Germany, Italy, Poland, and Slovakia

Participants

DIW Berlin DR. ERIKA SCHULZ AND DR. JOHANNES GEYER responsible for DE and DK

SAVBA DR. MAREK RADVANSKÝ AND GABRIELA DOVÁĽOVÁ responsible for SK

CASE Prof. DR. STANISŁAWA GOLINOWSKA, DR. EWA KOCOT, AND DR. AGNIESZKA SOWA,

responsible for PL

CeRP DR. FLAVIA CODA MOSCAROLA (subcontract CeRP) responsible for IT

Health care - Tasks

A Current employment situation in EU countries and detailed analyses in selected countries (DE, DK, PL, SK, IT)

B Impact of ageing on the demand for health care services and its workforce (status-quo-projection for selected countries)

C Impact of changes in health workforce supply (selected countries)

D Employment and expected gap in the health care labour market (selected countries)

Share of employment in sector Q ‚human health and social work‘ (%)

2011: 23 mio. in EU27 - 10.4% of total employment

2000 – 2011: 5 mio. new jobs, thereof 1.5 million during the crisis (2008 -2011).

Source: EU LFS

4

6

8

10

12

14

16

18

20

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Denmark

Germany

EU27

Italy

Poland

Slovakia

Human health and social work (Q)

Human health (Q86) Residential care (Q87)

Social work activities without accommodation (Q88)

Hospital activities

Medical and dental practice activities

Other human health activities

Overview sector Q

Share of subsectors Q86, Q87, and Q88 (%)

12.4 mio. (EU27), 5.1 mio. (selected countries) employed in human health

75% female employment

32% elderly employment (50+); 18 % (55+)

0,37

0,58 0,590,68

0,75 0,76

0,24

0,20 0,230,17

0,13 0,100,39

0,22 0,18 0,16 0,12 0,13

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

DK EU27 DE SK IT PL

Social work activities without accommodation

Residential care activities

Human health activities

Source: EU LFS

2011

More than half of health care workforce is employed in hospitals

Institutional and ambulatory health care 2010

High share of elderly employment in ambulatory care (22%)

Alarming signal: share of elderly practising physicians (55+) in DK 31.8%, DE 39.5%, IT 42.2% and SK 33.5%

6050

63 6168

57

31

31

27 2820

23

919

11 11 1220

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Denmark Germany Italy Poland Slovakia EU27*

Other human health activities

Medical and dental practice activities

Hospital activities

Changes in population size and age-structure

Increase in the number of elderly

and oldest old

Decline in working-age population

Impact on the demand for services

+ employees

Impact on the supply of health care

workforce

Impact of demographic change

Demand

Preferred Methods

Supply

Utilisation approach-Hospital admissions, length of stay-Contacts to doctors-Other services-Combined with popu- lation projections (tough and friendly scenarios)

Top down approach-Estimation of total labour force (WP10)-Estimation of employment and growth by sectors (WP9)-Calculation for subsectors

Estimation of future demand and supply

Data on utilization of hospital services are available for all selected countries; limited availability of data on utilization of ambulatory care services. Data from population surveys or insurance funds.

Hospital care Ambulatory care

DenmarkNational Patient Register published by National Statistical Office

National Statistical Office based on data collected by regions

GermanyHospital Diagnosis Statistics published by National Statistical Office

Data on health care utilization of insurants of one Social Health Insurance Funds (Barmer GEK)

Rehabilitation Diagnosis Statistics published by National Statistical office

ItalyEurostat data based on statistics of the Ministry of Health in Italy

Survey data collected by National Statistical Office every 5 years

PolandEurostat data based on statistics of the Central Statistical Office GUS: Health and Health care in 2010;

EHIS European health Information Survey

SlovakiaEurostat data based on statistics of the National Health Information Center

EHIS European health Information Survey

Source: Compilation by DIW Berlin.

Data sources (demand)

Utilization of hospital services

Utilization = number of patients and average length of stay by age-groups and gender

Past trends: increase in inpatients, but decline in length of stay

0

2

4

6

8

10

12

14

Day

s

Length of hospital stay of inpatients in 2010

Germany

Denmark

Italy

PolandSlovakia

Changes in hospital utilization – pure demographic effect

Hospital care I

2010tough friendly tough friendly tough friendly

Denmark 5 5 5 1 1 12 19Germany 146 148 160 2 15 2 10Italy 59 66 72 7 13 12 21Poland 47 48 51 1 5 3 10Slovakia 8 9 10 1 1 10 17

2025

Total hospital days in million

Source: Results of country reports Schulz 2013b; Schulz 2013c; Coda Moscarola 2013; Golinowska et al 2013; Radvanský 2013.

changes 2025/2010

in %

Changes in hospital utilization – trend extrapolation in prevalence and length of stay

Hospital care II

2010tough friendly tough friendly tough friendly

Denmark* 5 4 4 -1 -1 -18 -12Germany** 146 108 117 -38 -29 -26 -20Poland** 47 43 46 -4 -1 -8 -2Slovakia*** 8 8 8 0 0 -5 1*) Half of past annual average growth rate in length of stay; half of past annual growth rate in prevalence rates.**) Trend of annual average growth rate in length of stay; half of past annual growth rate in prevalence rates.***) Trend of annual average growth rate in length of stay; trend of past annual growth rate in prevalence rates.Source: Results of country reports Schulz 2013b; Schulz 2013c; Golinowska et al 2013; Radvanský 2013.

2025

Total hospital days in million

changes 2025/2010

in %

Changes in hospital employment – constant utilization rates

2010tough friendly tough friendly tough friendly

Denmark 115 126 133 11 18 9.6 15.7Germany 1121 1138 1232 17 111 1.5 9.9Italy* 613 668 715 55 102 9.0 16.6Poland 211 213 227 2 16 0.9 7.6Slovakia 65 78 80 13 15 20.0 23.1*) Personnel of hospitals and ambulatories (no extraction of hospital staff possible)

2025 changes 2025/2010

in 1,000 persons in %

Source: Results of country reports Schulz 2013b; Schulz 2013c; Coda Moscarola 2013; Golinowska et al 2013; Radvanský 2013.

Hospital employment

Available utilization data on ambulatory care

GPs Specialists Dentists otherDenmark X X X XGermany* (X) (X) X someItaly** X (X) X somePoland X X X -Slovakia X X X -*) GPs and specialists; prescription of therapeutical measures, drugs, medical aids as dummies for utilization of other ambulatory care providers. **) Specialists working in hospitals and ambulatory care facilities. Other areas: rehabilitation measures, first aids, diagnostic examinations.Source: Results of country reports Schulz 2013b; Schulz 2013c; Coda Moscarola 2013; Golinowska et al 2013; Radvanský 2013.

Utilization of ambulatory services

Changes in the number of doctor‘s and dentist‘s consultations between 2010 and 2025 in %

GPs Specialists Dentists GPs Specialists Dentists

Denmark* 5.9 5.0 4.0 10.6 8.8 7.0Germany** -2.9 -6.9 3.6 -1.8Italy 4.7 6.8 1.0 10.9 12.5 6.4Poland -0.2 -0.3 -8.5 6.1 5.0 -4.0Slovakia 4.3 4.9 -2.1 9.6 10.2 2.6*) Dental care for adult persons (children are treated by dentists employed by the municipality).**) Doctors' consultations in total (GPs and specialists)Source: Results of country reports Schulz 2013b; Schulz 2013c; Coda Moscarola 2013; Golinowska et al 2013; Radvanský 2013.

tough scenario friendly scenario

Demand for ambulatory health workforce

Changes in the demand for workforce in offices of doctors and dentists between 2010 and 2025 in %

tough friendlyDenmark* 5.0 8.8Germany -4.2 1.8Italy** 1.5 7.8Poland -1.7 3.7Slovakia 5.2 11.9*) Only GPs and dentists.**) GPs, paediatricians; dentists.Source: Results of country reports Schulz 2013b; Schulz 2013c; Coda Moscarola 2013; Golinowska et al 2013; Radvanský 2013.

Health care workforce supply

Population in working age: based on demographic scenarios tough and friendly by education levelChanges in male and female activity rates by education level: based on EU LFS for males, females and age-groups by education level, time series 2000 to 2011.Changes in total labour supply: population combined with (a) constant and (b) increasing activity ratesComparison with the NEMESIS results for labour supply – problem different accounting methods between NA and LFS NEMESIS results for employment in non-market services, own calculation of the development in health care employment using constant share of sector Q86, Q87+88 in non-market services

Changes in total labour force – comparing own calculations and NEMESIS results

Labour supply

2010 2010 changes 2025/10LFS tough friendly tough friendly NA tough friendly

in millions in millions

Denmark 2.9 -0.3 1.9 1.6 4.0 3.0 -0.6 2.0Germany 41.8 -13.4 -8.3 -4.4 0.8 43.6 -5.6 -0.4Italy 25.0 -0.1 4.3 2.3 6.6 26.8 3.7 9.7Poland 18.1 -7.0 -2.5 -6.9 -2.4 17.6 -0.5 4.4Slovakia 2.7 -4.3 -0.5 -1.2 2.6 2.5 0.1 4.7Total 90.6 -7.8 -3.1 -2.8 1.9 93.5 -1.7 3.6Source: Huisman et al, 2013.; LFS; Boitier et al., 2013: NEMESIS results; calculation of DIW Berlin.

in %constant

changes 2025/2010 in %

increasingactivity rates

Employment by sectors – changes 2025/2010 in %

Country totalNon market

services

Health care and social work (Q)*

Human health (Q86)*

Residential care and

social work (Q87+88)*

Denmark 0.0 6.6 6.6 6.6 6.6Germany -8.5 -2.1 -8.6 -12.7 -2.7Italy -1.3 -17.7 -17.7 -17.7 -17.7Poland -3.3 9.9 9.9 9.9 9.9Slovakia 3.9 0.9 0.9 0.9 0.9total -4.9 -3.7 -7.1 -9.6 -3.0

Denmark 3.9 12.9 12.9 12.9 12.9Germany 0.4 17.4 11.8 5.4 20.9Italy 8.7 -0.3 -0.3 -0.3 -0.3Poland 5.1 28.1 28.1 28.1 28.1Slovakia 11.7 18.8 18.8 18.8 18.8total 4.1 14.5 11.3 7.9 17.1*) Estimation of DIW Berlin with the exception of Germany.

Changes in employment 2015/2010 in %

tough scenario

friendly scenario

Source: Boitier, B., Lancesseur, N. and Zagamé, P. "Global scenarios for European socio-ecological transition", NEUJOBS Deliverable D9.2, 2013, for scenarios results; calculations of DIW Berlin.

Estimated changes in the demand and supply of health care workforce 2025/2010 in %

Comparing demand and supply I

Demand Supply Demand SupplyDenmark 8.2 6.6 13.4 12.9Germany -1.3 -12.7 5.7 5.4Italy 8.5 -17.7 15.8 -0.3Poland -0.1 9.9 6.4 28.1Slovakia* 14.6 0.9 19.2 18.8*) The high change in demand can be partly traced back to the significant increase in hospital staff between 2010 and 2011.

Source: Calculation of DIW Berlin based on the supply side projections of the NEMESIS model and on the country specific variations in the demand for health personnel.

Friendly scenarioTough scenario

Comparing demand and supply II

-20

-15

-10

-5

0

5

10

15

20

25

30

Denmark Germany Italy Poland Slovakia*

In %

Changes in health care workforce demand and supply in %

Tough scenario DemandTough scenario SupplyFriendly scenario DemandFriendly scenario Supply

Summary and conclusions

• The pure demographic effect is expected to lead to high imbalances on the health care market in particular in Germany, Italy, and Slovakia in the tough scenario, and in Italy also in the friendly scenario.

• Other factors influencing demand which could not be taken into account:

• New medical and pharmaceutical treatments • Changes in health status, e.g. due to socio-ecological

transition• Changes in health behaviour• Factors influencing the health workforce supply: • Intensifying international recruitment strategies• Changing working conditions• Changes in health care organisation (patient-centred

care)