Winkelmann Juliane, Muench Ulrike, Maier Claudia B
Department of Healthcare Management, Technische Universität Berlin, H 80, Straße des 17. Juni 135, 10623, Berlin, Germany.
Department of Social and Behavioural Sciences, University of California San Francisco, School of Nursing, 3333 California Street, Ste 455, San Francisco, CA, 94118, USA.
BMC Health Serv Res. 2020 Oct 12;20(1):937. doi: 10.1186/s12913-020-05760-y.
Country-level data suggest large differences in the supply of health professionals among European countries. However, little is know about the regional supply of health professionals taking a cross-country comparative perspective. The aim of the study was to analyse the regional distribution of physicians, nurses and midwives in the highest and lowest density regions in Europe and examine time trends.
We used Eurostat data and descriptive statistics to assess the density of physicians, nurses and midwives at national and regional levels (Nomenclature of Territorial Units for Statistics (NUTS) 2 regions) for 2017 and time trends (2005-2017). To ensure cross-country comparability we applied a set of criteria (working status, availability over time, geographic availability, source). This resulted in 14 European Union (EU) countries and Switzerland being available for the physician analysis and eight countries for the nurses and midwives analysis. Density rates per population were analysed at national and NUTS 2 level, of which regions with the highest and lowest density of physicians, nurses and midwives were identified. We examined changes over time in regional distributions, using percentage change and Compound Annual Growth Rate (CAGR).
There was a 2.4-fold difference in the physician density between the highest and lowest density countries (Austria national average: 513, Poland 241.6 per 100,000) and a 3.5-fold difference among nurses (Denmark: 1702.5, Bulgaria: 483.0). Differences by regions across Europe were higher than cross-country variations and varied up to 5.5-fold for physicians and 4.4-fold for nurses/midwives and did not improve over time. Capitals and/or major cities in all countries showed a markedly higher supply of physicians than more sparsely populated regions while the density of nurses and midwives tended to be higher in more sparsely populated areas. Over time, physician rates increased faster than density levels of nurses and midwives.
The study shows for the first time the large variation in health workforce supply at regional levels and time trends by professions across the European region. This highlights the importance for countries to routinely collect data in sub-national geographic areas to develop integrated health workforce policies for health professionals at regional levels.
国家层面的数据显示，欧洲国家之间卫生专业人员的供应存在巨大差异。然而，从跨国比较的角度来看，对于卫生专业人员的地区供应情况却知之甚少。本研究的目的是分析欧洲最高和最低人口密度地区内科医生、护士和助产士的区域分布，并研究其时间趋势。
我们使用欧盟统计局的数据和描述性统计方法，评估了2017年国家和地区层面（统计领土单位命名法（NUTS）2级地区）内科医生、护士和助产士的密度以及时间趋势（2005 - 2017年）。为确保跨国可比性，我们应用了一组标准（工作状态、随时间的可获得性、地理可获得性、来源）。这使得14个欧盟国家和瑞士可用于内科医生分析，8个国家可用于护士和助产士分析。在国家和NUTS 2级层面分析了每人口的密度率，从中确定了内科医生、护士和助产士密度最高和最低的地区。我们使用百分比变化和复合年增长率（CAGR）研究了区域分布随时间的变化。
密度最高和最低的国家之间，内科医生密度相差2.4倍（奥地利全国平均水平：每10万人中有513人，波兰为241.6人），护士密度相差3.5倍（丹麦：1702.5人，保加利亚：483.0人）。欧洲各地区之间的差异高于国家间差异，内科医生差异高达5.5倍，护士/助产士差异高达4.4倍，且未随时间改善。所有国家的首都和/或主要城市内科医生的供应明显高于人口较为稀少的地区，而护士和助产士的密度在人口较为稀少的地区往往更高。随着时间的推移，内科医生的比例增长速度快于护士和助产士的密度水平。
该研究首次表明了欧洲地区卫生人力供应在区域层面和各职业时间趋势上的巨大差异。这凸显了各国定期收集次国家地理区域数据以制定区域层面卫生专业人员综合卫生人力政策的重要性。
