The health workforce demand: a systematic literature review

Lopes, Diana Fernandes; Ramos, Ana Luísa; Castro, Eduardo Anselmo de

doi:10.1590/1413-81232021266.1.40842020

Diana Fernandes Lopes

Departamento de Ciências Sociais, Políticas e do Território, Unidade de Investigação em Governança, Competitividade e Políticas Públicas (GOVCOPP), Universidade de Aveiro. Campus Universitário de Santiago. 3810-193 Aveiro. Portugal. lopesdiana@ua.pt

https://orcid.org/0000-0002-6879-1625

Ana Luísa Ramos

Departamento de Economia, Gestão, Engenharia Industrial e Turismo, Unidade de Investigação em Governança, Competitividade e Políticas Públicas (GOVCOPP), Universidade de Aveiro. Abeiro Portugal.

https://orcid.org/0000-0003-4401-7747

Eduardo Anselmo de Castro

Departamento de Ciências Sociais, Políticas e do Território, Unidade de Investigação em Governança, Competitividade e Políticas Públicas (GOVCOPP), Universidade de Aveiro. Campus Universitário de Santiago. 3810-193 Aveiro. Portugal. lopesdiana@ua.pt

https://orcid.org/0000-0001-9017-5098

Collaborations

DF Lopes and AL Ramos designed the study. DF Lopes collected the data, performed the analyses, and wrote the initial draft. AL Ramos and EA Castro (supervision) were involved in the correction of the manuscript’s final drafts. The authors all read, contributed to, and agreed to submit the manuscript for publication.

Chief editors:

Maria Cecília de Souza Minayo, Romeu Gomes, Antônio Augusto Moura da Silva

Figures (5)
Tables (6)

Thumbnail

Figure 1
PRISMA flowchart of the study selection (cut-off date: 7^th of January 2019).

Thumbnail

Figure 2
Overview of the general aspects of the selected publications.

Thumbnail

Figure 3
Characterization of the selected articles according to: (a) scale of application and (b) scientific field.

Thumbnail

Figure 4
Characterization of the selected articles according to: (a) profession, and (b) typology of healthcare services.

Thumbnail

Table 1
Distribution of the selected studies per methodology.

Thumbnail

Chart 1
Pros and cons of selected methods.

Thumbnail

Model Demand “Method*” OR “technique*” OR “tool*” OR “Model?*” OR “estimat*” “Health care” OR “healthcare” AND (“demand*” OR “requirement*”) Human resources for health Context “Workforce” OR “professionals” OR “worker*” OR “manpower” OR “human health resources” OR “human resources for health” “Plan*” OR “policy*”

Thumbnail

Clinical Journals Medical journals Dental journals . Acta Ophthalmologica . Archives of Pathology & Laboratory Med. . Cardiologia . Cardiovascular Surgery . British Dental Journal . Community Dentistry and Oral Epidemiology . International Dental Journal . Investigative and Clinical Urology Others . Neurology . Academic Emergency Medicine . Alimentary Pharmacology and Therapeutics . Diabetes Cares . Ethnicity and Disease . Journal of the Academy of Nutrition and Dietetics . Mayo Clinic proceedings . PM and R: The Journal of Injury, function, and rehabilitation . JAMA . Milbank Quarterly . Revista Argentina de Family Practice . Otolaryngology - head and neck surgery . Ophthalmology . Pediatrics . Pedriatics and Neonatology . The Annals of Thoracic Surgery . The Journal of Thoracic and Psychiatric Serv. Journals Related to Health Policy and Management . Australian Health Review . BMC Public Health . Human Resources for Health . IIE Transactions (Institute of Industrial Eng.) . Bulletin of the WHO . Emerald Group Publishing Limited . Health Care Management Science . Health Policy . Health Policy and Planning . Health Systems . Israel Journal of Health Policy Research . Long Range Planning . Management Science . PLoS One . Policy, Politics, and Nursing Practice . The Lancet Public Health

Thumbnail

Authors Year of publication Journal Scopus citations Angus et al. 2000 Journal of American Medical Association 712 Thomas et al. 2009 Psychiatric Services 194 Vijan et al. 2004 Alimentary Pharmacology & Therapeutics 121 Scheffler et al. 2008 Bulletin of the World Health Organization 105 Hofer et al. 2011 The Milbank Quarterly: A Multidisciplinary Journal of Population Health and Health Policy 104 Dall et al. 2013 Neurology 93 Schubert et al. 2001 Mayo Clinic Proceedings 37 Liu et al. 2017 Human Resources for Health 34 Murphy et al. 2012 Health Policy 27 Lipscomb et al. 1998 Management Science 25 Tuulonen et al. 2009 Acta Ophthalmologica 25 Gallagher et al. 2010 British Dental Journal 24 Zimbelman et al. 2010 PM & R: The Journal of Injury, Function and Rehabilitation 24 Kim et al. 2012 Otolaryngology-Head and Neck Surgery 23 Lee et al. 1995 Ophthalmology 20 Rizza et al. 2003 Diabetes Care 17 Murphy et al. 2009 Policy, Politics, & Nursing Practice 17 Hooker et al. 2012 Journal of the Academy of Nutrition and Dietetics 17 Vanderby et al. 2010 The Annals of Thoracic Surgery 16 Holliman et al. 1997 Academic Emergency Medicine 12

Thumbnail

No Ref. Pub. year Country Scale Health professions Components addressed Affiliation/Application 1 [18] 1976 ISR / ISR Country Physicians (GP; PD; SUR; D; OPH, GYN; OR; N; U) 1 Demand and supply 2 [19] 1993 UK / CHN Country Physicians Demand 3 [30] 1995 USA / USA Country Physicians (ophthalmologists and optometrists) Demand, need and supply 4 [41] 1997 USA / USA Country (states) Emergency physicians (EP) Demand and supply 5 [52] 1998 USA / USA Country Internal medicine Demand 6 [63] 2000 USA / USA Country Physicians (intensivists and pulmonologists) Demand, needs and supply 7 [67] 2001 USA / USA Country Physicians (anaesthesiologists) Demand and supply 8 [68] 2003 USA / USA Country Physicians (endocrinologists) Demand, needs and supply 9 [69] 2004 USA / USA Country Physicians (endoscopists) Demand and supply 10 [70] 2008 USA / WHO region Countries Physicians Demand, needs and supply 11 [20] 2009 CAN / CAN Province (Nova Scotia) Nurses Demand, needs and supply 12 [21] 2009 FIN / FIN Country Physicians (ophthalmologists) Needs, costs and supply 13 [22] 2009 USA / USA County Physicians (mental health professionals) Demand, needs and supply 14 [23] 2010 USA / USA State (Island of Hawaii) Physicians Demand and supply 15 [24] 2010 ENG / ENG Country Dentists Demand and supply 16 [25] 2010 USA / USA Country Physical therapists (PT) Demand and supply 17 [26] 2010 CAN / CAN Country Physicians (cardiac surgeons) Demand and supply 18 [27] 2011 USA / USA State (50) Physicians (Primary healthcare) Demand 19 [32] 2012 USA / USA Country Dietitians and dietetic technicians Demand and supply 20 [28] 2012 USA / USA Country Physicians (otolaryngology workforce) Demand and supply 21 [31] 2012 NLD / THA Province Mix of HRH (physicians and nurses) Demand and needs 22 [33] 2012 CAN / CAN Country Nurses Demand, needs and supply 23 [29] 2012 JPN / JPN Country Physicians Demand and supply 24 [34] 2013 USA / USA Country and 50 states Physicians (neurology workforce) Demand and supply 25 [35] 2013 UK / ENG Subregional communities & region Dental team Demand, needs and supply 26 [36] 2013 TWN / TWN Country Physicians (paediatricians) Demand and supply 27 [37] 2013 UK / ENG Country Dental team Demand and supply 28 [38] 2014 CAN / JAM Country Pharmacists Needs and supply 29 [39] 2014 CAN / CAN Country Cardiac surgeons Demand and supply 30 [40] 2014 CAN / CAN Country Thoracic surgeons Demand, needs and supply 31 [45] 2015 ITA / ITA Region Physicians Demand and supply 32 [46] 2015 USA / USA Country and 50 states Occupational therapists Demand and supply 33 [43] 2015 USA / USA Country Nurses (paediatric nurse practitioners (PNPs)) Demand and supply 34 [49] 2015 ISR / ISR Country Nurses Demand and supply 35 [48] 2015 USA / USA Country Pathologists Demand and needs 36 [47] 2015 SGP / SGP Country Ophthalmologists Demand, needs and supply 37 [44] 2015 UK / LKA Country Odontology team Demand, needs and supply 38 [42] 2015 AUS / AUS Country Physicians (radiology) Demand and supply 39 [50] 2016 USA / USA Country Nurses Demand 40 [51] 2016 ARG / ARG Country Physicians Demand 41 [53] 2016 DEU / DEU Region Dentists Demand and supply 42 [54] 2016 CAN / OECD countries Country Mix of HRH (midwives, nurses, physicians) Needs and supply 43 [55] 2016 AUS / AUS State (South Australia) Physicians (GP) Demand, needs and supply 44 [56] 2016 ITA / ITA Region Physicians Demand, needs and supply 45 [57] 2017 CHE / 6 countries Country (AZE, MWI, MMR, PER, UZB & ZMB) Mix of HRH (SRMNAH2 workers) Needs 46 [58] 2017 KOR / KOR Country Physicians (urologists) Demand and supply 47 [59] 2017 AUS / AUS State (South Australia) Physicians (general practitioners (GP)) Needs and supply 48 [60] 2017 JPN / JPN Prefecture (Hokkaido) Physicians Demand and supply 49 [61] 2017 USA / WHO countries Country (165) Mix of HRH (nurses/midwives, physicians & other HRH) Demand and supply 50 [62] 2018 AUS / AUS State (South AUS) Mix of HRH (Therapists, Psychiatrists, Psychosocialists) Needs 51 [64] 2018 PRT / PRT Country Physicians Demand 52 [65] 2018 AUS / AUS State (South & Western AUS) Physicians (General practitioners) Demand, needs and supply 53 [66] 2018 PRT / PRT Country Physicians Demand and supply 1 GP: General practitioners; PD: Paediatrics; SUR: Surgery; D: Dermatology; OPH: Ophthalmology; GYN: Gynaecology; OR: Orthopaedics; N: Neurology; U: Urology. 2 SRMNAH: Sexual, reproductive, maternal, new-born and adolescent health workers.

Methods	Reference
Straightforward models	[23,30,43,48,49,57,62,66]
Regression methods (linear regression, autoregressive models, multivariate reg. model)	[18,22,25,27,28,32,35,41,46,53,58,61,63,64,67,68,70]
Simulation-based methods
System dynamics	[20,21,26,33,36,39,42,44,45,47,51,54,56,60]
Monte Carlo Simulation	[24,59]
Microsimulation	[34,40]
Other simulation models	[19,29,31,37,38,50,52,55,65,69]

Pros and cons	How it benefits the HRH planning	Challenges and issues
Straightforward models +Simple to use -Narrow scope -Easy to misuse the results by not recognizing the boundaries of their credibility -Limited validity, since the past and current data represent what was provided rather than a target -Subject to criticism, given the lack of scientific evidence	The development and implementation of these models are simple and have a low time consumption A typical user can use them (e.g., a policymaker) Reduced implementation costs Do not require specialized software	Results should be carefully analyzed, as they are based on strong assumptions and typically on few demand-related parameters Uncertainty and sensitivity analyses are typically unaddressed
Regression methods +Simple, widely known +Creates an overall understanding of what happened in the past and provides valuable insights regarding what may happen in the future -Limited validity, since the historical data represent what was provided rather than what is needed -Subject to criticism when this tool is not coupled with other instruments	Can help in the identification of critical relationships between relevant variables Can serve as a scenario to explore and an input (complement) for simulation models	Dependent on data availability Do not deal with uncertain data Do not display a component of sensitivity analysis Specialized software and specific expertise may be required
Simulation-based models +Building process can clarify the understanding of the real system +Allow optimization of the real system +Can maintain better control over experimental conditions +Time compression/expansion: can evaluate the system on a slower or faster time scale than the real system -Expensive and time-consuming -Easy to misuse simulation -Deterministic simulations are unable to deal with data uncertainty -Stochastic simulation usually requires several runs at given input values	They provide an overall picture of the problem and represent the links between variables A generic approach that can incorporate assumptions and restrictions from a scalar level to sophisticated mathematical formulations Stochastic simulations can perform robustness analysis by handling data uncertainty or scenario building Allow sensitivity analysis	Development can be demanding and laborious Complex for typical users Require specialized software and specific expertise Higher costs of implementation

Model	Demand
“Method” OR “technique” OR “tool” OR “Model?” OR “estimat*”	“Health care” OR “healthcare” AND (“demand” OR “requirement”)
Human resources for health	Context
“Workforce” OR “professionals” OR “worker*” OR “manpower” OR “human health resources” OR “human resources for health”	“Plan” OR “policy”

Clinical Journals
Medical journals	Dental journals
. Acta Ophthalmologica . Archives of Pathology & Laboratory Med. . Cardiologia . Cardiovascular Surgery	. British Dental Journal . Community Dentistry and Oral Epidemiology . International Dental Journal
. Investigative and Clinical Urology	Others
. Neurology	. Academic Emergency Medicine . Alimentary Pharmacology and Therapeutics . Diabetes Cares . Ethnicity and Disease . Journal of the Academy of Nutrition and Dietetics . Mayo Clinic proceedings . PM and R: The Journal of Injury, function, and rehabilitation
. JAMA
. Milbank Quarterly . Revista Argentina de Family Practice . Otolaryngology - head and neck surgery . Ophthalmology . Pediatrics . Pedriatics and Neonatology . The Annals of Thoracic Surgery . The Journal of Thoracic and Psychiatric Serv.
Journals Related to Health Policy and Management
. Australian Health Review . BMC Public Health	. Human Resources for Health . IIE Transactions (Institute of Industrial Eng.)
. Bulletin of the WHO . Emerald Group Publishing Limited . Health Care Management Science . Health Policy . Health Policy and Planning . Health Systems	. Israel Journal of Health Policy Research . Long Range Planning . Management Science . PLoS One . Policy, Politics, and Nursing Practice . The Lancet Public Health

Authors	Year of publication	Journal	Scopus citations
Angus et al.	2000	Journal of American Medical Association	712
Thomas et al.	2009	Psychiatric Services	194
Vijan et al.	2004	Alimentary Pharmacology & Therapeutics	121
Scheffler et al.	2008	Bulletin of the World Health Organization	105
Hofer et al.	2011	The Milbank Quarterly: A Multidisciplinary Journal of Population Health and Health Policy	104
Dall et al.	2013	Neurology	93
Schubert et al.	2001	Mayo Clinic Proceedings	37
Liu et al.	2017	Human Resources for Health	34
Murphy et al.	2012	Health Policy	27
Lipscomb et al.	1998	Management Science	25
Tuulonen et al.	2009	Acta Ophthalmologica	25
Gallagher et al.	2010	British Dental Journal	24
Zimbelman et al.	2010	PM & R: The Journal of Injury, Function and Rehabilitation	24
Kim et al.	2012	Otolaryngology-Head and Neck Surgery	23
Lee et al.	1995	Ophthalmology	20
Rizza et al.	2003	Diabetes Care	17
Murphy et al.	2009	Policy, Politics, & Nursing Practice	17
Hooker et al.	2012	Journal of the Academy of Nutrition and Dietetics	17
Vanderby et al.	2010	The Annals of Thoracic Surgery	16
Holliman et al.	1997	Academic Emergency Medicine	12

N^o	Ref.	Pub. year	Country	Scale	Health professions	Components addressed
N^o	Ref.	Pub. year	Affiliation/Application	Scale	Health professions	Components addressed
1	[18]	1976	ISR / ISR	Country	Physicians (GP; PD; SUR; D; OPH, GYN; OR; N; U) ¹	Demand and supply
2	[19]	1993	UK / CHN	Country	Physicians	Demand
3	[30]	1995	USA / USA	Country	Physicians (ophthalmologists and optometrists)	Demand, need and supply
4	[41]	1997	USA / USA	Country (states)	Emergency physicians (EP)	Demand and supply
5	[52]	1998	USA / USA	Country	Internal medicine	Demand
6	[63]	2000	USA / USA	Country	Physicians (intensivists and pulmonologists)	Demand, needs and supply
7	[67]	2001	USA / USA	Country	Physicians (anaesthesiologists)	Demand and supply
8	[68]	2003	USA / USA	Country	Physicians (endocrinologists)	Demand, needs and supply
9	[69]	2004	USA / USA	Country	Physicians (endoscopists)	Demand and supply
10	[70]	2008	USA / WHO region	Countries	Physicians	Demand, needs and supply
11	[20]	2009	CAN / CAN	Province (Nova Scotia)	Nurses	Demand, needs and supply
12	[21]	2009	FIN / FIN	Country	Physicians (ophthalmologists)	Needs, costs and supply
13	[22]	2009	USA / USA	County	Physicians (mental health professionals)	Demand, needs and supply
14	[23]	2010	USA / USA	State (Island of Hawaii)	Physicians	Demand and supply
15	[24]	2010	ENG / ENG	Country	Dentists	Demand and supply
16	[25]	2010	USA / USA	Country	Physical therapists (PT)	Demand and supply
17	[26]	2010	CAN / CAN	Country	Physicians (cardiac surgeons)	Demand and supply
18	[27]	2011	USA / USA	State (50)	Physicians (Primary healthcare)	Demand
19	[32]	2012	USA / USA	Country	Dietitians and dietetic technicians	Demand and supply
20	[28]	2012	USA / USA	Country	Physicians (otolaryngology workforce)	Demand and supply
21	[31]	2012	NLD / THA	Province	Mix of HRH (physicians and nurses)	Demand and needs
22	[33]	2012	CAN / CAN	Country	Nurses	Demand, needs and supply
23	[29]	2012	JPN / JPN	Country	Physicians	Demand and supply
24	[34]	2013	USA / USA	Country and 50 states	Physicians (neurology workforce)	Demand and supply
25	[35]	2013	UK / ENG	Subregional communities & region	Dental team	Demand, needs and supply
26	[36]	2013	TWN / TWN	Country	Physicians (paediatricians)	Demand and supply
27	[37]	2013	UK / ENG	Country	Dental team	Demand and supply
28	[38]	2014	CAN / JAM	Country	Pharmacists	Needs and supply
29	[39]	2014	CAN / CAN	Country	Cardiac surgeons	Demand and supply
30	[40]	2014	CAN / CAN	Country	Thoracic surgeons	Demand, needs and supply
31	[45]	2015	ITA / ITA	Region	Physicians	Demand and supply
32	[46]	2015	USA / USA	Country and 50 states	Occupational therapists	Demand and supply
33	[43]	2015	USA / USA	Country	Nurses (paediatric nurse practitioners (PNPs))	Demand and supply
34	[49]	2015	ISR / ISR	Country	Nurses	Demand and supply
35	[48]	2015	USA / USA	Country	Pathologists	Demand and needs
36	[47]	2015	SGP / SGP	Country	Ophthalmologists	Demand, needs and supply
37	[44]	2015	UK / LKA	Country	Odontology team	Demand, needs and supply
38	[42]	2015	AUS / AUS	Country	Physicians (radiology)	Demand and supply
39	[50]	2016	USA / USA	Country	Nurses	Demand
40	[51]	2016	ARG / ARG	Country	Physicians	Demand
41	[53]	2016	DEU / DEU	Region	Dentists	Demand and supply
42	[54]	2016	CAN / OECD countries	Country	Mix of HRH (midwives, nurses, physicians)	Needs and supply
43	[55]	2016	AUS / AUS	State (South Australia)	Physicians (GP)	Demand, needs and supply
44	[56]	2016	ITA / ITA	Region	Physicians	Demand, needs and supply
45	[57]	2017	CHE / 6 countries	Country (AZE, MWI, MMR, PER, UZB & ZMB)	Mix of HRH (SRMNAH² workers)	Needs
46	[58]	2017	KOR / KOR	Country	Physicians (urologists)	Demand and supply
47	[59]	2017	AUS / AUS	State (South Australia)	Physicians (general practitioners (GP))	Needs and supply
48	[60]	2017	JPN / JPN	Prefecture (Hokkaido)	Physicians	Demand and supply
49	[61]	2017	USA / WHO countries	Country (165)	Mix of HRH (nurses/midwives, physicians & other HRH)	Demand and supply
50	[62]	2018	AUS / AUS	State (South AUS)	Mix of HRH (Therapists, Psychiatrists, Psychosocialists)	Needs
51	[64]	2018	PRT / PRT	Country	Physicians	Demand
52	[65]	2018	AUS / AUS	State (South & Western AUS)	Physicians (General practitioners)	Demand, needs and supply
53	[66]	2018	PRT / PRT	Country	Physicians	Demand and supply

[TFN1] Captions: “+” stands for positive aspects and “-” for negative aspects.

The health workforce demand: a systematic literature review

A procura por recursos humanos em saúde: revisão sistemática da literatura

Abstract