Financial Management in Nursing

MAN 207

Health Manpower Shortages

and Surpluses

Reported by: Ms. Lovely An Dannizah De Perio

 Objectives:
At the end of the discussion:
Definition, Measurement and Policies
Framework for the Imbalance of Human Resource for Health
Need and Demand for Healthcare
Driving Forces to Workforce Challenges
Health Workforce in the Philippine Health Institutions
Definitions:
 Imbalance – an unfair distribution of resources among countries,
organizations and individuals.
 Shortage – a condition where there is an excess demand of
products in comparison to the quantity supplied in the market.
 Surplus – refers to the amount of resource that exceeds the amount
that is actively utilized.
 Imbalance (shortage/surplus)
From an economic perspective, a skill imbalance (shortage/surplus) occurs
when the quantity of a given skill supplied by the workforce and the
quantity demanded by employers diverge at the existing market conditions.
A shortage/surplus is the result of the disequilibrium between the
demand and supply of labor.
In non-economic definitions are usually normative like there is a shortage
of labor relative to defined norms.
In case of healthcare personnel, these definition are based either on value
judgement or on a professional determination such as deciding the
appropriate number of physicians for the general population
 Nature of Imbalance
Differentiate between dynamic imbalance and static imbalances –
In a competitive labour market, we should expect most of
imbalances to resolve themselves through time; these are dynamic. In
contrast, a static imbalance occurs because supply does not
increase/decrease, and market equilibrium is therefore not
achieved.
 Regarding the nature of imbalance relates to qualitative versus
quantitative. In a tight labour market, employers might not find the
ideal candidate, but still recruit someone. Under these conditions, the
issue becomes one of the quality of job candidates rather than quantity
of people willing and able to do the job
 Measurement of Imbalance
 Employment Indicators – vacancies, growth of the workforce,
occupational unemployment rate, turnover rate
 Activity Indicators - overtime
 Monetary Indicators – real wage rate, rate of return
 Normative Population-based Indicators – doctor/population ratio,
nurse/population ratio
 Main Advantage and Disadvantages of Shortage/Surplus
Indicators
Indicator Advantages Disadvantages
Employment Indicators:
Easy to measure It does not capture private practitioners
Vacancies
Widely Used Budget constraints may “hide” a shortage
problem
It can be applied to any health It might be difficult to assess whether a
Growth of the Workforce profession, in any healthcare system workforce growth respond to an initial
shortage or not
It can be applied to any health The occurrence simultaneous health
Comparative Occupational profession, in any healthcare system workforce unemployment and imbalance
Unemployment Rate complicates the interpretation of this
indicators
Turnover Rates Easy to measure Level of turnover might be influenced by
elements not related to imbalance
Activity Indicator:
Overtime It is a sensitive indicator It might reflect a deliberate policy
 Main Advantage and Disadvantages of Shortage/Surplus
Indicators
Indicator Advantages Disadvantages
Monetary Indicators:
Wage might be influenced by factors not
Real Wage Rate Easy to measure related to imbalances
It is difficult to quantify the shortage or
surplus
It is a relatively sophisticated Relatively complex to estimate and difficult
Rate of Return indicator to quantify the shortage/surplus
Normative Population-Based Indicator:
Doctor per 10,000 It is easy to estimate There is a certain degree of subjectivity
population when establishing a “gold standard”.
Nurses per 10,000 It allows to quantify imbalances
population
 Typology of Imbalances
 Profession/Specialty Imbalances – under this category, we consider an
imbalance to the various health professions such as doctors or nurses as well
as shortages within a profession (e.g. shortage of one type of specialist).
 Geographical Imbalances – these are disparities between urban and rural
regions and rich and poor regions.
Institutional and Services Imbalances – these are the differences in health
workforce supply between the healthcare facilities as well as the services.
 Gender Imbalances – these are the disparities in female/male
representation in the health workforce.
 The Framework shown comprises
of 6 key components: Health Labor
Demand, Health Job Supply,
Health Care System, Policies,
Resources, Global Factors.
Such components directly or
indirectly contribute in defining
and changing the whole
population as well as the health
workforce.

Framework for the Imbalance of Human

Resources for Health
 Six Key Components of the Framework
1. Health Labor Demand
Utilization of Healthcare - we should consider factors determining the demand for health services.
Personal characteristics – such as health needs, cultural and sociodemographic characteristics – and economic
factors play an important role.

2. Health Labor Supply

 Education/Training - The availability of a renewed health workforce, as well as the type of profession
and specialty chosen by individuals, is a major concern for health decision-makers. These issues are of
particular relevance, especially since the number of younger people, predominantly women, choosing a
nursing career is declining in some countries and since in professional training/education, individuals' choices
do not always match the absorptive capacity of the market.
 Labor Participation - the impact of wage increases on labor participation, in particular for nurses. In
the short term, higher wages can have at least two effects on the labor supply of current qualified nurses:
first, qualified nurses who are working in other occupations may return to nursing activities; second, nurses
now in practice may respond by working more hours. In the long run, higher wages in nursing relative to
other occupations make nursing an attractive profession and will draw more people into nurse training
programs.
 Migration - Migration of health personnel can have a serious impact on the supply of human
resources in health, because it may exacerbate health personnel imbalances in "sending" countries. It is
suggested that migration is an "individual, spontaneous and voluntary act" that is motivated by the perceived
net gain of migrating – that is, the gain will offset the tangible and intangible costs of moving . Decisions to
migrate are often a family strategy to produce a better income and improve survival chances.
 Six Key Components of the Framework
3. Healthcare System
 Market failures - Most markets are characterized by market failures, but
what is unique to the health services market is the extent of these market failures,
Governments try to correct health care market failures through policy
interventions.
 Stakeholders - The health care system is characterized by a wide range of
institutional stakeholders involved in shaping human resources for health, all of
whom may have different objectives. The objectives of a union or professional
association do not necessarily coincide, for example, with those of a government
ministry, a hospital manager or the central government.
 Time Lag - adjustments between the demand and supply for health
personnel may take a long time. In the health care field; the time lag between
education and practicing may be quite substantial.
 Potential market Power – this is the hospital’s potential monopsony power.
 Six Key Components of the Framework
4. Policies
Non Health contributes to shaping the health care system and have
Health an influence on the demand and supply of health labor.
5. Resources/Services
 Financial/Physical/Knowledge - Financial, physical and knowledge resources are crucial to any
type of health care workforce. The level of resources attributed to the health care system, and
how these resources are used, will have a significant impact on health workforce issues.
6. Global factors
Economic - there is evidence of a correlation between the level of economic
development of a country and its level of human resources for health.
Sociodemographic - both the demand and supply are likely to be affected by
sociodemographic elements such as the age distribution of the population.
Cultural - both cultural and political values also affect the demand for and supply of
human resources for health.
Geographical - affect the organization of health services delivery. 
Framework for the Imbalance of Human
Resources for Health
 Different Types of Needs
 Felt Need – subjective view determined by the individual’s
perceptions of their need for health.
Normative Need – depends on the judgement of professionals.
 Unfelt Need – depends on the existence of pre-symptomatic
disease.
Expressed Needs – felt needs turned into actions.
Relative Need – this refers to the level of need of a population rather
than a single individual.
 POPULATION
S cr
ee
nin
g

Professionally
Felt Need Demand
Defined Need
Illness Behavior
e nt
gem
d
a l Ju Rationing
ni c
Cli
Felt Need Unmet Need Met Need

Conceptual Model of Need, Demand and Use

 POPULATION
S cr
ee
nin
g

Professionally
Felt Need Demand
Defined Need
Illness Behavior
e nt
gem
d
a l Ju Rationing
ni c
Cli
Felt Need Unmet Need Met Need

Conceptual Model of Need, Demand and Use

 Driving Forces to Workforce Challenges
 According to World Health Organization (2006), workers in health
systems around the world are experiencing increasing stress and
insecurity as they react to complex array of forces.
 Workforce
Driving Forces
Challenges
Health Needs Numbers
Demographics Shortage/Excess
Disease Burden
Epidemics Skill Mix
Health team Balance

Health Systems
Distribution
Financing
Internal (Urban/Rural)
Technology
International Migration
Consumer Preferences

Working Conditions
Context
Compensation
Labor and Education
Non-financial Incentives
Public Sector Reforms
Workplace safety
Globalization

Forces Driving the Workforce

 Health Workforce in
Philippine Health Institutions

The density of health workers such as doctors and nurses are

significantly higher in more urbanized and economically developed
geographical locations.

A high proportion of health workers are hospital-based, and areas

with more hospital register a higher density of health workers.
 Health Workers in Institutions per 10,000 Population,
2017
Group of Islands Region Doctors Nurses RHU’s
Philippines 3.9 8.6 2, 587
NCR NCR 10.6 12.6 492
CAR 6.4 15.8 97
Ilocos Region (I) 4.0 11.2 150
Cagayan Valley (II) 3.4 12.1 96
The rest of Luzon
Central Luzon (III) 3.6 7.5 293
CALABARZON (IV A) 2.8 6.5 225
MIMAROPA (IV B) 1.9 5.8 82
Bicol Region (V) 2.5 7.8 134
Visayas Western Visayas (VI) 3.1 7.2 147
Central Visayas (VII) 3.1 10.4 163
Eastern Visayas (VIII) 2.6 7.0 161
Mindanao Zamboanga Peninsula (IX) 2.6 9.5 92
Northern Mindanao (X) 2.9 9.3 121
Davao Region (XI) 3.0 7.1 68
SOCCKSARGEN (XII) 2.3 7.6 52
CARAGA (XIII) 2.1 7.9 82
ARMM 0.9 4.2 131
 Health Workers in Institutions per 10,000 Population,
2017
Group of Islands Region Doctors Nurses RHU’s
Philippines 3.9 8.6 2, 587
NCR NCR 10.6 12.6 492
CAR 6.4 15.8 97
Ilocos Region (I) 4.0 11.2 150
Cagayan Valley (II) 3.4 12.1 96
The rest of Luzon
Central Luzon (III) 3.6 7.5 293
CALABARZON (IV A) 2.8 6.5 225
MIMAROPA (IV B) 1.9 5.8 82
Bicol Region (V) 2.5 7.8 134
Visayas Western Visayas (VI) 3.1 7.2 147
Central Visayas (VII) 3.1 10.4 163
Eastern Visayas (VIII) 2.6 7.0 161
Mindanao Zamboanga Peninsula (IX) 2.6 9.5 92
Northern Mindanao (X) 2.9 9.3 121
Davao Region (XI) 3.0 7.1 68
SOCCKSARGEN (XII) 2.3 7.6 52
CARAGA (XIII) 2.1 7.9 82
ARMM 0.9 4.2 131
 Health Workers in Institutions per 10,000 Population,
2017
Group of Islands Region Doctors Nurses RHU’s
Philippines 3.9 8.6 2, 587
NCR NCR 10.6 12.6 492

CAR 6.4 15.8 97

Ilocos Region (I) 4.0 11.2 150
Cagayan Valley (II) 3.4 12.1 96
The rest of Luzon
Central Luzon (III) 3.6 7.5 293
CALABARZON (IV A) 2.8 6.5 225
MIMAROPA (IV B) 1.9 5.8 82
Bicol Region (V) 2.5 7.8 134
Visayas Western Visayas (VI) 3.1 7.2 147
Central Visayas (VII) 3.1 10.4 163
Eastern Visayas (VIII) 2.6 7.0 161
Mindanao Zamboanga Peninsula (IX) 2.6 9.5 92
Northern Mindanao (X) 2.9 9.3 121
Davao Region (XI) 3.0 7.1 68
SOCCKSARGEN (XII) 2.3 7.6 52
CARAGA (XIII) 2.1 7.9 82
ARMM 0.9 4.2 131
 Health Workers in Institutions per 10,000 Population,
2017
Group of Islands Region Doctors Nurses RHU’s
Philippines 3.9 8.6 2, 587
NCR NCR 10.6 12.6 492
CAR 6.4 15.8 97
Ilocos Region (I) 4.0 11.2 150
Cagayan Valley (II) 3.4 12.1 96
The rest of Luzon
Central Luzon (III) 3.6 7.5 293
CALABARZON (IV A) 2.8 6.5 225
MIMAROPA (IV B) 1.9 5.8 82

Bicol Region (V) 2.5 7.8 134

Visayas Western Visayas (VI) 3.1 7.2 147
Central Visayas (VII) 3.1 10.4 163
Eastern Visayas (VIII) 2.6 7.0 161
Mindanao Zamboanga Peninsula (IX) 2.6 9.5 92
Northern Mindanao (X) 2.9 9.3 121
Davao Region (XI) 3.0 7.1 68
SOCCKSARGEN (XII) 2.3 7.6 52
CARAGA (XIII) 2.1 7.9 82
ARMM 0.9 4.2 131
 Health Workers in Institutions per 10,000 Population,
2017
Group of Islands Region Doctors Nurses RHU’s
Philippines 3.9 8.6 2, 587
NCR NCR 10.6 12.6 492
CAR 6.4 15.8 97
Ilocos Region (I) 4.0 11.2 150
Cagayan Valley (II) 3.4 12.1 96
The rest of Luzon
Central Luzon (III) 3.6 7.5 293
CALABARZON (IV A) 2.8 6.5 225
MIMAROPA (IV B) 1.9 5.8 82
Bicol Region (V) 2.5 7.8 134
Visayas Western Visayas (VI) 3.1 7.2 147
Central Visayas (VII) 3.1 10.4 163
Eastern Visayas (VIII) 2.6 7.0 161
Mindanao Zamboanga Peninsula (IX) 2.6 9.5 92
Northern Mindanao (X) 2.9 9.3 121
Davao Region (XI) 3.0 7.1 68
SOCCKSARGEN (XII) 2.3 7.6 52
CARAGA (XIII) 2.1 7.9 82
ARMM 0.9 4.2 131
 Health Workers in Institutions per 10,000 Population,
2017
Group of Islands Region Doctors Nurses RHU’s
Philippines 3.9 8.6 2, 587
NCR NCR 10.6 12.6 492
CAR 6.4 15.8 97
Ilocos Region (I) 4.0 11.2 150
Cagayan Valley (II) 3.4 12.1 96
The rest of Luzon
Central Luzon (III) 3.6 7.5 293
CALABARZON (IV A) 2.8 6.5 225
MIMAROPA (IV B) 1.9 5.8 82
Bicol Region (V) 2.5 7.8 134
Visayas Western Visayas (VI) 3.1 7.2 147
Central Visayas (VII) 3.1 10.4 163
Eastern Visayas (VIII) 2.6 7.0 161
Mindanao Zamboanga Peninsula (IX) 2.6 9.5 92
Northern Mindanao (X) 2.9 9.3 121
Davao Region (XI) 3.0 7.1 68
SOCCKSARGEN (XII) 2.3 7.6 52
CARAGA (XIII) 2.1 7.9 82
ARMM 0.9 4.2 131
 Health Workers in Institutions per 10,000 Population,
2017
Group of Islands Region Doctors Nurses RHU’s
Philippines 3.9 8.6 2, 587
NCR NCR 10.6 12.6 492
CAR 6.4 15.8 97
Ilocos Region (I) 4.0 11.2 150
Cagayan Valley (II) 3.4 12.1 96
The rest of Luzon
Central Luzon (III) 3.6 7.5 293
CALABARZON (IV A) 2.8 6.5 225
MIMAROPA (IV B) 1.9 5.8 82
Bicol Region (V) 2.5 7.8 134
Visayas Western Visayas (VI) 3.1 7.2 147
Central Visayas (VII) 3.1 10.4 163
Eastern Visayas (VIII) 2.6 7.0 161
Mindanao Zamboanga Peninsula (IX) 2.6 9.5 92
Northern Mindanao (X) 2.9 9.3 121
Davao Region (XI) 3.0 7.1 68
SOCCKSARGEN (XII) 2.3 7.6 52
CARAGA (XIII) 2.1 7.9 82
ARMM 0.9 4.2 131