The Oxford Handbook of Health Economics by Sherry Glied Peter C Smith

Author:Sherry Glied, Peter C Smith [Sherry Glied, Peter C Smith]
Language: eng
Format: epub
Publisher: Oxford University Press, USA
Published: 2011-04-06T14:00:00+00:00

CHAPTER 21

THE GLOBAL HEALTH WORKFORCE*

TILL BÄRNIGHAUSEN AND DAVID E. BLOOM

21.1 INTRODUCTION

“PEOPLE deliver health” (Joint Learning Initiative 2004). The health workforce, i.e. the people who are “primarily engaged in action with the primary intent of enhancing health” (WHO 2006), diagnose illnesses, heal, care for people, monitor health outcomes, support treatment adherence, provide medical information and prevent diseases. The importance of health workers as decision-makers and service providers in health systems is obvious. The magnitude of their role is matched by their impact on health spending. WHO estimates that across countries worldwide about 50 percent of total public and private health expenditure (including capital costs) is spent on health worker wages, salaries and allowances (Hernandez et al. 2006).

In the following, we review the health economics and health systems literature on the health workforce. We organize the review according to three perspectives on health workers, which correspond roughly to chronological phases of academic publication: health workforce planning (1960s and 1970s), the health worker as economic actor (1980s and 1990s), and the health worker as necessary resource (1990s and 2000s).

A major research focus of studies on the health care workforce in the 1960s and 1970s was on models to predict future health staffing needs; many planning models developed in this period are still applied today. This research was triggered by shortages of specific types of health workers in developed countries and by reports from socialist countries that health manpower planning could aid health policymakers in ensuring an adequate supply of health workers.

In the 1980s and 1990s, the research focus shifted to the study of health workers’ effects on allocative and technical efficiency in health systems. This research was motivated by the perception of rising health expenditures in developed countries and the belief that health workers do not always act in their patients’ best interests. In this chapter, we review the literature on one research theme in this phase that is not discussed in detail elsewhere in this book (health worker licensure).

In the 1990s and continuing in the 2000s, health workers increasingly became viewed as a resource necessary to the achievement of population health goals. In developed countries, essential health care could not be delivered in rural and remote areas because the human resources for such delivery were not available. In developing countries, it became apparent that population health goals—such as the United Nations Millennium Development Goals (MDGs) to “reduce child mortality,” “improve maternal health,” and “combat HIV/AIDS, malaria and other diseases” (United Nations 2009)—could not be attained unless the sizes of many national health workforces were dramatically increased. Given these two major themes in this phase, we review the research on programs to increase the supply of health workers to underserved areas in developed countries and studies measuring and analyzing international health worker migration.

In separate sub-sections below, we describe the health policy backgrounds that led to each phase of research and then review relevant literature. The three perspectives are of course highly stylized; the backgrounds are reductionist descriptions of much richer policy contexts; and the periods overlap.

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