The purpose of this report is to analyse the impact of a government policy which promotes the health care reform on health care workforce. All the information of this report was gathered through internet.
The findings are that the supply of health workforce is not enough, the distribution of workforce is unbalance, remote and rural areas can not provide attractive environment for health professionals, health education and training need to be improved, the amount of nurses working in rural areas should be expanded, the monitoring and evaluation makes policies slow and difficult to performance, and health care services are lack of coordination and integration.
It is recommended that health workforce planning is a continually changing subject, so the lately materials should be used in this report which might be better than using outdated information.
The purpose of this report is to analyse the impact of a government policy which promotes the health care reform on health care workforce.Background information
National Health and Hospital Reform Commission (NHHRC) is an organisation that develops a long-term health reform plan for a modern Australia. Its final report named "A Healthier Future for all Australia" (2009, p.9) points out that "a practical national plan for health reform will benefit Australians, not just now but well into the future". Australian Health Workforce Official Committee (AHWOC) published a Health Workforce Impact Checklist and Guideline which can help to find out the workforce issues that might impact new policies, proposals and programs.Definition
The public health workforce: According to a report of the Public Health Functions Project, "The public health workforce has frequently been defined as those individuals employed by local, State, and Federal government health agencies"Scope and focus
This report is focusing on the primary care services (community health, public dental services, family and child health services, and alcohol and drug treatment services as well as general practitioner services). In addition, another important material is Health Workforce Impact Checklist and Guidelines, including 7 principles, which can be used to assess the recommendation represented by NHHRC.Methods
Use Health Workforce Checklist and Guideline to assess the recommendation of the final report conducted by NHHRC. Find references through internet to prove the opinions.
According to health workforce checklist and guideline, principle 1 is about health workforce supply and refers to workforce intakes, recruitment and retention.
It is said that shortages of medical personnel are existing in most medical sphere, especially in general practice (Brooks, Lapsley & Butt 2003). According to Joyce, McNeil and Stoelwinder (2006), the supply of GP workforce is facing a chronic shortage from 2001 to 2012, which has a similar situation with the hospital non-specialist workforce. Schofield and Beard (2005, pp 80-83) reveal that the decline of baby boomer clinicians will increase the pressure of health workforce and the policy makers who tries to "ensure the workforce needs are met over the next 20 years".
Retirement is an important determinant of the workforce supply. Australia Institute of Health and Welfare (2005) reported that 45% of health workforces were 55 or beyond 55.The Commonwealth Government could ameliorate the policy and incentives "to encourage the ongoing employment among older clinicians" (Schofield and Beard 2005, pp.80-83). It is known that promoting flexible working hours is another measure to absorb medical labour force (Joyce, McNeil & Stoelwinder 2006).Principle 2
Principle 2 is used to judge whether all Australians has equal rights to access equitable health care.
It is obvious that the health workforce distribution has a defect. According to Commonwealth of Australia (2009, p10), "workforce shortages exist across most primary health care professions, and are exacerbated mal-distribution". Dussault and Franceschini (2006) stress that unbalance distribution of health care personnel is a long-term and widespread problem; what's worse, it causes inequality between rural and urban population in health care. The health problems are prominent in rural areas because of the lack of health workforce, while there are too many staffs in wealthier areas, especially doctors (Dussault & Franceschini 2006).
Government funds in the establishment of facilities, which is an important approach for outreach services (Commonwealth of Australia 2009). In addition, government can ascend invest in health expenditure (such as health insurance and training of health professionals) to ensure both rural and urban population has equivalent health care services (Australian Institute of Health and Welfare 2008). Dassault and Franceschini (2006) maintain that multiple incentives of working in remote areas have great appealing for those health practitioners.Principle 3
Principle 3 focuses on the comfortable health care environments, which make staff willing to work in the health organizations.
Actually, workforce recruitment and retention of health professionals is a complicated interaction between personal factors and environments3. For instance, Schoo et al. (2005) mentions that some allied health professionals leave the remote or rural areas, because their spouses can not find appropriate jobs there. It is considered that "there is a lack of a good information and performance measures to support primary health care professional" (Commonwealth of Australia 2009).
Schoo et al. (2005) suggests that the government should satisfy both individual practitioners' and their families' needs, so that rural areas could retain the existing health professionals and even recruit more new professionals. According to Commonwealth of Australia (2009), the improvement of Physical infrastructure can offer advanced equipments and comfortable working environment to attract medical practitioners.Principle 4
Principle 4 refers to the education and training of health workforce, which is ensured to be skilled and competent.
It is estimated that current education and training arrangements can not provide "the future needs of primary health care" (Commonwealth of Australia 2009, p9). The recent health system has insufficient resources to coordinate the medical education and training (McGrath et al. 2006). McGrath et al (2006, p346) also considers that "The links between prevocational and vocational training must be improved".
Commonwealth of Australia (2009) proposes that health practitioners should establish clear roles and responsibilities around core competencies. Recently, Australian government expands the fund of health workforce and community-based clinical training, so both GP training places has risen by 33% since 2004, and nursing training places also are set up 1,134 more than before in 2009 (Commonwealth of Australia 2006).Principle 5
Principle 5 is to get optimal use of workforce skills and best outcomes through changing the old arrangement of health workforce or creating new roles.
The amount of nurses which should be expanded is insufficient in remote and rural areas. According to Mental Health Workforce Advisory Committee (2008), in 2005 majority of Mental Health Nurses (MHNs) worked in urban areas with 69 FTE per 100,000 population, which was approximately 2 times as large as those working in rural or very remote areas. The main obstacle of expanding professional roles is State laws; besides, the lack of funding in health service is another element (Health Profession Council of Australia 2005)
Health Profession Council of Australia (2005) emphasizes that the redesign of health workforce should be established on professional basis. Mental Health Workforce Advisory Committee (2008) proposes that "further development of mental health nurse practitioner roles"; meanwhile, improve the working conditions to attract graduate nurses; moreover, boosting the job roles in primary health care.Principle 6
Principle 6 is about some factors that can impact organizations or policy makers to practice workforce policy and planning.
Dussault and Franceschini (2006) present that the government develops new policies to fit the standard of lately health care services, but the policies always are slow and difficult to publish because of the complex monitoring and evalution.
Policy performed directly by government only can not effectively get expected health care outcomes for consumers; however, "true collaborative partnership between industry and government are likely to result in mutually agreeable outcomes" (Health Profession Council of Australia 2005, p5).Principle 7
Principle 7 is about the relation of stakeholders that can impact the performance of policy and help to find out the workforce issues.
Commonwealth of Australia (2009) reveals that the health care services are lack of coordination and integration, especially in the areas of aged care and specialist care. Commonwealth government not only changes the policy and but also increases investment to ensure the health care services which meet the needs of communities. The funding in infrastructures can improve the access of various services for communities, and enhance the work efficiency of health professionals (Commonwealth of Australia 2009)
Commonwealth government fund in health services training and infrastructures to ascend the cohesion of Australian health workforce (Health Professions Council of Australia 2005).Conclusions
There are still gaps and disadvantages in health workforce planning, such as the short supply and mal-distribution of workforce; furthermore, the health training and policies should be improved. Consequently, Commonwealth Government should enhance the investment of primary health care services.
- Brooks, PM, Lapsley, HM & Butt, DB 2003, 'Medical workforce issues in Australia: tomorrow's doctors too few, too far', MJA, vol. 179, no. 8, pp. 206-208.
- Dassault, G & Franceschini, MC 2006, 'Not enough there, too many here: understanding geographical imbalances in the distribution of health workforce', Human Resources for Health, vol. 4, no. 12.
- McGrath, BP, Graham, JS, Crotty, BJ & Jolly, BC 2006, 'Lack of integration of medical education in Australia: the need for change', MJA, vol.184, no. 7, pp. 346-348.
- Joyce, CM, McNeil, JJ, & Stoelwinder, JU 2006, ' More doctors, but not enough: Australia medical workforce supply 2001-2012', MJA, vol. 184, no. 9, pp. 441-446.
- Schofield, DJ & Beard, JR 2005, 'Baby boomer doctors and nurses: demographic change and transitions to retirement', MJA, vol. 183, no. 2, pp. 80-83.
- Schoo, AM, Stagnitti, KE, Mercer, C & Dunbar, J 2005, 'A conceptual model for recruitment and retention: Allied health workforce enhancement in Western Victoria, Australia', Rural and Remote Health, 23 December, viewed 21 March 2010, http://www.rrh.org.au.
- Teusner, DN & Spencer, AJ, 2003. Dental labour force, Australia 2000, p. 24.
- Australian Institute of Health and Welfare 2008, Australian's health, Canberra, Australia.
- Australian Institute of Health and Welfare 2005, Medical labour force 2003, Canberra, Australia.
- Commonwealth of Australia 2009, Building a 21st Century Primary Health Care System: A Draft of Australia's First National Primary Health Care Strategy, Austrlia.
- Health Professions Council of Australia 2005, Australian's health workforce, Melbourne, Australia.
- Mental Health Workforce Advisory Committee 2008, Mental health workforce: supply of metal health nurses, Australia.