Elsevier

Health Policy

Volume 110, Issue 1, April 2013, Pages 6-13
Health Policy

Review
Bringing a European perspective to the health human resources debate: A scoping study

https://doi.org/10.1016/j.healthpol.2012.11.002Get rights and content

Abstract

Healthcare systems across the world are increasingly challenged by workforce shortages and misdistribution of skills. Yet, no comprehensive European approach to health human resources (HHR) policy exists and action remains fragmented. This scoping study seeks to contribute to the debates by providing an overview of existing HHR research, and by exploring the challenges of a European approach with a focus on workforce planning. In terms of methods, we build on a scoping review comprising literature analysis and qualitative data gathered from policy experts. In our analysis we observe an overall lack of integrated HHR approaches as major obstacle of efficient HHR planning, and find that five dimensions of integration in HHR policy are needed: system, occupational, sector, gender, and socio-cultural integration. Increasing the analytical complexity of HHR planning models does not automatically bring about more reliable and efficient planning, as the added value of these models is highly context-dependent. Yet Europe is highly diverse and we therefore argue the need for a strategic HHR perspective that is capable of bridging many different HHR policies and planning systems, and combining national and European solutions efficiently.

Introduction

Healthcare systems across the world are increasingly challenged by workforce shortages and misdistribution of skills [1], [2]. In Europe, it is expected that the healthcare sector will be confronted with a huge shortage – up to one to two million – of healthcare professionals by 2020 [3]. Also, the future skill-mix is expected to be incongruent with the development of healthcare needs [4]. Healthcare consumers are changing due to demographic, epidemiological and socio-cultural developments. At the same time, the size and composition of the health workforce are also changing as a result of changing gender relations and professional, organisational and technological developments. For many countries this implies that the (quantitative and qualitative) match between healthcare demand and supply will be increasingly difficult to achieve and to sustain.

Such scenarios have rung the bells of policymakers [5], [6]. Yet a specific European approach to health human resources (HHR) is still poorly developed and no comprehensive data and monitoring systems exist. Contemporary efforts towards establishing and advancing HHR policy are mainly driven by global organisations and often focused on developing countries [2], [7], [8], [9], [10], [11]. Within the western world, HHR issues are mostly addressed in Anglo-Saxon countries and therefore heavily biased towards North America and/or towards National Health Service (NHS) systems (United Kingdom and Australia) with workforce planning relying on the inflow of professionals from abroad [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24].

Remarkably, so far no specific European approach to HHR policy has been developed. This is especially surprising because European Union (EU) labour market regulation – together with the east-west push and pull factors – have created specific incentives towards cross-border mobility and migration of health professionals between the member states and candidate countries [3], [25]. Taken together, this picture drawn from the international and scholarly HHR debates suggests that there is a need for HHR approaches and empirical research that adequately reflect the situation of Europe and the interdependencies between European countries.

Recently, there have been attempts to bring a European perspective to the HHR debates that contributed to the awareness of the challenges of projected workforce shortages and imbalances [3], [26], [27], [28], [29], [30], [31]. This article builds upon these contributions by presenting a scoping study [32], [33]. We seek to contribute to the debate by providing an overview of research on HHR, and by an exploration of the challenges and chances of HHR policy in Europe.

Bringing a ‘European perspective’ to HHR research and policy may start with the countries of the European Economic Area and Switzerland that can to some extend build on joint regulation and policies, but should aim towards an expansion into the WHO European region. We suggest using the term ‘health human resources’ rather than ‘human resources for health’; the latter term is often used in the international literature but linked to a specific WHO programme and policy strategy [2], [7] and therefore less appropriate for our purpose. We refer to HHR and HHR policy as an umbrella concept that includes different strands of governing, managing and planning the health workforce. Hence, there is no uniform definition of HHR policy in the literature and the different strands of HHR may have overlaps. In Box 1 we therefore summarise the proposed terminology and analytical distinction used in this article.

The article begins with mapping the field of existing approaches and research into HHR policy. We then turn our attention towards the challenges and chances of HHR policy in Europe. We briefly describe the situation of research on HHR issues and then discuss the need for an integrated approach to HHR. We conclude by discussing our results with respect to future HHR research and the possibilities of developing an integrated European comparative approach to HHR policy.

Section snippets

Methodology

We build on a scoping review of the literature. Following the definitions by Arksey and O’Malley [32] this seems useful considering our goals to (1) evaluate existing research on the topic of HHR, (2) to summarise and disseminate research findings, and (3) to identify gaps in the literature. Here, we focus on the gap analysis that serves as a springboard towards more explorative approaches.

While a scoping review complies with the meta-analysis and systematic reviews approach, no quality

Mapping the field of HHR policy

The emergence of HHR policy (as defined in Box 1) is a new development. Until recently, issues of the health workforce were rarely recognised as specific area of health policy but limited to traditional forms of HR management and personnel administration, and dominated by workforce planning focussing exclusively on doctors [36]. The modern term health human resources policy became first known as ‘manpower planning’ in the 1970s and early 1980s in North America and was mainly driven by

Where are we now in HHR policy and research in Europe?

Health human resources have clearly moved up on the agenda of European policy [3], [26], [27], [29], [46], [47], [48], [49]. Many European Union member states are investing to get HHR management practices in place and some country-specific planning models also exist [50]. Drawing on different approaches and data sources, a rapidly growing body of statistical data and research has emerged that is used for estimating and predicting shortages of qualified healthcare staff [3], [5]. While these

Overcoming the limitations of HHR policy: the challenges of integrated approaches

The previous section has highlighted a lack of integrated approaches as a key problem of managing HHR more effectively [39], [44], [64], [65]. Yet ‘integration’ needs further investigation when applied to HHR policy. We have identified five major dimensions of integration which are related to the challenges of HHR policy and management as described above:

  • 1.

    system integration: connectedness between the educational system and the health labour market, and between the latter and broader labour

Conclusions

This scoping study has set out the need to bring a European perspective to the HHR debate. We have drawn state-of-the-art research together, sketched its limitations and have highlighted the challenges of furthering integration in the field of HHR policy in Europe. Our analysis now provides a more systematic basis on which to review the opportunities of a European HHR approach and to map out the way forward in researching HHR through a European lens.

First and foremost, HHR planning has to be

Conflict of interest

The authors declare that they have no conflict of interests.

Acknowledgements

We wish to thank our colleagues in various different research networks and collaborative projects for valuable discussions and for sharing and supporting our attempts towards furthering European HHR research. We are also thankful to colleagues at NIVEL who commented on an earlier version and to two anonymous reviewers of Health Policy for their very helpful comments.

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