RESUMO
PROBLEM: Ensuring an adequate supply of the midwife workforce will be essential to meet the future demands for maternity care within Australia. BACKGROUND: Aim: To project the overall number of midwives registered with the Nursing and Midwifery Board of Australia and the timing of their retirement to 2043 based upon the ageing of the population. METHODS: Using data on the number of registered midwives released by the Nursing and Midwifery Board of Australia we calculated the five-year cumulative attrition rate of each five-year age group. This attrition rate was then utilized to estimate the number of midwives registered in each five-year time period from 2018 to 2043. We then estimated the number of midwives that would be registered after also accounting for stated retirement intentions. FINDINGS: Between 2018 and 2023 the overall number of registered midwives will decline from 28,087 to 26,642. After this time there is expected to be growth in the total number, reaching 28,392 in 2028 and 55,747 in 2043. If midwives did relinquish their registration at a rate indicated in previous workforce satisfaction surveys, the overall number of registered midwives would decline to 19,422 in 2023, and remain below 2018 levels until 2038. DISCUSSION: Due to the age distribution of the current registered midwifery workforce the imminent retirement of a large proportion of the workforce will see a decline in the number of registered midwives in the coming years. Additional retirement due to workforce dis-satisfaction may exacerbate this shortfall.
Assuntos
Atitude do Pessoal de Saúde , Mão de Obra em Saúde/tendências , Serviços de Saúde Materna/organização & administração , Enfermeiros Obstétricos/psicologia , Aposentadoria , Adulto , Idoso , Envelhecimento , Austrália , Feminino , Política de Saúde , Humanos , Intenção , Pessoa de Meia-Idade , Tocologia/estatística & dados numéricos , Tocologia/tendências , Enfermeiros Obstétricos/estatística & dados numéricos , Satisfação Pessoal , Gravidez , Inquéritos e QuestionáriosRESUMO
BACKGROUND: 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. METHODS: 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). RESULTS: 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. CONCLUSIONS: 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.
Assuntos
Mão de Obra em Saúde/tendências , Tocologia/estatística & dados numéricos , Enfermeiras e Enfermeiros/provisão & distribuição , Médicos/provisão & distribuição , Europa (Continente) , HumanosRESUMO
RESUMO O acesso à saúde de forma universal e equitativa está preconizado na Constituição Federal de 1988, devendo ser garantida pelo Sistema Único de Saúde (SUS). Dentre os diversos fatores que contribuem para a não efetivação dos princípios do SUS, destacam-se a insuficiência de profissionais e as disparidades regionais na distribuição de recursos humanos, principalmente médicos. Este artigo relata a experiência de avaliação do Programa Mais Médicos (PMM) por uma equipe multidisciplinar composta por 28 pesquisadores, a partir de trabalho de campo em 32 municípios com 20% ou mais da população em extrema pobreza selecionados em todas as regiões do Brasil (áreas remotas, distantes das capitais e comunidades quilombolas rurais), além de análises sobre os 5.570 municípios brasileiros baseadas em bancos de dados do Ministério da Saúde. A pesquisa resultou em vasta produção científica, apontando importantes resultados, como ampliação do acesso à saúde e redução de internações evitáveis. As reflexões aqui trazidas permitem concluir que o PMM contribuiu para a efetivação e consolidação dos princípios e diretrizes do SUS e garantiu acesso à saúde, especialmente para as populações mais pobres, municípios pequenos e regiões remotas e longínquas.
ABSTRACT The universal and equitable access to health is established in the Brazilian Federal Constitution of 1988 and must be guaranteed by the Brazilian Unified Health System - the Sistema Único de Saúde (SUS). The lack of professionals and the large regional differences in the distribution of human resources, mainly physicians, are factors that contribute to the non-fulfillment of the SUS principles. This article reports the experience of evaluation of the More Doctors Program (PMM) by a multidisciplinary team composed of 28 researchers, based on field work in 32 municipalities with 20% or more of the population in extreme poverty selected in all regions of Brazil (remote areas, far from capitals, and rural maroon communities), as well as analyzes of the 5,570 Brazilian municipalities based on the Ministry of Health databases. The research resulted in a vast scientific production, pointing out important results, such as broadening of access to health and reducing of avoidable hospitalizations. The reflections brought here show that the PMM contributed to the implementation and consolidation of the SUS principles and guidelines, and guaranteed access to health, especially for the poorest populations, small municipalities and remote and distant regions.
Assuntos
Humanos , Serviços de Saúde Rural/tendências , Mão de Obra em Saúde/tendências , Atenção Primária à Saúde , Brasil , Programas Nacionais de Saúde/tendênciasRESUMO
OBJECTIVE: To describe the character and composition of the 2015 US adult rheumatology workforce, evaluate workforce trends, and project supply and demand for clinical rheumatology care for 2015-2030. METHODS: The 2015 Workforce Study of Rheumatology Specialists in the US used primary and secondary data sources to estimate the baseline adult rheumatology workforce and determine demographic and geographic factors relevant to workforce modeling. Supply and demand was projected through 2030, utilizing data-driven estimations regarding the proportion and clinical full-time equivalent (FTE) of academic versus nonacademic practitioners. RESULTS: The 2015 adult workforce (physicians, nurse practitioners, and physician assistants) was estimated to be 6,013 providers (5,415 clinical FTE). At baseline, the estimated demand exceeded the supply of clinical FTE by 700 (12.9%). By 2030, the supply of rheumatology clinical providers is projected to fall to 4,882 providers, or 4,051 clinical FTE (a 25.2% decrease in supply from 2015 baseline levels). Demand in 2030 is projected to exceed supply by 4,133 clinical FTE (102%). CONCLUSION: The adult rheumatology workforce projections reflect a major demographic and geographic shift that will significantly impact the supply of the future workforce by 2030. These shifts include baby-boomer retirements, a millennial predominance, and an increase of female and part-time providers, in parallel with an increased demand for adult rheumatology care due to the growing and aging US population. Regional and innovative strategies will be necessary to manage access to care and reduce barriers to care for rheumatology patients.
Assuntos
Prestação Integrada de Cuidados de Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/tendências , Mão de Obra em Saúde/tendências , Avaliação das Necessidades/tendências , Reumatologistas/tendências , Reumatologia/tendências , Idoso , Área Programática de Saúde , Feminino , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Admissão e Escalonamento de Pessoal/tendências , Reumatologistas/provisão & distribuição , Fatores de Tempo , Estados UnidosRESUMO
Providing health care to patients and families living in rural America presents significant challenges, but comes with unique rewards. The physician who chooses a rural life typically cares for an underserved and aging population, which is often less healthy and affluent than its urban and suburban counterparts. At the same time, rural clinicians feel deeply connected to their patients and their communities. Physicians cite strong doctor-patient relationships as a primary motivator to practice in a rural setting, in addition to lower cost of living and slower pace of life1. Those who choose primary care specialties also enjoy the challenge of caring for multiple, interrelated aspects of health for their patients and community. During Kansas City University of Medicine and Biosciences' (KCU) century-long history, we have offered our osteopathic medical students the opportunity to learn in rural areas during the third and fourth years. As our new, state-of-the-art medical school campus opens in Joplin, Missouri, we will build on our commitment to rural health by offering first- and second-year KCU-Joplin students training opportunities in rural settings, and expanding third- and fourth-year rural clinical rotations. The rich experience to learn rural medicine offers the potential to connect medical students, patients and community in new and exciting ways, building on the firm foundation of osteopathic medical training grounded in strong patient-centered primary care.
Assuntos
Médicos/psicologia , Saúde da População Rural/normas , Estudantes de Medicina/psicologia , Economia/tendências , Mão de Obra em Saúde/tendências , Humanos , Kansas/epidemiologia , Área Carente de Assistência Médica , Missouri/epidemiologia , Medicina Osteopática/educação , Medicina Osteopática/normas , Relações Médico-Paciente , Médicos/estatística & dados numéricos , Atenção Primária à Saúde/normas , Saúde da População Rural/tendências , População Rural/estatística & dados numéricos , Faculdades de Medicina/normas , Estudantes de Medicina/estatística & dados numéricosRESUMO
In September 2015 the nations of the world signed up to the ambitious goal of ensuring that everyone in the world should have access to health care universal health coverage and that nobody should be left behind. This report makes the very simple point that universal health coverage cannot possibly be achieved without strengthening nursing globally. This is partly about increasing the number of nurses, but also crucially about making sure their contribution is properly understood and enabling them to work to their full potential. The report goes on to argue that strengthening nursing will have the triple impact of improving health, promoting gender equality and supporting economic growth. Much of what is said here will be familiar to nursing leaders, but they alone cannot bring about the changes that are needed. Politicians, non-nursing health leaders and others must work with them to create radical changes in how nurses are perceived and in what they are permitted and enabled to do. (AU)
Assuntos
Humanos , Enfermagem/tendências , Mão de Obra em Saúde/tendências , Tocologia , Administração de Serviços de Saúde/tendências , Equidade em Saúde , EconomiaRESUMO
This article assesses professional development trajectories in top-, middle- and basic-level health workforce groups (doctors, nurses, care assistants) in different European Union countries using available international databases. Three theoretical strands (labour market, welfare state, and professions studies) were connected to explore ideal types and to develop a matrix for comparison. With a focus on larger EU-15 countries and four different types of healthcare systems, Germany, Italy, Sweden and the United Kingdom serve as empirical test cases. The analysis draws on selected indicators from public statistics/OECD data and micro-data from the EU Labour Force Survey. Five ideal typical trajectories of professional development were identified from the literature, which served as a matrix to compare developments in the three health workforce groups. The results reveal country-specific trajectories with uneven professional development and bring opportunities for policy interventions into view. First, there is a need for integrated health labour market monitoring systems to improve data on the skills mix of the health workforce. Second, a relevant number of health workers with fixed contracts and involuntary part-time reveals an important source for better recruitment and retention strategies. Third, a general trend towards increasing numbers while worsening working conditions was identified across our country cases. This trend hits care assistants, partly also nurses, the most. The research illustrates how public data sources may serve to create new knowledge and promote more sustainable health workforce policy.
Assuntos
Mão de Obra em Saúde/tendências , Enfermeiras e Enfermeiros/estatística & dados numéricos , Assistentes de Enfermagem/estatística & dados numéricos , Atenção à Saúde , Europa (Continente) , Humanos , Médicos/estatística & dados numéricos , Desenvolvimento de Pessoal/métodosRESUMO
BACKGROUND: The World Health Organization defines a "critical shortage" of health workers as being fewer than 2.28 health workers per 1000 population and failing to attain 80% coverage for deliveries by skilled birth attendants. We aimed to quantify the number of health workers in five African countries and the proportion of these currently working in primary health care facilities, to compare this to estimates of numbers needed and to assess how the situation has changed in recent years. METHODS: This study is a review of published and unpublished "grey" literature on human resources for health in five disparate countries: Mali, Sudan, Uganda, Botswana and South Africa. RESULTS: Health worker density has increased steadily since 2000 in South Africa and Botswana which already meet WHO targets but has not significantly increased since 2004 in Sudan, Mali and Uganda which have a critical shortage of health workers. In all five countries, a minority of doctors, nurses and midwives are working in primary health care, and shortages of qualified staff are greatest in rural areas. In Uganda, shortages are greater in primary health care settings than at higher levels. In Mali, few community health centres have a midwife or a doctor. Even South Africa has a shortage of doctors in primary health care in poorer districts. Although most countries recognize village health workers, traditional healers and traditional birth attendants, there are insufficient data on their numbers. CONCLUSION: There is an "inverse primary health care law" in the countries studied: staffing is inversely related to poverty and level of need, and health worker density is not increasing in the lowest income countries. Unless there is money to recruit and retain staff in these areas, training programmes will not improve health worker density because the trained staff will simply leave to work elsewhere. Information systems need to be improved in a way that informs policy on the health workforce. It may be possible to use existing resources more cost-effectively by involving skilled staff to supervise and support lower level health care workers who currently provide the front line of primary health care in most of Africa.
Assuntos
Pessoal de Saúde/estatística & dados numéricos , Mão de Obra em Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , África Subsaariana , Pessoal de Saúde/tendências , Mão de Obra em Saúde/tendências , Humanos , Atenção Primária à Saúde/tendências , Características de Residência , Fatores Socioeconômicos , Estatísticas VitaisAssuntos
Mão de Obra em Saúde/estatística & dados numéricos , Mão de Obra em Saúde/tendências , Reumatologia/estatística & dados numéricos , Reumatologia/tendências , Especialização/estatística & dados numéricos , Especialização/tendências , Educação Médica/estatística & dados numéricos , Educação Médica/tendências , Saúde Holística/educação , Saúde Holística/tendências , Humanos , Profissionais de Enfermagem/educação , Profissionais de Enfermagem/estatística & dados numéricos , Profissionais de Enfermagem/tendências , Satisfação do Paciente , Assistentes Médicos/educação , Assistentes Médicos/estatística & dados numéricos , Assistentes Médicos/tendências , Padrões de Prática Médica/tendênciasAssuntos
Atenção à Saúde/tendências , Política de Saúde , Disparidades em Assistência à Saúde/tendências , Causas de Morte , Atenção à Saúde/economia , Emigração e Imigração , Infecções por HIV/epidemiologia , Política de Saúde/legislação & jurisprudência , Política de Saúde/tendências , Acessibilidade aos Serviços de Saúde , Mão de Obra em Saúde/estatística & dados numéricos , Mão de Obra em Saúde/tendências , Disparidades em Assistência à Saúde/economia , Humanos , Expectativa de Vida/tendências , Mortalidade Prematura/tendências , Programas Nacionais de Saúde , Pandemias , África do Sul/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologiaRESUMO
Radiotherapy (RT) is required for nearly half of the newly diagnosed cancer patients. To optimise the quality and availability of RT, guidelines have been proposed by European Society for Radiotherapy and Oncology-QUAntification of Radiation Therapy Infrastructure And Staffing Needs (ESTRO-QUARTS) and the International Atomic Energy Agency (IAEA). This study evaluates the present status of RT capacity in Europe and the projected needs by 2020 as per these recommendations. Thirty-nine of the 53 countries, listed in Europe by the UN Statistical Division, whose cancer incidences, teletherapy and human resources were available in the Global Cancer Incidence, Mortality and Prevalence (GLOBOCAN), International Agency for Research on Cancer (IARC) and DIrectory of RAdiotherapy Centres (DIRAC) (IAEA) databases were evaluated. A total of 3550 teletherapy units (TRT), 7017 radiation oncologists (RO), 3685 medical physicists (MP) and 12,788 radiotherapy technologists (RTT) are presently available for the 3.44 million new cancer cases reported annually in these countries. The present infrastructure and human resources in RT are estimated to provide RT access to 74.3% of the patients requiring RT. The current capacity in TRT, RO, MP and RTT when compared with recommended guidelines has a deficit of 25.6%, 18.3%, 22.7% and 10.6%, respectively. Thus, to respond to requirements by 2020, the existing capacity needs to be augmented by an additional 1698 TRTs, 2429 ROs, 1563 MPs and 2956 RTTs. With an imminent rise in cancer incidence, multifaceted strategic planning at national and international levels within a coordinated comprehensive cancer control programme is highly desirable to give adequate access to all patients who require radiotherapy across Europe. Specific steps to address this issue at national and continental levels involving all major stakeholders are proposed.
Assuntos
Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Mão de Obra em Saúde/estatística & dados numéricos , Neoplasias/radioterapia , Radioterapia/métodos , Europa (Continente)/epidemiologia , Previsões , Geografia , Guias como Assunto , Necessidades e Demandas de Serviços de Saúde/tendências , Mão de Obra em Saúde/tendências , Humanos , Incidência , Neoplasias/epidemiologia , Prevalência , Radioterapia/tendênciasRESUMO
BACKGROUND: Rehabilitation care is an important part of comprehensive care for MS patients. Little is known about the number of physiatry residents who are interested in providing care to individuals with multiple sclerosis [MS]. OBJECTIVE: This study examines factors that influence physiatry residents' interest in providing care to MS patients. METHODS: We randomly sampled half of all Accreditation Council for Graduate Medical Education-certified physical medicine and rehabilitation residency programs in the continental United States and Puerto Rico. Surveys were received from 74% of programs (Stage 1 response rate) and from 221 residents (45% Stage 2 response rate). RESULTS: Residents expressing interest in providing MS care were more likely to be female, Asian, and to select statements emphasizing multidisciplinary care approaches and a community of dedicated professional colleagues as positive features of MS patient care. Residents interested in teaching and with more education debt were marginally more likely to express interest in MS care. CONCLUSIONS: Medical education should emphasize the need for physical medicine and rehabilitative care among individuals with MS, the ability of physiatrists to improve the functional status and quality of life for MS patients, and the team-based nature of MS care.
Assuntos
Atitude do Pessoal de Saúde , Mão de Obra em Saúde , Internato e Residência/métodos , Esclerose Múltipla/terapia , Assistência ao Paciente/métodos , Medicina Física e Reabilitação/métodos , Adulto , Feminino , Mão de Obra em Saúde/tendências , Humanos , Internato e Residência/tendências , Masculino , Esclerose Múltipla/diagnóstico , Assistência ao Paciente/tendências , Medicina Física e Reabilitação/educação , Medicina Física e Reabilitação/tendênciasRESUMO
The aim of this study was to examine trends in the geographic distribution of nursing staff in Japan from 2000 to 2010. We examined time trends in the rates of nursing staff per 100,000 population across 349 secondary health service areas. Using the Gini coefficient as a measure of inequality, we separately analyzed the data of 4 nursing staff types:public health nurses (PHN), midwives (MW), nurses (NS), and associate nurses (AN). Then, using multilevel Poisson regression models, we calculated the rate ratios (RRs) and their 95% confidence intervals (CIs) for each type of nursing staff per 1-year change. Overall, the distribution of PHN, MW, and NS improved slightly in terms of the Gini coefficient. After adjusting for prefectural capital and population density, PHN, MW, and NS significantly increased;the RRs per 1-year increment were 1.022 (95% CI:1.020-1.023), 1.021 (95% CI:1.019-1.022), and 1.037 (95% CI:1.037-1.038), respectively. In contrast, AN significantly decreased;the RR per 1-year increment was 0.993 (95% CI:0.993-0.994). Despite the considerable increase in the absolute number of nursing staff in Japan (excluding AN), this increase did not lead to a sufficient improvement in distribution over the last decade.
Assuntos
Política de Saúde/tendências , Mão de Obra em Saúde/estatística & dados numéricos , Mão de Obra em Saúde/tendências , Recursos Humanos de Enfermagem/estatística & dados numéricos , Recursos Humanos de Enfermagem/tendências , Disparidades em Assistência à Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/tendências , Humanos , Japão/epidemiologia , Licenciamento em Enfermagem/estatística & dados numéricos , Licenciamento em Enfermagem/tendências , Tocologia/estatística & dados numéricos , Tocologia/tendências , Análise Multinível , Avaliação das Necessidades/estatística & dados numéricos , Avaliação das Necessidades/tendências , Enfermagem em Saúde Pública/estatística & dados numéricos , Enfermagem em Saúde Pública/tendênciasRESUMO
Cancer is one of the major non-communicable diseases posing a threat to world health. Unfortunately, improvements in socioeconomic conditions are usually associated with increased cancer incidence. In this Commission, we focus on China, India, and Russia, which share rapidly rising cancer incidence and have cancer mortality rates that are nearly twice as high as in the UK or the USA, vast geographies, growing economies, ageing populations, increasingly westernised lifestyles, relatively disenfranchised subpopulations, serious contamination of the environment, and uncontrolled cancer-causing communicable infections. We describe the overall state of health and cancer control in each country and additional specific issues for consideration: for China, access to care, contamination of the environment, and cancer fatalism and traditional medicine; for India, affordability of care, provision of adequate health personnel, and sociocultural barriers to cancer control; and for Russia, monitoring of the burden of cancer, societal attitudes towards cancer prevention, effects of inequitable treatment and access to medicine, and a need for improved international engagement.
Assuntos
Neoplasias/terapia , Idoso , Idoso de 80 Anos ou mais , Alcoolismo/epidemiologia , Neoplasias da Mama/diagnóstico , China , Neoplasias Colorretais/diagnóstico , Características Culturais , Detecção Precoce de Câncer/tendências , Desenvolvimento Econômico/tendências , Poluição Ambiental/efeitos adversos , Etnicidade , Feminino , Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/tendências , Mão de Obra em Saúde/tendências , Disparidades em Assistência à Saúde/tendências , Humanos , Índia , Masculino , Medicina Tradicional Chinesa , Pessoa de Meia-Idade , Neoplasias/prevenção & controle , Serviços de Saúde Rural/tendências , Federação Russa/epidemiologia , Sexismo , Fumar , Estigma Social , Serviços Urbanos de Saúde/tendênciasRESUMO
Major economic, political, demographic, social, and operational system factors are prompting evolutionary changes in health care delivery. Of particular significance, the "graying of America" promises new challenges and opportunities for health care social work. At the same time, the Patient Protection and Affordable Care Act of 2010, evolution of Accountable Care Organizations, and an emphasis on integrated, transdisciplinary, person-centered care represent fundamental shifts in service delivery with implications for social work practice and education. This article identifies the aging shift in American demography, its impact on health policy legislation, factors influencing fundamentally new service delivery paradigms, and opportunities of the profession to address the health disparities and care needs of an aging population. It underscores the importance of social work inclusion in integrated health care delivery and offers recommendations for practice education.
Assuntos
Prestação Integrada de Cuidados de Saúde/tendências , Gastos em Saúde/tendências , Política de Saúde/tendências , Mão de Obra em Saúde/tendências , Expectativa de Vida/tendências , Patient Protection and Affordable Care Act , Dinâmica Populacional/tendências , Serviço Social/tendências , Envelhecimento , Prestação Integrada de Cuidados de Saúde/economia , Prestação Integrada de Cuidados de Saúde/legislação & jurisprudência , Financiamento Governamental/tendências , Financiamento Pessoal/tendências , Previsões , Política de Saúde/legislação & jurisprudência , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Humanos , Expectativa de Vida/etnologia , Serviço Social/educação , Serviço Social/legislação & jurisprudência , Fatores Socioeconômicos , Estados UnidosRESUMO
There is growing consensus that the health care workforce in the United States needs to be reconfigured to meet the needs of a health care system that is being rapidly and permanently redesigned. Accountable care organizations and patient-centered medical homes, for instance, will greatly alter the mix of caregivers needed and create new roles for existing health care workers. The focus of health system innovation, however, has largely been on reorganizing care delivery processes, reengineering workflows, and adopting electronic technology to improve outcomes. Little attention has been paid to training workers to adapt to these systems and deliver patient care in ever more coordinated systems, such as integrated health care networks that harmonize primary care with acute inpatient and postacute long-term care. This article highlights how neither regulatory policies nor market forces are keeping up with a rapidly changing delivery system and argues that training and education should be connected more closely to the actual delivery of care.
Assuntos
Atenção à Saúde/tendências , Ocupações em Saúde/educação , Política de Saúde , Mão de Obra em Saúde/tendências , Papel Profissional , Difusão de Inovações , Eficiência , Reforma dos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Estados UnidosAssuntos
Atenção à Saúde , Mão de Obra em Saúde/legislação & jurisprudência , Terapias Complementares/legislação & jurisprudência , Conflito de Interesses/legislação & jurisprudência , Consciência , Atenção à Saúde/legislação & jurisprudência , Educação Médica/legislação & jurisprudência , Governo Federal , Previsões , Reforma dos Serviços de Saúde , Mão de Obra em Saúde/economia , Mão de Obra em Saúde/tendências , Humanos , Admissão e Escalonamento de Pessoal/economia , Admissão e Escalonamento de Pessoal/legislação & jurisprudência , Atenção Primária à Saúde , Governo Estadual , Estados Unidos , Denúncia de Irregularidades/legislação & jurisprudência , Carga de Trabalho/economia , Carga de Trabalho/legislação & jurisprudênciaRESUMO
En este informe, se aborda en primer lugar, la crisis mundial de los sistemas de la salud y su relación con tres aspectos fundamentales: la escasez universal de los recursos humanos sanitarios, la mala distribución de los mismos y la movilidad del personal sanitario a las zonas más ricas, más cosmopolitas y con más oportunidades, incidiendo especialmente en este último punto a través del análisis de las tendencias en los flujos más frecuentes, los lugares más reconocidos como receptores o emisores o las motivaciones aludidas por el personal sanitario para migrar. En segundo lugar, se describen algunas consecuencias y problemáticas asociadas a este panorama, como la pérdida económica potencial y real, la reducción de la calidad de la atención sanitaria o el aumento de la intención de migrar. Por último, se realiza una exposición de las diferentes alternativas puestas en marcha o propuestas por los diferentes agentes implicados en el estudio y la solución de esta situación de crisis, junto con algunas valoraciones sobre su desarrollo y resultados. Las iniciativas encontradas en la revisión se destacan agrupándolas en las categorías relacionadas con la contratación, la planificación de recursos, la formación, y la política laboral; resaltando, por su relevancia, las iniciativas centradas en la cooperación y colaboración entre países como instrumentos de intervención. (AU)