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Health workforce development in the European Union: A matrix for comparing trajectories of change in the professions


  • Pavolini, Emmanuele
  • Kuhlmann, Ellen


This article assesses professional development trajectories in top-, middle- and basic-level health workforce groups (doctors, nurses, care assistants) in different European Union countries using available international databases. Three theoretical strands (labour market, welfare state, and professions studies) were connected to explore ideal types and to develop a matrix for comparison. With a focus on larger EU-15 countries and four different types of healthcare systems, Germany, Italy, Sweden and the United Kingdom serve as empirical test cases. The analysis draws on selected indicators from public statistics/OECD data and micro-data from the EU Labour Force Survey. Five ideal typical trajectories of professional development were identified from the literature, which served as a matrix to compare developments in the three health workforce groups. The results reveal country-specific trajectories with uneven professional development and bring opportunities for policy interventions into view. First, there is a need for integrated health labour market monitoring systems to improve data on the skills mix of the health workforce. Second, a relevant number of health workers with fixed contracts and involuntary part-time reveals an important source for better recruitment and retention strategies. Third, a general trend towards increasing numbers while worsening working conditions was identified across our country cases. This trend hits care assistants, partly also nurses, the most. The research illustrates how public data sources may serve to create new knowledge and promote more sustainable health workforce policy.

Suggested Citation

  • Pavolini, Emmanuele & Kuhlmann, Ellen, 2016. "Health workforce development in the European Union: A matrix for comparing trajectories of change in the professions," Health Policy, Elsevier, vol. 120(6), pages 654-664.
  • Handle: RePEc:eee:hepoli:v:120:y:2016:i:6:p:654-664
    DOI: 10.1016/j.healthpol.2016.03.002

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    References listed on IDEAS

    1. Vicarelli, Giovanna & Pavolini, Emmanuele, 2015. "Health workforce governance in Italy," Health Policy, Elsevier, vol. 119(12), pages 1606-1612.
    2. Glinos, Irene A., 2015. "Health professional mobility in the European Union: Exploring the equity and efficiency of free movement," Health Policy, Elsevier, vol. 119(12), pages 1529-1536.
    3. Kuhlmann, Ellen & Larsen, Christa, 2015. "Why we need multi-level health workforce governance: Case studies from nursing and medicine in Germany," Health Policy, Elsevier, vol. 119(12), pages 1636-1644.
    4. Maier, Claudia B., 2015. "The role of governance in implementing task-shifting from physicians to nurses in advanced roles in Europe, U.S., Canada, New Zealand and Australia," Health Policy, Elsevier, vol. 119(12), pages 1627-1635.
    5. Kroezen, Marieke & Dussault, Gilles & Craveiro, Isabel & Dieleman, Marjolein & Jansen, Christel & Buchan, James & Barriball, Louise & Rafferty, Anne Marie & Bremner, Jeni & Sermeus, Walter, 2015. "Recruitment and retention of health professionals across Europe: A literature review and multiple case study research," Health Policy, Elsevier, vol. 119(12), pages 1517-1528.
    6. Barbazza, Erica & Langins, Margrieta & Kluge, Hans & Tello, Juan, 2015. "Health workforce governance: Processes, tools and actors towards a competent workforce for integrated health services delivery," Health Policy, Elsevier, vol. 119(12), pages 1645-1654.
    7. Oesch, Daniel & Rodriguez Menes, Jorge, 2010. "Upgrading or polarization? Occupational change in Britain, Germany, Spain and Switzerland, 1990-2008," MPRA Paper 21040, University Library of Munich, Germany.
    8. Yuko AOYAMA & Manuel CASTELLS, 2002. "An empirical assessment of the informational society: Employment and occupational structures of G-7 countries, 1920–2000," International Labour Review, International Labour Organization, vol. 141(1-2), pages 123-159, March.
    9. Tomoko Ono & Gaétan Lafortune & Michael Schoenstein, 2013. "Health Workforce Planning in OECD Countries: A Review of 26 Projection Models from 18 Countries," OECD Health Working Papers 62, OECD Publishing.
    10. Tsiachristas, A. & Wallenburg, I. & Bond, C.M. & Elliot, R.F. & Busse, R. & van Exel, J. & Rutten-van Mölken, M.P. & de Bont, A., 2015. "Costs and effects of new professional roles: Evidence from a literature review," Health Policy, Elsevier, vol. 119(9), pages 1176-1187.
    11. Correia, Tiago & Dussault, Gilles & Pontes, Carla, 2015. "The impact of the financial crisis on human resources for health policies in three southern-Europe countries," Health Policy, Elsevier, vol. 119(12), pages 1600-1605.
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    Cited by:

    1. Palese, Alvisa & Grassetti, Luca & Bandera, Davide & Zuttion, Ranieri & Ferrario, Barbara & Ponta, Sandra & Hayter, Mark & Watson, Roger, 2018. "High feeding dependence prevalence in residents living in Italian nursing homes requires new policies: Findings from a regionally based cross-sectional study," Health Policy, Elsevier, vol. 122(3), pages 301-308.
    2. Pütz, Robert & Kontos, Maria & Larsen, Christa & Rand, Sigrid & Ruokonen-Engler, Minna-Kristiina, 2019. "Betriebliche Integration von Pflegefachkräften aus dem Ausland: Innenansichten zu Herausforderungen globalisierter Arbeitsmärkte," Study / edition der Hans-Böckler-Stiftung, Hans-Böckler-Stiftung, Düsseldorf, volume 127, number 416.


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