In the Sunday, Feb 8 issue of the New York Times there was an article about the impact of the economic crisis and extreme austerity measures in Greece on health care. This NYT article looks in particular at the shortage of nurses forcing hospital patients to hire private nursing care. Enter the entrepreneurs and a burgeoning business of selling illegal nursing care. Not surprisingly, the “nurses” (mostly or entirely women I assume) who provide this care are untrained which is leading to a variety of noticeable consequences. Besides substandard care for individuals (an important issue in and of itself), there has been an increased spread of illnesses in hospitals because the illegal nurses are not following basic hygiene protocols like wearing gloves.
Given that I’m thinking about health care workforce issues a lot right now, this article caught my attention and made me wonder what data is available related to health resources (particularly workforce) and health outcomes. No one is expecting such extreme problems in the countries I’m looking at (the U.S., Finland, and Estonia), but they are anticipating a shortage of health and social services workers adequately trained to work with our aging populations. Beyond the substitution of unqualified and untrained workers, what impact might a worker shortage have? It’s easy to imagine the impact on an individual’s health through delays in care, not getting care at all, or getting inadequate care. But what about a population’s health? Does a shortage of health care workers, make us, as a country, less healthy?
The short answer seems to be yes. A variety of studies both between and within countries have found that the density of health care workers (i.e., the number of workers divided by the number of people in the population), particularly doctors and nurses, is associated with health outcomes ranging from maternal and infant health and mortality to mortality, hospitalization, and spending among Medicare beneficiaries in the U.S. Of course, it’s probably more complicated than density alone. Geography, race, and FTEs (i.e., the amount of care provided vs. the number of workers) are important too.
There’s not as much data on other types of health workers such as community health workers, social workers, and complementary and alternative medicine practitioners. Nor is there as much focused specifically on outcomes among the older population as there is about mothers and children. (At least I haven’t found it yet – if you know of some, please share!). Given that geriatricians, geriatric nurses, and geriatric social workers are where health care worker shortages are predicted to grow over the coming years, some understanding of what counts as a shortage and what impact that may have is worth thinking about.