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Opportunities for, and implications of, skill mix changes in health care pathways: Pay, productivity and practice variations in a needs-based planning framework

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  • Birch, Stephen
  • Gibson, Jon
  • McBride, Anne

Abstract

Health workforce planning is traditionally based on demographically-driven ‘silo-based’ models in which future requirements for particular health professions are determined by applying estimates of the future population to the existing population-based level of workforce supply. Estimates of future workforce requirements are focused on, and constrained by population size and requirements increase monotonically. Key failures of existing models include (1) lack of integration between planning the health care workforce, health care services and health care funding and (2) lack of integration between planning different health care inputs and the potential for substitution between inputs. Hence planning models fail to incorporate emerging developments in healthcare delivery and workforce change. We present an integrated needs-based framework for health workforce planning and apply the framework using data from nine European countries to explore the workforce and financial implications of re-configuring the delivery of care through changes in the allocation of treatment tasks between health care professions (skill mix). We show that cost consequences depend not only on pay differences. Instead, workforce planning in rapidly changing workforce environments must consider and incorporate between-provider group differences in productivity (the number of patients that are served per fixed period of time) and practice style (the number and mix of tasks used in providing care to the same type of patient).

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  • Birch, Stephen & Gibson, Jon & McBride, Anne, 2020. "Opportunities for, and implications of, skill mix changes in health care pathways: Pay, productivity and practice variations in a needs-based planning framework," Social Science & Medicine, Elsevier, vol. 250(C).
    • Handle: RePEc:eee:socmed:v:250:y:2020:i:c:s0277953620300824
    DOI: 10.1016/j.socscimed.2020.112863
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    References listed on IDEAS

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    1. Maier, Claudia B. & Batenburg, Ronald & Birch, Stephen & Zander, Britta & Elliott, Robert & Busse, Reinhard, 2018. "Health workforce planning: which countries include nurse practitioners and physician assistants and to what effect?," Health Policy, Elsevier, vol. 122(10), pages 1085-1092.
    2. Kroezen, Marieke & Van Hoegaerden, Michel & Batenburg, Ronald, 2018. "The Joint Action on Health Workforce Planning and Forecasting: Results of a European programme to improve health workforce policies," Health Policy, Elsevier, vol. 122(2), pages 87-93.
    3. Stephen Birch & George Kephart & Gail Tomblin-Murphy & Linda O'Brien-Pallas & Rob Alder & Adrian MacKenzie, 2007. "Human Resources Planning and the Production of Health: A Needs-Based Analytical Framework," Canadian Public Policy, University of Toronto Press, vol. 33(s1), pages 1-16, January.
    4. 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.
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    2. James Avoka Asamani & Christmal Dela Christmals & Gerda Marie Reitsma, 2021. "Advancing the Population Needs-Based Health Workforce Planning Methodology: A Simulation Tool for Country Application," IJERPH, MDPI, vol. 18(4), pages 1-20, February.
    3. Lenzen, Sabrina & Birch, Stephen, 2023. "From population numbers to population needs: Incorporating epidemiological change into health service planning in Australia," Social Science & Medicine, Elsevier, vol. 328(C).
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