Belgian Health Care Knowledge Centre, Brussels, Belgium.
Hum Resour Health. 2009 Feb 13;7:10. doi: 10.1186/1478-4491-7-10.
Anticipating physician supply to tackle future health challenges is a crucial but complex task for policy planners. A number of forecasting tools are available, but the methods, advantages and shortcomings of such tools are not straightforward and not always well appraised. Therefore this paper had two objectives: to present a typology of existing forecasting approaches and to analyse the methodology-related issues.
A literature review was carried out in electronic databases Medline-Ovid, Embase and ERIC. Concrete examples of planning experiences in various countries were analysed.
Four main forecasting approaches were identified. The supply projection approach defines the necessary inflow to maintain or to reach in the future an arbitrary predefined level of service offer. The demand-based approach estimates the quantity of health care services used by the population in the future to project physician requirements. The needs-based approach involves defining and predicting health care deficits so that they can be addressed by an adequate workforce. Benchmarking health systems with similar populations and health profiles is the last approach. These different methods can be combined to perform a gap analysis. The methodological challenges of such projections are numerous: most often static models are used and their uncertainty is not assessed; valid and comprehensive data to feed into the models are often lacking; and a rapidly evolving environment affects the likelihood of projection scenarios. As a result, the internal and external validity of the projections included in our review appeared limited.
There is no single accepted approach to forecasting physician requirements. The value of projections lies in their utility in identifying the current and emerging trends to which policy-makers need to respond. A genuine gap analysis, an effective monitoring of key parameters and comprehensive workforce planning are key elements to improving the usefulness of physician supply projections.
预测未来医疗挑战所需的医生数量，是政策制定者的一项关键但复杂的任务。有许多预测工具可用，但这些工具的方法、优势和缺点并不直观，也并非总是得到很好的评估。因此，本文有两个目标：介绍现有的预测方法类型，并分析与方法相关的问题。
我们在电子数据库 Medline-Ovid、Embase 和 ERIC 中进行了文献回顾，并分析了各国的具体规划经验。
确定了四种主要的预测方法。供应预测方法定义了维持或在未来达到任意预定服务水平所需的流入量。基于需求的方法估计未来人口使用的医疗服务数量，以预测医生的需求。基于需求的方法涉及定义和预测医疗保健不足，以便通过适当的劳动力来解决这些不足。以具有相似人口和健康特征的卫生系统为基准是最后一种方法。这些不同的方法可以结合起来进行差距分析。这些预测的方法学挑战很多：通常使用静态模型，且其不确定性未得到评估；用于模型的有效和全面的数据往往缺乏；快速变化的环境会影响预测情景的可能性。因此，我们综述中包含的预测的内部和外部有效性似乎有限。
没有一种单一的方法被广泛接受来预测医生的需求。预测的价值在于它们能够识别当前和新兴趋势，政策制定者需要对这些趋势做出反应。真正的差距分析、对关键参数的有效监测以及全面的劳动力规划是提高医生供应预测有用性的关键要素。
