Conceptual demand model for doctors

Transcription

1 LC Paper No. CB(2)260/13-14(01) Healthcare Manpower Planning and Projection November 11 th 2013 Conceptual demand model for doctors Service 2

2 Conceptual demand model for doctors Service Productivity change Technology diffusion Complementarity/ Substitution (between health worker type) 3 Conceptual demand model for doctors (Inpatient) 1. Total number of discharges 2. Total Service number of bed days (stratified by DRG and by service sector) Service Productivity change Technology diffusion Complementarity/ Substitution (between health worker type) 4

3 Conceptual demand model for doctors (Outpatient) Total number of visits (stratified by specialty and by service sector) Service Productivity change Technology diffusion Complementarity/ Substitution (between health worker type) 5 Conceptual supply model for doctors Pre existing Newly eligible Total number of Renewal proportion Conversion into number of clinically active doctors 1. No longer in medical practice but not retired 2. Natural attrition / retirement 3. Otherwise deregistrated Local Non local Number of clinically active (stratified by specialty and by service sector) Workforce participation rate 1. Female male ratio 2. Preference for part time work otherwise (likely age dependent) 6

4 Conceptual supply model for doctors Pre existing Newly eligible Total number of Renewal proportion Conversion into number of clinically active doctors 1. No longer in medical practice but not retired 2. Natural attrition / retirement 3. Otherwise deregistered Local Non local Number of clinically active (stratified by specialty and by service sector) Differential capacity and work pattern by service sector Standard working hours and/or other overarching policy changes Workforce participation rate 1. Female male ratio 2. Preference for part time work otherwise (likely age dependent) Newly eligible

5 Newly eligible Newly eligible Newly eligible

6 Demand FTE Supply Approach Concept Basis Criticisms Application -based Demand / utilisation-based Benchmarking Trend analysis Socially optimal number of doctors Number likely to employ Defined standard of care Historical trends Disease incidence Doctor encounters Time/pat encounter Time in patient care/year Current utilisation patterns Estimates of change in demographics and demand Empirical analysis Lack efficacy and efficiency data No technological change Assumes resources by need Current inequities carried forward Assumes all care useful No non-curative service No change in care modality Doctor/pop ratio Assumes efficient mix and number Assumes no diff in health care sys No diffs in roles (e.g. GP/FM) Aggregate-level, timeseries data Estimate doctor/pop/capita, GDP, pop growth and ageing Assume supply = demand Assume more health care only limited by willingness to pay RAND (Arch Opthalmol 1998) GMENAC (1981) RAND (J B & Joint Surg 1998) Health Workforce Australia (NHWT 2010) Weiner (1994) Weiner (2004) Cooper (Health Affairs 2002) HRSA (2008) 12