호주의 근거중심의 의료인력 계획 (Health Workforce Australia)

How evidence-based workforce planning in Australia is informing policy development in the retention and distribution of the health workforce

Ian F Crettenden, Maureen V McCarty, Bethany J Fenech*, Troy Heywood, Michelle C Taitz and Sam Tudman

o 배경

¡ 호주의 당면 과제

- The self-sufficiency challenge

- The demographic challenge

- The cost challenge

- The co-ordination challenge

- The distribution challenge

¡ HWA 설립의 과정

- 1995년 AMWAC 설립

- 2000년 AHWAC 설립

- 2006년 AMWAC와 AHWAC 해체(ceased), 2010년까지 한시적 Taskforce 설립

- 2008년 COAG는 National Partnership Agreement on Hospital and Health Reform에 동의

- 2008년 이와 동시에 HWA 설립 (HWA is an Australian Commonwealth statutory authority and reports to the Standing Council on Healthc (SCoH).)

¡ HW2025 프로젝트의 목적

- 현재의 문제는 국가 수준의 문제이며, HW2025는 국가 수준에 초점을 둠

- 미래 의료인력 정책과 개혁의 방향의 토론을 위한 토대 마련

 

o 연구 목적

¡ 어떻게 호주에서 근거중심 보건의료인력 계획을 활용하고 있는가

¡ HW 2025 project의 원칙과 방법론

 

o 연구 방법 : Workforce supply의 예측

¡ Dynamic stock and flow model 활용

¡ 네 개의 핵심 input

- 1) workforce stock (in 5-year age and gender cohorts);

- 2) domestic new entrants;

- 3) migration (permanent and temporary); and

- 4) net exits, which included all permanent and temporary flows out of the workforce.

o 연구 방법 : Workforce demand의 예측

¡ Utilization method 활용

¡ 현재의 Service utilization pattern에 기반하고 있으며 potential demand나 unmet demend에 대한 가정은 없음

 

o 연구 방법 : 시나리오 분석

¡ 가능한 정책 옵션의 효과를 보여주기 위하여 Scenario analysis 활용

• Ÿ Innovation and reform scenarios

• Ÿ Productivity scenario
• Ÿ Low demand scenario
• Ÿ Workforce retention scenario (nurses only)

• Ÿ Immigration scenarios

• Ÿ Medium and high self-sufficiency scenarios

• Ÿ Other impact scenarios

• Ÿ High demand scenario
• Ÿ Capped working hours scenario (doctors only)

¡ 기본 원칙

- Methodological robustness and coherency

- Use of national data

- Explicit assumptions

- Consultation and review processes

- Iterative process

 

o 결론

¡ HW2025 방법과 원칙의 가치

- 기존의 의료인력 계획은 다양한 방법으로 다양한 기관(정부, 고용자, 전문직)에서 이루어졌으나 국가 수준의 그림을 얻지는 못하였음.

- 이전에도 국가 차원의 계획을 수립한 적은 있으나 각각의 전문과목 인력을 개별적으로 조사하였고, 시기적으로도 분절된 ‘고립된’ 방법이었음.

- 역사적으로 보건의료와 고등교육 sector가 의료인력 계획 단계에서 서로 연결지어진 적이 없었음.

¡ 호주의 첫 번째 핵심(major)적, 장기적 국가수준의 예측으로서 근거 중심의 접근을 통해서 ‘하던대로 하는’ 식은 더 이상 지속가능하지 않음을 보여줌

¡ 의료인력 예측을 기반으로 미래 방향을 토론하는 기반이 될 수 있음.

¡ HW2025는 한번 하고 마는(one-off)프로젝트가 아니며 HWA가 지속적으로 개발하고 발전시킬 것임.

 

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Hum Resour Health. 2014 Feb 3;12:7. doi: 10.1186/1478-4491-12-7.

How evidence-based workforce planning in Australia is informing policy development in the retention anddistribution of the health workforce.

Crettenden IF, McCarty MV, Fenech BJ1, Heywood T, Taitz MC, Tudman S.

Author information

Abstract

BACKGROUND:

Australia's health workforce is facing significant challenges now and into the future. Health Workforce Australia (HWA) was established by the Council of Australian Governments as the national agency to progress health workforce reform to address the challenges of providing a skilled, innovative and flexible health workforce in Australia. HWA developed Australia's first major, long-term national workforce projections for doctors, nurses and midwives over a planning horizon to 2025 (called Health Workforce 2025; HW 2025), which provided a national platform for developing policies to help ensure Australia's health workforce meets the community's needs.

METHODS:

A review of existing workforce planning methodologies, in concert with the project brief and an examination of data availability, identified that the best fit-for-purpose workforce planning methodology was the stock and flow model for estimating workforce supply and the utilisation method for estimating workforce demand. Scenario modelling was conducted to explore the implications of possible alternative futures, and to demonstrate the sensitivity of the model to various input parameters. Extensive consultation was conducted to test the methodology, data and assumptions used, and also influenced the scenarios selected for modelling. Additionally, a number of other key principles were adopted in developing HW 2025 to ensure the workforce projections were robust and able to be applied nationally.

RESULTS:

The findings from HW 2025 highlighted that a 'business as usual' approach to Australia's health workforce is not sustainable over the next 10 years, with a need for co-ordinated, long-term reforms by government, professions and the higher education and training sector for a sustainable and affordable health workforce. The main policy levers identified to achieve change were innovation and reform, immigration, training capacity and efficiency and workforce distribution.

CONCLUSION:

While HW 2025 has provided a national platform for health workforce policy development, it is not a one-off project. It is an ongoing process where HWA will continue to develop and improve health workforce projections incorporating data and methodology improvements to support incremental health workforce changes.

PMID:

 

24490586

 

[PubMed - in process] 

PMCID:

 

PMC3922608

 

Free PMC Article