REMUNERATION OF DOCTORS AND NURSES: PROGRESS AND PERSISTING ISSUES
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1 REMUNERATION OF DOCTORS AND NURSES: PROGRESS AND PERSISTING ISSUES Joint session of Health Data Correspondents and Health Accounts Experts Paris, 17 October 2013
2 Background Remuneration levels of doctors and nurses affect: Attractiveness/retention in these professions Health spending in the country Difficult data collection Review of data availability and comparability
3 Outline 1. Doctor remuneration Definitions, results, limitations 2. Nurse remuneration Definitions, results, limitations 3. Comparisons with other workers in the country
4 1. Doctor remuneration - Definition Average gross annual income, including social security contributions and income taxes payable by the employee Includes - Extra formal payments, bonuses, overtime, etc. - Income for private practice (for salaried) - Salaried work (for selfemployed) Excludes - Social contributions payable by the employer (for salaried) - Practice expenses (for self-employed) - Doctors in training
5 1. Doctor remuneration - Definition Includes only: fully-qualified physicians Full-time workers Distinguishes between: GPs and Specialists (all specialties combined) Salaried and Self-employed
6 1. Doctor remuneration - Data collection Main sources: Health insurance schemes (BEL, FRA) Salary registers (NLD) Ad-hoc studies and surveys (CZE, DNK, DEU, ITA)
7 Remuneration of doctors, US$ PPP, 2011 (or nearest year) 207 Australia ¹ 1. Doctor remuneration Results Austria Salaried Self-employed Specialists USD PPP, thousands Belgium 2 Canada Chile 3 Czech Republic ¹ Denmark Estonia Finland France 4 Germany 1 Greece Hungary 3 Iceland 3 Ireland Israel Italy Mexico 3 Netherlands 3 New Zealand Norway Poland Slovak Republic Slovenia Spain Turkey 5 United Kingdom 6 General practitioners (GPs) 1. Physicians in training are included (resulting in an underestimation). 2. Data include practice expenses (resulting in an overestimation). 3. Data on salaried doctors relate only to public sector employees who tend to receive lower remuneration than those working in the private sector (resulting in an underestimation). 4. Remuneration of self-employed physicians is net income rather than gross income (resulting in an underestimation). 5. Figures are net income rather than gross income (resulting in an underestimation). 6. Specialists in training are included (resulting in an underestimation). Source: OECD Health Statistics Salaried Self-employed USD PPP, thousands
8 1. Doctor remuneration data limitations Underestimation: Payments for overtime work, bonuses, other supplementary excluded (AUT for GPs, IRL and NZL for salaried specialists, FRA, ITA, PRT, SVK and SWE); Incomes from private practices for salaried doctors excluded (e.g. CZE, HUN, PRT, SVN, ISL, IRL and SWE for specialists); Informal payments excluded (e.g. GRC and HUN); Public sector only (CHL, DNK, HUN, NOR and SVK); Net income rather than gross income (FRA and TUR); Physicians in training included (AUS, CZE, DEU, and GBR for specialists) Part-time workers included (AUS, AUT, BEL, NLD, and for GPs). Overestimation: Practice expenses included for self-employed GPs (BEL)
9 Growth in the remuneration of GPs and specialists, (or nearest year) Average annual growth rate (%, in nominal terms) 1. Doctor remuneration Results GPs Specialists The growth rate for the Netherlands is for self-employed GPs and specialists. Source: OECD Health Statistics 2013
10 1. Doctor remuneration data limitations No data Japan (no split between GPs and specialists) Korea (why?) Switzerland (reliability of source) Lack of recent data United States (2001) Sweden (2002) Luxembourg, Portugal (both 2005) Serious data comparability issues Belgium (Practice expenses included) France (Net income rather than gross) Germany (Physicians in training included) United Kingdom (Specialists in training included)
11 2. Nurse remuneration - Definitions Average gross annual income, including social security contributions and income taxes payable by the employee Includes - Extra formal payments, bonuses, overtime, etc. - Any supplementary income Salaried nurses working in hospitals Excludes - Social contributions payable by the employer - Care workers without certification in nursing (Nursing aides) - Midwives - Nurse managers
12 2. Nurse remuneration - Data collection Main sources: Hospital reports (AUS, GRC) Labour force or earnings surveys (CAN, CZE, FIN, DEU, ITA, JPN,USA) Payroll data (DNK, IRL)
13 x 4 Remuneration of hospital nurses, USD PPP, 2011 (or nearest year) 2. Nurse remuneration Results Luxembourg United States ¹ Ireland Australia ¹ Denmark Norway Canada ¹ Belgium New Zealand Germany Chile Netherlands Spain Israel United Kingdom Japan Iceland Finland Italy France Greece Slovenia Mexico Turkey Poland Czech Republic Estonia Slovak Republic Hungary 1. Data refer to registered ("professional") nurses in the United States, Australia and Canada (resulting in an overestimation). Source: OECD Health Statistics USD PPP, thousands
14 2. Nurse remuneration data limitations Overestimation: Registered/ professional nurses only (e.g., in AUS, CAN and USA). Underestimation: Nurses working part-time included(e.g. BEL); Additional income (overtime payments and bonuses) and informal payments excluded (e.g. ITA, PRT and SVN); Public sector only, health assistants and nurse assistants included (NZL).
15 Source: OECD Health Statistics Growth in the remuneration of hospital nurses, (or nearest year) Average annual growth rate (%, in nominal terms) 2. Nurse remuneration Results n.a n.a
16 2. Nurse remuneration data limitations No data Austria, Korea, Sweden, Switzerland. Lack of recent data Portugal (2005) France (2009) Data comparability issues Registered nurses (AUS, CAN, USA)
17 3. Comparing remuneration level of doctors and nurses with other workers in the country Current indicator: Ratio to average wage of all workers Data extracted from the Labour Force Survey database Possible new indicator: Ratio to average wage of tertiary-educated workers Data extracted from the Education database
18 Remuneration of doctors, ratio to average wage of all workers, 2011 (or nearest year) // Salaried Self-employed Specialists Australia ¹ Austria Belgium 2 Canada Czech Republic ¹ Denmark Estonia Finland France 3 Germany 1 Greece Hungary 4 Ireland Israel Italy Netherlands Norway Poland Slovak Republic Slovenia Spain United Kingdom 5 1. Physicians in training included (resulting in an underestimation). 2. Practice expenses included (resulting in an over-estimation). 3. Remuneration of self-employed physicians is net income, not gross income (resulting in an underestimation). 4. Public sector employees only (resulting in an underestimation). 5. Specialists in training included (resulting in an underestimation). Source: OECD Health Statistics 2013, Ratio to average wage of all workers in each country n.a. 0 n.a. n.a. n.a. n.a. n.a. General practitioners (GPs) Salaried Self-employed Ratio to average wage of all 6 workers in each country
19 Remuneration of doctors, ratio to average wage of tertiary-educated workers, 2011 (or nearest year) Salaried Self-employed Specialists Ratio to earnings workers with tertiary education 2 n.a. 0 Australia Austria Belgium Canada Chile Czech Republic n.a. Denmark Estonia Finland France Germany n.a. Greece n.a. Hungary 0.9 Ireland Israel Italy n.a. Netherlands New Zealand n.a. Norway n.a. Poland Slovak Republic Slovenia Spain United Kingdom General practitioners (GPs) Salaried Self-employed Ratio to earnings for workers with tertiary education
20 Remuneration of hospital nurses, ratio to average wage, 2011 (or nearest year) Luxembourg Israel United States ¹ Greece Spain Australia ¹ Germany Poland Canada ¹ Belgium Ireland Japan Denmark Czech Republic Italy Norway Slovenia Estonia Netherlands Finland France United Kingdom Slovak Republic Hungary Ratio to average wage of all workers in each country Greece Israel Spain New Zealand Australia ¹ Chile United States ¹ Belgium Luxembourg Canada ¹ United Kingdom Denmark Finland Slovenia France Norway Estonia Ireland Poland Germany Italy Netherlands Czech Republic Slovak Republic Hungary Ratio to average wage of tertiaryeducated workers in each country 1. Data refer to registered ("professional") nurses in the United States, Australia and Canada (resulting in an over-estimation). Source: OECD Health Statistics 2013
21 National Correspondents are invited to: COMMENT on the possibility to fill data gaps and improve the comparability of data submitted; COMMENT on possible adjustments to national data submissions to improve comparability (along the lines of adjustments made in the Dutch report); COMMENT on the use of the average income of tertiary-educated workers only to compare the remuneration levels of doctors and nurses.
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