OECD/EUROSTAT/WHO JOINT QUESTIONNAIRE

2012

FOCUS ON DOCTORS

OECD Health Data National Correspondents Meeting 11-12 October 2012

Content of the Joint Questionnaire

• Physicians

• Midwives, nurses and caring personnel

• Dentists, pharmacists, physiotherapists

• Hospital employment

• Graduates

Health employment

and education

• Hospitals

• Hospital beds

• Beds in nursing and residential care facilities

• Medical equipment

Physical and technical resources

Only one change in 2012: Physicians by categories

2012 Round of Joint Questionnaire

• 61 countries involved in 2012 – 34 OECD countries (in Europe and outside Europe)

– 27 other European countries (EU members/candidates and other WHO-Europe members)

• Same timeline as for OECD Health Data questionnaire – Half of OECD countries met the deadline of end February

for returning the questionnaire

– Data validation process from March to June, implying a lot of exchanges between national correspondents and colleagues from international organisations

– Data from the JQ released on 28 June in OECD Health Data 2012 (and later in summer in WHO-Europe and Eurostat databases)

2012 Change

Nb % between

(96 series) 2012/11

Israel 90 94% 5%

Estonia 84 88% 1%

Denmark 83 86% -2%

Korea 80 83% 11%

Netherlands 80 83% 1%

Austria 77 80% 1%

Chile 77 80% 44%

Finland 77 80% 0%

Iceland 77 80% 0%

France 73 76% 2%

New Zealand 71 74% 5%

United States 71 74% 8%

Luxembourg 70 73% 28%

Germany 69 72% 1%

Italy 69 72% 1%

Slovenia 69 72% 12%

Spain 68 71% 7%

Hungary 67 70% -1%

Average 66 69% 5%

General improvement in data availability

2012 Change

Nb % between

(96 series) 2012/11

Average 66 69% 5%

Ireland 66 69% -6%

Czech Republic 65 68% -1%

Norway 65 68% 1%

Slovak Republic 65 68% 2%

Poland 64 67% 3%

Switzerland 64 67% 6%

Australia 62 65% 2%

Portugal 62 65% 6%

Greece 61 64% -2%

Canada 60 63% 1%

Belgium 56 58% 18%

Turkey 48 50% 0%

Japan 43 45% -3%

Sweden 39 41% 7%

United Kingdom 34 35% 1%

Mexico 32 33% 6%

Total number of physicians:

data availability

Concept Definition Number of countries available

Practising • Providing services directly to patients

27 (+2 since 2010: ITA, FRA)

Professionally active

• Practising • Working in the health system as administrators, managers, researchers, teachers, etc.

24 (+5 since 2010:

IRL, LUX, NLD, NOR, SWE)

Licensed to practice

• All physicians who are licensed to practice, including practising or non-practising (e.g. unemployed, retired, working abroad)

23 (+2 since 2010: CHL, NOR)

• The use of different sources for the three concepts reduces data consistency

• Data variability due to the use of surveys

Total number of physicians:

data issues (1)

2.5

3.0

3.5

4.0

4.5

5.0

1995 1997 1999 2001 2003 2005 2007 2009 2011

Practising Professionally active Licensed to practice

registry

Source: OECD Health Data 2012.

Physicians per 1000 population, Israel

LFS

registry

• Breaks in time series limit data analysis over time

Total number of physicians:

data issues (2)

2.0

2.5

3.0

3.5

4.0

4.5

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010

Hungary Norway Poland

B

B B

B

B

B

B B B

Practising physicians per 1000 population

Source: OECD Health Data 2012.

• Remaining data gaps, in particular for key concept “practising”

Total number of physicians:

data issues (3)

0

1

2

3

4

5

6

7

Gre

ece

Au

stri

a N

orw

ay

Ital

y Po

rtu

gal

Swit

zerl

and

Sw

eden

Sp

ain

G

erm

any

Icel

and

C

zech

Rep

ub

lic

Isra

el

Den

mar

k Sl

ova

k R

epu

blic

Fi

nla

nd

Fr

ance

Es

ton

ia

Irel

and

A

ust

ralia

B

elgi

um

N

eth

erla

nd

s H

un

gary

Lu

xem

bo

urg

U

nit

ed K

ingd

om

N

ew Z

eala

nd

U

nit

ed S

tate

s Sl

ove

nia

C

anad

a Ja

pan

Po

lan

d

Mex

ico

K

ore

a Tu

rkey

C

hile

Practising Professionally active Licenced to practice

Physicians per 1000 population, 2010

Source: OECD Health Data 2012.

Practising vs professionally active

physicians, 2010

0

1

2

3

4

5

Pe

r 1

00

0 p

op

ula

tio

n

Practising physicians Professionally active physicians

19% 2% 5% 7% 9% 11% 0% 7% 0% 7% 8% 5% 12% 13% 1% 5% 3% 3% 9%

On average: +7%

Source: OECD Health Data 2012.

Practising vs licensed physicians, 2010

0

1

2

3

4

5

6

7

Pe

r 1

00

0 p

op

ula

tio

n

Practising physicians Physicians licensed to practice

37% 56% 28% 44% 66% 88% 55% 29% 32% 23% 67% 69% 53% 60% 18% 31% 61% 23%

On average: +47%

Source: OECD Health Data 2012.

Approaches to fill data gaps for

“practising” concept

• Identify new potential data sources

• Use estimation methods Two examples: 1) First approach based on the average difference (7%) between practising and

professionally active physicians across other OECD countries. (For countries having data on “professionally active” and no data on “practising”).

2) Second approach based on the fact that the trends are usually very similar for practising and professionally active physicians. (For countries having time series on “professionally active” and at least one data point on “practising”, e.g. FIN, FRA, ITA, SVK and CHE).

2.0

2.5

3.0

3.5

4.0

4.5

2000 2002 2004 2006 2008 2010

Germany

Australia

USA

Practising Professionally active

Physicians per 1000 population, 2000-10

Source: OECD Health Data 2012.

Physicians by categories

Amendments to the 2012 questionnaire

Categories of physicians Extracts from definitions

1) Generalist medical practitioners (2211)

General practitioners • GPS, family doctors responsible for continuous care • Interns or residents specialising in general practice

Other generalist (non-specialist) medical practitioners

• Non-specialist physicians in hospital or elsewhere • Interns or residents without any area of specialisation yet

2) Specialist medical practitioners (2212)

• Specialists

• Interns or residents training for a specialty

General paediatricians

Obstetricians & gynaecologists

Psychiatrists

Medical group of specialists

Surgical group of specialists

Other specialists n.e.c.

3) Medical doctors not further defined (2210)

• Doctors who cannot be classified in other categories • Interns and residents who cannot be classified in other categories

• Generalists (total) and specialists (total and breakdown):

33 countries (all except JPN)

+ 5 countries since 2010 (CHL, HUN, LUX, ESP, SWE)

• Breakdown between GPs and other generalists/ non-specialists (requested for the first time in 2012):

15 countries

Physicians by categories:

data availability

• A number of countries have adjusted their data submission according to the new specifications

Physicians by categories:

improvement in data allocation

50 42

20 13 9 13 23

7 13 9

38 18

13

53

11

51 56

62

23

77

52 59

64

33

80

8 2

18

63

13 15

0

20

40

60

80

100

Generalists GPs Other generalists Specialists Doctors n.f.d.

2011 questionnaire 2012 questionnaire %

Source: OECD Health Data 2012.

Better identification of GPs

Less physicians in the “not further defined” category

Physicians by category, in % of total number of physicians, 2009

• Gaps in the split between GPs and other generalists/ non-specialists for about half of countries

• When Total generalists=GPs

Is it because there are no “other generalists”? (e.g. LUX, ESP)

Is it because it is not possible to distinguish “GPs” from “other generalists”? (e.g. FRA)

Physicians by categories:

data issues (1) Per 1000

pop

Total

generalists

GPs Other

generalists

Ireland 2.79 0.57 2.22

Norway 2.46 0.83 1.63

Portugal 1.99 0.50 1.49

France 1.59 (d) 1.59 ..

Austria 1.58 0.78 0.80

Germany 1.57 0.66 0.91

Australia 1.52 1.17 0.35

Netherlands 1.26 0.72 0.54

Finland 1.13 .. ..

Belgium 1.12 1.12 ..

Canada 1.12 1.12 ..

Italy 0.94 0.77 0.18

Chile 0.88 0.88 ..

Estonia 0.83 0.74 0.10

Luxembourg 0.82 0.82 0.00

Korea 0.80 0.44 0.35

United Kingdom 0.80 .. ..

New Zealand 0.75 .. ..

Spain 0.75 0.75 0.00

Mexico 0.74 0.74 ..

Denmark 0.73 .. ..

Czech Republic 0.70 .. ..

Israel 0.69 0.26 0.43

Sweden 0.63 0.63 ..

Switzerland 0.61 .. ..

Iceland 0.57 0.57 ..

Turkey 0.56 .. ..

Slovenia 0.51 0.44 0.07

Poland 0.46 0.21 0.25

Slovak Republic 0.41 .. ..

Hungary 0.34 .. ..

Greece 0.30 .. ..

United States 0.30 0.30 .. Source: OECD Health Data 2012.

• Still big variations in total number of generalists per capita (less variations in number of GPs)

Physicians by categories:

data issues (2)

0.6 0.8

0.5 0.8 0.7

1.2 0.7 0.8 0.7 0.8

0.4 0.8

0.3 0.4 0.2

2.8

2.5

2.0

1.6 1.6 1.6 1.5

1.3 1.1 1.1 1.1

1.0 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.8 0.7 0.7 0.7 0.7 0.6 0.6 0.6 0.6 0.5 0.5 0.4 0.3 0.3 0.3

0

1

2

3 Generalist medical practitioners General practitioners Other generalists (non-specialists)

Physicians by category, per 1000 population, 2010

Source: OECD Health Data 2012.

• Still high share of “physicians not further defined” in some countries

Physicians by categories:

data issues (3)

66 62 60 52 49 49 47 43 42 40 38 36 35 33 33 31 30 29 29 26 26 21 21 21 20 20 20 17 16 16 14 12 12

5

34 38 40 52 48 51 53 57 58 60 60 64

46

67

50 60

71 71

50 66

74

41

79 76 65 64

77

54 64 62

86 88

58 56

2 1

20 18 9

22 9

38

3 15

3

29 20 22

1

31 39

0

20

40

60

80

100

Generalist medical practitioners Specialist medical practitioners Medical doctors n.f.d. %

Source: OECD Health Data 2012.

Physicians by category, in % of total number of physicians, 2010

• The data do not add up for some countries

– Double-counting of physicians who have more than one specialty (AUT, IRL, PRT, GBR)

– Underreporting of specialists (ESP includes specialists working in hospital only)

Physicians by categories:

data issues (4)

GPs Other generalists

General paedia- tricians

Obstetric. & gynae- cologists

Psychia-trists

Medical group

Surgical group

Other specialists

Doctors not further defined

Sum

Austria 16.2 16.7 3.1 4.1 3.1 20.4 18.5 1.0 17.6 100.7

Ireland (2011)

17.6 48.8 2.6 1.9 5.1 17.3 11.3 1.4 0.0 106.0

Portugal 13.0 39.1 3.9 3.8 2.7 20.8 15.4 4.9 - 103.6

Spain 19.9 0.0 3.6 2.7 2.1 15.8 18.2 21.2 - 83.5

United Kingdom

29.6 5.5 4.3 7.1 23.1 26.9 4.0 - 100.4

Physicians by category, in % of total number of physicians, 2010

Source: OECD Health Data 2012.

• No change except the proposed move of “Occupational medicine”

2013 Joint Questionnaire

Physicians by categories

Generalist medical practitioners (2211)

- General practitioners - Other generalist (non-specialist) medical practitioners

Specialist medical practitioners (2212)

- General paediatricians - Obstetricians & gynaecologists - Psychiatrists - Medical group of specialists - Surgical group of specialists - Other specialists n.e.c.

Medical doctors not further defined (2210)

“Occupational medicine”

• Comment on the experience with filling the 2012 joint questionnaire on doctors, in particular any issues when allocating doctors by category

• Comment on the prospects of filling any persisting data gaps in reporting data on practising (and/or professionally active doctors), or indicate whether it may be acceptable to use some agreed-upon method to fill key persisting data gaps

• Agree on the reallocation of “occupational medicine” in the “medical group of specialists”

Discussion