The Joint Action on Health Workforce Planning and Forecasting: Results of a European programme to improve health workforce policies

Health workforce (HWF) planning and forecasting is faced with a number of challenges, most notably a lack of consistent terminology, a lack of data, limited model-, demand-based- and future-based planning, and limited inter-country collaboration. The Joint Action on Health Workforce Planning and Forecasting (JAHWF, 2013–2016) aimed to move forward on the HWF planning process and support countries in tackling the key challenges facing the HWF and HWF planning. This paper synthesizes and discusses the results of the JAHWF. It is shown that the JAHWF has provided important steps towards improved HWF planning and forecasting across Europe, among others through the creation of a minimum data set for HWF planning and the ‘Handbook on Health Workforce Planning Methodologies across EU countries’. At the same time, the context-sensitivity of HWF planning was repeatedly noticeable in the application of the tools through pilot- and feasibility studies. Further investments should be made by all actors involved to support and stimulate countries in their HWF efforts, among others by implementing the tools developed by the JAHWF in diverse national and regional contexts. Simultaneously, investments should be made in evaluation to build a more robust evidence base for HWF planning methods.     

Mobile medics? The mobility of doctors in the European Economic Area

The Treaty of Rome seeks to generate a common European market whereby all barriers to the free movement of produce, capital, services and labour are removed. Current EU policy on the free movement of labour requires that healthcare workers, who are EU citizens and meet certain training criteria, have the right to register to practice in member states other than the one in which they trained. This policy is underpinned by the EEC Directives. For example, the Medical Directive 93/16/EEC describes the framework for the mutual recognition of medical diplomas, certificates and other evidence of qualifications through out the European Economic Area (EEA). The potential impact of this for health policy is clear-workforce planning and the demand for doctors, (and also nurses and other health care professionals), could be particularly affected by new forces impacting on their supply. This paper reports on the reality of labour mobility today, and on the factors upon which mobility depends, by the means of a case study which, investigated the movement into UK of doctors from the EEA. At a formal level there is mutual recognition of diplomas, certificates and other evidence of qualifications. However, formal and 'real life' recognition could be in tension equating in policy terms to an implementation deficit. As a result, there is a 'mixed picture' which makes predicting the future (both for individual countries and for the European Union) even more difficult. Furthermore, different policy objectives have to be reconciled. Do we want high mobility; or do we want to preserve national manpower planning?     

欧洲国家健康水平的关键影响因素分析——基于欧洲36个国家的定性比较分析(QCA)

国家健康水平受多个健康的社会决定因素共同影响。通过收集36个欧洲国家健康水平的相关数据,展示欧洲国家间健康不平等的差异,运用定性比较分析（QCA）,旨在探究对于国家健康水平而言,哪些是核心影响条件,哪些因素共同作用及如何作用于健康水平。研究发现,欧洲地区经济发达的国家健康水平更高,风险、质量（效用）、卫生经济和卫生可及性这四个维度共同影响健康总体水平,在诸多指标中找出四个关键指标分别代表四个维度,包括成人饮酒量（-）、可避免死亡人数（-）、人均卫生支出（+）和未被满足的健康需求（-）,前三个指标所代表的三个维度对于健康水平的影响是核心条件,高于欧盟平均健康水平的国家,在质量（效用）维度全部优于欧盟平均水平,而其他三个维度相较于欧盟平均水平而言情况各异。从实现更好的国家健康水平的影响因素两条组合路径来看,高支出和高质量作为核心条件的类型组合,比低风险和高质量作为核心条件的类型组合所代表的国家案例略多。欧洲的证据可以为发展中国家实现健康跨越式发展提供发展经验,并对我国区域间健康均等化发展提供有益借鉴。     

Higher education in health promotion in Europe: a comparative analysis of master's level training programmes using HP-Source.net

This report summarises opportunities in Europe for master's degree level training in health promotion. Using data available at www.HP-Source.net, 105 study programmes at 71 institutions, spread over 20 European countries, were identified that include health promotion as a main subject. The programmes were analysed along a number of dimensions, including title, learning objectives, curricula, learning and teaching methods, entry requirements, duration, accreditation, language(s) of instruction and participation in European educational structures. The present analysis reveals great diversity along all these dimensions, but also several clusters of programmes that offer quite similar education in health promotion. Of special interest is the range of options available in Europe for length of study, ranging from one to two years, with part-time as well as full-time options.     

Social inequalities in 'sickness': European welfare states and non-employment among the chronically ill

The aim of this paper is to examine educational inequalities in the risk of non-employment among people with illnesses and how they vary between European countries with different welfare state characteristics. In doing so, the paper adds to the growing literature on welfare states and social inequalities in health by studying the often overlooked 'sickness'-dimension of health, namely employment behaviour among people with illnesses. We use European Union Statistics on Income and Living Conditions (EU-SILC) data from 2005 covering 26 European countries linked to country characteristics derived from Eurostat and OECD that include spending on active labour market policies, benefit generosity, income inequality, and employment protection. Using multilevel techniques we find that comprehensive welfare states have lower absolute and relative social inequalities in sickness, as well as more favourable general rates of non-employment. Hence, regarding sickness, welfare resources appear to trump welfare disincentives.     

Health differences between European countries

This paper examines self-reported health among individuals in 21 European countries. The purpose is to analyze how both individual- and country-level characteristics influence health. The study is based on data from the European Social Survey (ESS) conducted in 2003 and employs hierarchical modelling (N=38,472). We present three main findings: (1) individual-level characteristics, such as age, education, economic satisfaction, social network, unemployment, and occupational status are related to the health of individuals, both for women and men; (2) we tested how societal features, such as public expenditure on health, socioeconomic development, lifestyle, and social capital (social trust) were related to subjective health. Among the country-level characteristics, socioeconomic development, measured as GDP per capita (logarithm), is the indicator that is most strongly associated with better health, after controlling for individual-level characteristics; (3) the eastern European countries stand out as the countries where individuals report the poorest health. In our models, the individual-level variables explain 60% of the variance between countries, whereas 40% is explained by the macro-level variables.     

Volunteering and mutual aid in health and social care in the Czech Republic as an example of active citizenship

This article informs about recent research findings on voluntary and mutual aid in the Czech Republic with a special attention paid to formal volunteering in health and social care. The data suggest that public involvement is comparable to middle-frequency experienced in European countries. In this respect, volunteering is higher in the Czech Republic than in other former Eastern European countries and is an evidence of a successful and rapid restoration of the civic sector. New patterns of volunteering featured by planning, coordination, and contracting have spread out being strongly supported by national and EU policy measures. Managerial patterns of volunteering are dominating in health and social care institutions. Volunteering in health and social care is firmly motivated by emotional altruism; however, reciprocal (instrumental) and normative motivations are also present, though to a lesser extent compared to other sectors of volunteer activities. In the managerial pattern of volunteering altruism is balanced with personal gains and benefits for those who volunteer. Volunteering is deeply embedded in a civic, humanitarian paradigm instead of a religious faith and duty.     

EQ-5D-3L Norms for the European Older Population: Country-Specific Norms for 15 European Countires Based on the Survey of Health,Ageing, and Retirement in Europe

ObjectivesThis study presents a country-specific 3-level version of EQ-5D population norms for the European older population.MethodsNorm data were obtained from the fourth wave of the Survey of Health, Ageing and Retirement in Europe, and determined, for each EQ-5D dimension, the EQ–visual analog scale (EQ-VAS) and EQ-5D index values by 7 age groups and sex for 15 European countries. The EQ-5D index values were calculated using the European VAS value set for all countries.ResultsData resulting from 50 013 older respondents (mean age 65.9 years, range 50-111 years, 55.6% women) revealed an increasing number of self-reported health problems on EQ-5D dimensions and decreasing EQ-VAS scores with increasing age and for women compared with men. There are notable differences between countries in terms of the age gradient, the proportion of respondents in full health, and sex. Across all age groups, problems with pain & discomfort are the most frequent (36%-73% any problems), whereas problems with self-care are the least frequent (3%-31% any problems). The mean EQ-VAS score is 71.2 and the mean European VAS score is 0.79.ConclusionsGiven the growing number of older adults and elderly people in Europe, these population norms provide a valuable source of reference data that can be used to compare older adults or patient subgroups to the average of the general elderly population in a similar age or sex group in 15 European countries. The index value results may be further used to assess the burden of disease across older European populations and to identify the unmet needs of targeted older patient populations.     

基于内容分析法的部分典型国家卫生规划政策研究

目的：基于内容分析法分析当前世界各国卫生规划关注的热点领域，并通过比较研究揭示其中的共性和差异，为我国的卫生规划提供借鉴。方法：基于WHO Country Planning Cycle Database，筛选时间跨度覆盖2019年及以后且语言为英文的国家卫生政策战略，选取其中15个国家的规划文件，提取相关关键词，运用UCINET 6软件计算点度中心度。结果：各国规划文件的关键词可归为基本理念、体制机制、卫生资源、卫生服务、健康相关因素和效果评估6个分析维度。发达国家卫生规划基本理念维度以及“循证政策制定”、“服务质量”和“可及性”的点度中心度较高；发展中国家卫生规划健康相关因素维度、卫生资源维度关键词点度中心度较高。结论：“健康”和“整合”的理念受到各国关注，评估是较被忽视的环节。发达国家的卫生规划更倾向于对主旨和基本理念的把控，强调基于循证理念的政策制定；发展中国家更注重合作，通过资源合理配置保障服务提供，减轻疾病负担。我国卫生规划兼具发达和发展中国家的特点，后期需重视循证支持，构建更整合的医疗卫生体系，重视规划实施的评估和反馈。     

Health and labour force participation of older people in Europe: What do objective health indicators add to the analysis?

This paper studies labour force participation of older individuals in 11 European countries. The data are drawn from the new Survey of Health, Ageing and Retirement in Europe (SHARE). We examine the value added of objective health indicators in relation to potentially endogenous self-reported health. We approach the endogeneity of self-reported health as an omitted variables problem. In line with the literature on the reliability of self-reported health ambiguous results are obtained. In some countries self-reported health does a fairly good job and controlling for objective health indicators does not add much to the analysis. In other countries, however, the results show that objective health indicators add significantly to the analysis and that self-reported health is endogenous due to omitted objective health indicators. These latter results illustrate the multi-dimensional nature of health and the need to control for objective health indicators when analysing the relation between health status and labour force participation. This makes an instrumental variables approach to deal with the endogeneity of self-reported health less appropriate.     

Institutions, health shocks and labour market outcomes across Europe

This paper investigates the relationship between health shocks and labour market outcomes in 9 European countries using the European Community Household Panel. Matching techniques are used to control for the non-experimental nature of the data. The results suggest that there is a significant causal effect from health on the probability of employment: individuals who incur a health shock are significantly more likely to leave employment and transit into disability. The estimates differ across countries, with the largest employment effects being found in The Netherlands, Denmark, Spain and Ireland, and the smallest in France and Italy. Differences in social security arrangements help to explain these cross-country differences.     

Generic Versus Specific Competencies of Entry-Level Public Health Graduates: Employers’ Perceptions in Poland,the UK,and the Netherlands

Constant changes in society and the public health domain force public health professionals into new roles and the development of new competencies. Public health professionals will need to be trained to respond to this challenge. The aim of this comparative study among Poland, the UK and the Netherlands is to identify competence needs for Master of Public Health graduates entering the labour market from a European perspective. A self-administered questionnaire was sent to employers in the three countries, rating the importance of competency in public health on a master’s level. In all three countries, interpersonal competencies, like team working and communication skills, are rated as highly important. However, employers in the UK and Poland generally rate public health specific competencies as much more important than their Dutch colleagues. It is concluded that while public health specific knowledge is providing a useful starting point for entry-level public health professionals, employers increasingly recognise the value of generic competencies such as communication and team working skills. The results suggest a stronger emphasis on teaching methods that encourage active learning and the integration of skills, which is crucial for enhancing graduates’ employability, and foster an open attitude to multidisciplinary working, which is essential in modern health care.     

The role of strategic health planning processes in the development of health care reform policies: a comparative study of Eritrea, Mozambique and Zimbabwe

This paper reports on comparative analysis of health planning and its relationship with health care reform in three countries, Eritrea, Mozambique and Zimbabwe. The research examined strategic planning in each country focusing in particular on its role in developing health sector reforms. The paper analyses the processes for strategic planning, the values that underpin the planning systems, and issues related to resources for planning processes. The resultant content of strategic plans is assessed and not seen to have driven the development of reforms; whilst each country had adopted strategic planning systems, in all three countries a more complex interplay of forces, including influences outside both the health sector and the country, had been critical forces behind the sectoral changes experienced over the previous decade. The key roles of different actors in developing the plans and reforms are also assessed. The paper concludes that a number of different conceptions of strategic planning exist and will depend on the particular context within which the health system is placed. Whilst similarities were discovered between strategic planning systems in the three countries, there are also key differences in terms of formality, timeframes, structures and degrees of inclusiveness. No clear leadership role for strategic planning in terms of health sector reforms was discovered. Planning appears in the three countries to be more operational than strategic.     

Socioeconomic position in childhood and in adulthood and functional limitations in midlife: Data from a nationally-representative survey of French men and women

Research shows that lifetime socioeconomic circumstances are associated with adult health. Yet most studies to date have focused on mortality and additional data on morbidity outcomes are needed. Additionally, most research in this area has been conducted in Northern European countries or in the United States, and less is known about the extent of socioeconomic inequalities in health in other industrialized countries with different health and labour market characteristics. In this study, we examined the relationship between the socioeconomic trajectory from childhood to adulthood and functional limitations in midlife in France. We used data from a nationally-representative sample of French men and women conducted in 2002-2003 (the Life History survey). Participants (n = 4798) were 35-64 years of age at the time of the survey. standardized morbidity ratios (SMRs) associated with different lifelong trajectories were estimated using indirect age standardization. Overall, the socioeconomic trajectory from childhood to adulthood was associated with functional limitations in midlife in both men and women. The experience of lifelong socioeconomic disadvantage was associated with SMRs of 1.44, p < 0.0001 in men and 1.21, p = 0.0207 in women. In men, the prevalence of functional limitations was low among those who experienced upward intergenerational mobility and high among those who experienced a downward trajectory during the course of their professional career. Additionally, the prevalence of functional limitations was elevated among men and women who experienced unemployment. These findings indicate that in French men and women, lifetime socioeconomic circumstances are associated with functional limitations in midlife. Understanding the mechanisms that underlie these health disparities will require additional studies of specific health outcomes.     

Explaining health marginalisation of the lower educated: the role of cross-national variations in health expenditure and labour market conditions

Several studies have shown ample cross-national variation in the risk that lower educated people run to be in poor health. However, explanations for this cross-national variation are still scarce. In this article we aim at filling this lacuna by investigating to what extent cross-national variation in the health gap between the lower and higher educated in Europe is explained by governmental health expenditure, namely, how much governments contribute to a country's total healthcare costs, and labour market conditions, that is, unemployment rates and modernisation of the labour market. We used information from the European Social Survey (ESS) 2002-2008 on more than 90,000 individuals in 32 European nations, and estimated hierarchical models with cross-level interactions to test our expectations. Our results show that the relative risk of being in poor health of lower educated individuals is smaller in countries where the government spends much on healthcare and with a highly modernised labour market.     

Rethinking priorities in hospital management: a case from Central Asia

ObjectivesTo evaluate post-Soviet aspects of hospital management in Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan, considering indicators of health care and information on planning processes and factors that affect strategy in their hospitals.MethodsData on indicators of health care were obtained from government agencies, the WHO and the World Bank. A survey of hospital managers in each of the countries was undertaken to obtain opinions on matters influencing the operation of their organizations.ResultsThere was some increase in health expenditure for three countries and a recent decline for Kyrgyzstan. All countries had levels of out of pocket expenditure that were higher than recommended by WHO. Hospital bed occupancy was relatively constant. Average length of stay was higher than in European health systems. Managers in all countries reported greater motivation of staff in their work as a planning benefit. Difficulties with the implementation of plans were greater for Kyrgyzstan than the other countries. Inappropriate assessment during planning seemed important for two countries and changes in environment during implementation for two others. Issues with health policy and regulation, new health technologies, and changes in health behaviour and morbidity were considered significant by managers from all countries.ConclusionsThe health care indicator data and survey findings may reflect differences between the countries in the rate of reorganization of hospital sectors, available resources and political circumstances. They point to areas in need of attention for future hospital planning and challenges for managers in maintaining essential health services.     

Gesundheitsausgabenrechnung nach Alter und Geschlecht

The new German health expenditure data system, which the Federal Statistics Office compiles, corresponds with the methodology of the System of Health Accounts (SHA) which Eurostat and the OECD jointly developed together with the member states at roughly the same time. This system allows the allocation of health expenditure in three dimensions: by expenditure type (function), by the provider of the remunerated services (providers), and by the source of funding (financers). It includes the expenditure of private households and is consistent with the System of National Accounts methodology. The assumption that health expenditure is potentially becoming more and more determined by demographic influences (e.g. ageing populations) has created the need at an European level to study whether or not the participating countries could provide health expenditure data broken down by five rather than the original three SHA dimensions, i.e. to sub-categorize health expenditure by the age and gender of patients receiving health care services. Some countries (among them Germany) have carried out respective pilot studies for pharmaceutical expenditure, others for inpatient curative care. The German pilot study started with pharmaceutical expenditure (including medical goods provided by pharmacies) for the respective sources of funding, taken from the German health expenditure data system. Specific data sources – chosen separately for each source of funding – were used to break down the respective total expenditure by the 202 cells derived from the chosen age and gender categories, the most important being the stratified age-specific expenditure profile for the sector ?pharmacies“ used by the statutory Health Insurance System within the framework of the health risk equalization scheme, and the statistics of both the Statutory Accident Insurance System and private health insurance companies. The final project report ?Age- and gender-specific functional health accounts“ will be published by Eurostat shortly. It will contain the first estimates of comparable age and gender related health expenditure data for selected participating countries.     

"Health for all by the year 2000": a mere slogan or a workable formula?

In the last decade WHO launched its world-wide Health for All by the Year 2000 (HFA 2000) campaign. This has also been picked up by the WHO European Region and by individual countries within that region. In this context The Netherlands has started up work on a Health 2000 Report. In this article, the work on this report and its underlying model are carefully reviewed in the light of the HFA 2000 strategy, and the HFA 2000 goal is evaluated in the light of the health problems Western European countries are controlled with. The conclusion is that all three main elements of the HFA 2000 strategy are useful for long term health planning efforts in the European Region. Health for All by the Year 2000 is not a mere slogan but has proved to be a workable formula.     

Public health in eight European countries: an international comparison of terminology

OBJECTIVES: The aim of this paper was to assess the use of different terms pertaining to public health in selected Member States of the European Union. STUDY DESIGN AND METHODS: Qualitative research methods were used to compare the terminology among eight Member States. Seven to nine core terms were defined for each country, and a search was performed for these terms in the names of institutions and professional titles, organized into three comparable categories. RESULTS: The data analysis showed considerable diversity in terminology. The three most commonly used terms for each country, and the frequency distribution of the core terms for all eight countries were determined. CONCLUSION: Public health terminology and underlying concepts vary among Member States of the European Union. A large number of loosely related terms are in use, indicating the lack of a common conceptual framework for the discipline of public health. The most commonly used terms pertaining to public health are 'health sciences' and 'health promotion'. 'Public health' is not among the most commonly used terms.