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UDC: 614.23:616-082(574.51) DOI:10.24411/2415-7414-2019-10004
FORECASTING NEEDS ON GENERAL PRACTITIONERS ON THE BASIS OF ATTACHED POPULATION IN OUTPATIENT CLINICS OF ALMATY CITY
1*M.K. Kaidaulov, 2B.S. Turdaliyeva, 1G.E. Aimbetova, 3S.K. Meirmanov
1 National Medical University, Almaty, Kazakhstan 2 Kazakh Medical University of Continuing Education, Almaty, Kazakhstan 3 Ritsumeikan Asia - Pacific University, Beppu, Japan
ANNOTATION
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Health human resources forecasting is one of the key components of health human resources planning. Planning quality depends on proper assessment of the labor market and forecasting the needs of the population. There are many types of forecasting, however, the easiest approach is the forecast based on the number of attached population. In this regard, the purpose of this research is to forecast needs for general practitioners based on attached population in Almaty city. The forecast was made on the basis of statistical data of the Health Department of Almaty city and on the basis of survey that was conducted among 11 out of 34 outpatient clinics of Almaty city. The forecast was made on the basis of SPSS Statistics software. For outpatient clinics, where attached population has a tendency to growth, the Holt method was used, and for outpatient clinics, where the attached population has a tendency to decrease, a damped forecasting method was used. The results of study show that the need on general practitioners among 11 outpatient clinics in occupied positions was 8.5 positions, while the need in physical persons was 14.5. The forecasted need on general practitioners for 11 outpatient clinics shows that the need for general practitioners will be 304 positions, with a staff standard of 2,000 populations per 1 general practitioner, by 2023. As well as, the need for general practitioners and with a staff standard of 1,500 populations per 1 general practitioner, will amount to 405.5. An assessment of actual need for general practitioners within Almaty city shows that with a staff standard of 2,000 populations per 1 general practitioner will be 1215, and according to staff standard of 1,500 populations per 1 general practitioner the need will be 1559, by 2023.
Key words: forecasting, health human resources, general practitioners, nurses.
Ge
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eneral practitioners and nurses are key personnel in primary health care. General practitioners and nurses play the role of coordinators in the health care system as they carries out primary reception of patients [1]. In this regard, a huge burden is falling on general practitioners and nurses, as the number of home visits and outpatient clinics attendance increase annually.
In the domestic health care system there are many other challenges associated with physicians and nurses. In order to timely, prevent existing challenges in the health care system and take appropriate measures, it is necessary to properly forecast the possible needs for health human resources [2, 3, 4, 5, 6, 7].
Nowadays, forecasting the needs for primary care professionals in Kazakhstan is carried out by one of the following methods [8]: 1 .Forecasting based on attached population;
2.Forecasting based on establishment of target indicators.
Both methods have advantages and disadvantages. Forecasting needs based on attached population is the easiest approach, but this forecasting may be not realistic, since this method does not take into account key variables that can affect the need for health human resources.
The method based on indicators is also one of the easiest methods, but it has the
* kaidaulov_-_91@mail.ru
disadvantage of establishing indicators based on subjective opinion.
However, in this study, the forecasting of needs for general practitioners will be made based on the ratio of population to general practitioners.
The purpose of the study: Forecasting the need for general practitioners based on the number of population in Almaty city and forecasting the need for general practitioners in outpatient clinics based on attached population.
Methods and materials. Required materials were obtained from 11 outpatient clinics of Almaty city and from statistical report of the Health Management of Almaty city. In this study were selected outpatient
clinics that have relatively large staffing capacity of general practitioners and nurses. The staff data of outpatient clinics were obtained through a conducting questionnaire for personnel department and statistical department of outpatient clinics of Almaty city, within the framework of PhD dissertation: "Scientific approaches to the methodology of forecasting health human resources (in the example of general practitioners and nurses, in a metropolis)».
Objects of research: The objects of research are 11 polyclinics of Almaty city and general practitioners.
In this study, the following coefficients were determined based on the following formulas:
Turnover rate =
1. Turnover rate of medical workers
Dismissed by own will + Dismissed by administrative reasons
average number of employees
2. Hiring rate of medical workers
XlOO
Hiring rate=
Hired
XlOO
average number of employees
3. Rate of medical workers over 58 year
_ . - i. , , medical workers over 58 year ,
Rate of medical workers over 58 year =---xlOO
average number or employees
4. Rate of concurrent staff
Occupied positions
Rate of concurrent staff =----—--
Individuals
5. Forecasted need on general practitioners
Forecasted need on general practitioners = In + Inf + (Tr — Hr) + RSB
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Where:
In - the need for individuals on current year, based on the staff standards of 2000 population to 1 general practitioner, and 1500 population to 1 general practitioner
Inf - the need for individuals on forecasted year, based on the staff standards of 2000 population to 1 general practitioner, and 1500 population to 1 general practitioner
Tr - turnover rate Hr - hiring rate
R58 - Rate of medical workers over 58
year
The forecast was made on the basis of SPSS Statistics software. For outpatient clinics, where attached population has a tendency to growth, the Holt method was used, and for outpatient clinics, where the attached
_
population has a tendency to decrease, a damped forecasting method was used.
Results. First of all, the existing need for general practitioners was determined. The research results show that among 11 outpatient
clinics, the need for individuals is higher than the need for occupied positions. For example, the need for occupied positions was 8.5, while the need for individuals was 14.5 positions
(Table 1).
Table 1. Staff data of 11 outpatient clinics of Almaty city (general practitioners).
Outpatient clinics Established positions Occupied positions Vacancy Individuals
1 21 15 6,0 15
2 29 29 0 28
3 22 22 0 22
4 29 29 0 27
5 28 28 0 26
6 16 16 0 16
7 23 22 1,0 22
8 30 30 0 30
9 18,5 18 0,5 17
10 18 18 0 18
11 17 17 1,0 16
Total 251,5 244 8,5 237
The need among nurses is higher than among general practitioners. The need for nursing occupied positions was 11, while the need for individuals was 69 positions. It is worth noting that the ratio of general practitioners and nurses
was 2.4, which is lower than recommended level by World Healthcare Organization, which is 3 nurses per doctor. If we calculate the need for nurses on the basis of international standards, the need will increase significantly (Table 2).
Table 2. Staff data of 11 outpatient clinics of Almaty city (Nurses).
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Outpatient clinics Established positions Occupied positions Vacancy Individuals General practitioners/ Nurses ratio
1 55 54 1,0 54 2,6
2 58 58 0 54 2,0
3 66 66 0 66 3,0
4 58 58 0 58 2,0
5 84 84 0 52 2,0
6 32 32 0 32 2,0
7 69 59,5 9,5 57 2,47
8 90 90 0 89 2,96
9 48 47,5 0,5 35 2,05
10 36 36 0 36 2,0
11 42 42 0 36 2,25
Total 638 627 11 569 2,4
Analysis of health human resources general practitioners per year. The turnover
shows that the turnover rate of general rate of nurses is 19.6%, while the rate of hiring
practitioners is 22.3%, while the rate of is only 10.9%. As a result, the loss in nurses
recruitment was only 18.9%. These data show is 8.7% per year, which is higher than that of
that outpatient organizations lose 3.4% of general practitioners (Table 3).
Table 3. The dismissed and hired personnel rate.
Individuals Dismissed Hired Turnover rate Hiring rate
General practitioners 237 53 45 22,3% 18,9%
Nurses 569 61 34 19,6% 10,9%
Loss in human resources
General practitioners 3,4%
Nurses 8,7%
The rate of concurrent staff shows that general practitioners and nurses realizes additional work due to the lack of human resources. The rate of concurrent general practitioners according to the study was 1.02, which indicates a low need for general
practitioners, and among nurses this rate was 1.1, which means that nurses overworking for 10% due to staff shortages. Concurrent data once again proves the great shortage of nurses among selected 11 outpatient clinics of Almaty city (Table 4).
Table 4. The rate of concurrent staff.
Total General practitioners Nurses
Occupied positions 244 627
Individuals 237 569
The rate of concurrent staff 1,02 1,1
city tends to grow. The total number of attached population in 11 outpatient clinics will reach 608581, by 2023, whereas in 2017 the number of attached population was 552450. This data shows that in next 6 years the number of attached population in 11 outpatient clinics will grow by 9.3%. These indicates that in the future the need for general practitioners will increase (Table 5). S
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Table 5. The forecast of the attached population of 11 outpatient clinics, until 2023.
Outpatient clinics 2015 2016 2017 2018 2019 2020 2021 2022 2023
1 63607 62884 63278 64855 66432 68008 69585 71161 72738
2 61047 61772 62755 63235 64038 64840 65642 66444 67246
3 57385 57857 57851 58049 58591 59059 56464 59814 60116
The coefficient of general practitioners over 58 years old (58 years inclusively) was 2.3% of the total number of general practitioners. The rate of nurses over 58 years old (58 years inclusively) was 1.6% of the total number of nurses. The results show that the proportion of general practitioners and nurses above 58 years is low.The results of the study show that attached population in the majority outpatient clinics of Almaty
4 51486 55082 58174 55551 55109 54668 54227 53785 53344
5 64616 64231 64675 64040 63752 63464 63176 62888 62600
6 38125 30553 29852 31385 30959 30534 30111 29690 29270
7 45833 44832 45888 45904 45584 45264 44645 44626 44307
8 66379 67760 60776 64525 64480 64455 64442 64436 64432
9 31446 32828 34785 35161 36267 37374 38480 39587 40693
10 36803 35672 37626 42333 45345 48357 51369 54381 57393
11 30674 38690 36790 41152 42210 47268 50326 53384 56442
The forecasted need on general practitioners for 11 outpatient clinics shows that the need for general practitioners will be 304 positions, with a staff standard of 2,000 populations per 1 general practitioner, by 2023. The deficit in general practitioners will be 106 individuals, if we take into account the actual need of clinics in general practitioners (in 2017 the need in general practitioners was 39, according to attached population). Lost in general practitioners and lost associated with aging of general practitioners in the next 6 years will make up 19.3% of the 237 general practitioners. Taking into account all losses, the total forecasted deficit for general
practitioners among 11 outpatient clinics will be 151.7 individuals, by 2023.
The forecasted need on general practitioners for 11 outpatient clinics shows that the need for general practitioners will amount to 405.5 positions, with a staff standard of 1,500 populations per 1 general practitioner, by 2023. The deficit in general practitioners will be 168.5 individuals. If we take into account the actual need of clinics in general practitioners, the total deficit will be 207.5 individuals. Taking into account all losses, the total forecasted need for general practitioners among 11 outpatient clinics for 2023 is 253.2 individuals, by 2023 (Table 6).
Table 6. Forecasting the need on general practitioners for 11 outpatient clinics till 2023.
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Outpatient clinics and number of general practitioner Staff
standard
for 2015 2016 2017 2018 2019 2020 2021 2022 2023
1general practitioner
1 2000 pop. 32 31,5 31,6 32,4 33,2 34 34,8 35,6 36,4
(15) 1500 pop. 42,4 41,9 42,1 43,2 44,2 45,3 46,4 47,4 48,5
2 2000 pop. 30,5 30,8 31,4 31,6 32 32,4 32,8 33,2 33,6
(28) 1500 pop. 40,7 41,2 41,8 42,2 42,7 43,2 43,8 44,2 44,8
3 2000 pop. 28,6 28,9 28,9 29 29,3 29,5 28,2 29,9 30
(22) 1500 pop. 38,3 38,6 38,6 38,7 39 39,4 37,6 39,8 40
4 2000 pop. 25,7 27,5 29 27,8 27,5 27,3 27,1 26,9 26,7
(27) 1500 pop. 34,3 36,7 38,8 37 36,7 36,4 36,1 35,8 35,6
5 2000 pop. 32,3 32,1 32,3 32 31,8 31,7 31,5 31,4 31,3
(26) 1500 pop. 43 42,8 43,1 42,7 42,5 42,3 42,1 41,9 41,7
6 2000 pop. 19 15,2 14,9 15,7 15,5 15,3 15,05 14,8 14,6
(16) 1500 pop. 25,4 20,4 19,9 20,9 20,6 20,4 20 19,8 19,5
7 2000 pop. 22,9 22,4 22,9 22,9 22,8 22,6 22,3 22,3 22,1
(22) 1500 pop. 30,5 29,8 30,5 30,6 30,4 30,2 29,7 29,7 29,5
8 2000 pop. 33,2 33,8 30,4 32,3 32,2 32,2 32,2 32,2 32,2
(30) 1500 pop. 44,2 45,2 40,5 43 42,9 42,9 42,9 42,9 42,9
9 2000 pop. 15,7 16,4 17,4 17,6 18,1 18,7 19,2 19,8 20,3
(17) 1500 pop. 20,9 21,8 23,2 23,4 24,2 24,9 25,6 26,4 27,1
10 2000 pop. 18,4 17,8 18,8 21,2 22,7 24,2 25,7 27,2 28,7
(18) 1500 pop. 24,5 23,7 25 28,2 30,2 32,2 34,2 36,3 38,3
11 2000 pop. 15,3 19,3 18,4 20,6 21,1 23,6 25,1 26,7 28,2
(16) 1500 pop. 20,5 25,8 24,5 27,4 28,1 31,5 33,5 35,6 37,6
Total need in staff standard
1 general practitioners to 2000 population 273,6 275,7 276 283,1 286,2 291,5 293,9 300 304,1
Total need in staff standard
1 general practitioners to 1500 population 364,7 367,9 368 377,3 381,5 388,7 391,9 399,8 405,5
Deficit in staff standard
1 general practitioners to 2000 population - - 39 46,1 49,2 54,5 56,9 63 67,1
Deficit in staff standard
1 general practitioners to 1500 population - - 131 140,3 144,5 151,7 154,9 162,8 168,5
An analysis of the need on general practitioners at outpatient clinics shows that clinics numbered 1,2,3,8,9,10,11 will tend to have more general practitioners, due to the projected growth of attached population. Controversially, outpatient
clinics numbered 4, 5, 6, 7 will tend to have lower general practitioners, due to the projected decrease in the attached population. An analysis of the need on general practitioners by polyclinics is shown in Picture 1.
Picture 1. Forecasted need on general practitioners until 2023.
The forecasted need on general positions, with a staff standard of 2,000 practitioners for Almaty city shows that the populations per 1 general practitioner, by need on general practitioners will be 1062 2023. Taking into account all losses, the total
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forecasted need for general practitioners for general practitioner, by 2023. Taking into
Almaty city will be 1,215 positions. account all losses, the total forecasted need
The forecasted need on general for general practitioners for Almaty city will
practitioners will be 1416 positions, with be 1569 positions. Forecasted need on general
a staff standard of 1500 populations per 1 practitioners illustrated in Table 7.
Table 7. Forecasted need on general practitioners in Almaty city.
Years Population Need on general practitioners with a staff standard of 2,000 populations per 1 general practitioner Need on general practitioners with a staff standard of 1500 populations per 1 general practitioner
2010 1391095 695,5 927,4
2011 1414017 707 942,6
2012 1450327 725,2 966,8
2013 1475579 737,8 983,7
2014 1507509 753,7 1005
2015 1552349 776,2 1034,8
2016 1713220 856,61 1142
2017 1792500 896,2 1195
2018 1847768 923,8 1231,8
2019 1903037 951,5 1268,7
2020 1958305 979,1 1305,5
2021 2013574 1006,8 1342,4
2022 2068843 1034,4 1379,2
2023 2124112 1062 1416
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The projection of the number of population of exceed 2 million people (2124112), by 2023. Almaty city shows that the population city will This forecast is shown in picture 2.
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2200000.00
2000000.00
1 800000,00
1600000.00
1 400000.00
1 200000.00
S
Q rOOI-tbUiOlNCSCOu^KjUl
Наблюденные Прогнозируемые значения
Дата
Picture 2. Projection of Almaty population size, until 2023.
Conclusion. The results showed that the clinics lose 3.4% of general practitioners. This turnover rate is more than the hiring rate among means that until 2023, the clinics will lose 11outpatient clinics. In this regard, outpatient 17% of general practitioners from the total
number of individuals. Therefore, a loss of 17% was included as one of the components of the need while forecasting the need in general practitioners. As well as, the share of aging general practitioners was taken into account while forecasting the needs on general practitioners. Among 11 outpatient clinics, share of aging general practitioners was 2.3%.
The vacancy for general practitioners among 11 outpatient clinics in the study was 14.5 individuals in 2017. But an analysis of attached population among 11 outpatient clinics in 2017 shows that the need on general practitioners with a standard of 2000 population per 1 general practitioner was 39.
Attached population of clinics and
population of Almaty city have a tendency to growth until 2023. In this regard, the projected need of general practitioners among 11 clinics and need on general practitioners within Almaty city forecasted to grow.
All obtained data show that, there is no big deficit in general practitioners in 2017, but it will grow and consists 1,215 individuals by 2023. Moreover the need on general practitioners will be 1569 individuals with a staff standard 1500 people per 1 general practitioner by 2023.
Taking into account the results of study, outpatient organizations should pay attention to working environment and recruitment of general practitioners, since by 2023 the need for general practitioners will be doubled.
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World Health Organization. World health report 2006. Working together for health: report. World Health Organization. Geneva. 2006.209.
Massey L., Esain A., and Wallis M. Managing the complexity of nurse shortages: A case study of bank and agency staffing in an acute care Trust in Wales, UK//International Journal of Nursing Studies. 2009; 46: 912-919.
Wray J., Aspland J., Gibson H., Stimpson A., and Watson, R. "A wealth of knowledge": a survey of the employment experiences of older nurses and midwives in the NHS//International Journal of Nursing Studies.2009; 46: 977-985.
Takase M., Oba K., and Yamashita N. Generational differences in factors influencing job turnover among Japanese nurses: an exploratory comparative design//International Journal of Nursing Studies. 2009; 46: 957-967.
Gunnarsdyttir S., Clarke S.P., Rafferty A.M., and Nutbeam D.Front-line management, staffing and nurse-doctor relationships as predictors of nurse and patient outcomes. A survey of Icelandic hospital nurses//International Journal of Nursing Studies. 2009; 46: 920-927.
Gillespie B.M., Chaboyer W., and Wallis M. The influence of personal characteristics on the resilience of operating room nurses: a predictor study // International Journal of Nursing Studies. 2009; 46: 968-976. ^
Министерство здравоохранение и социального развития. Методы планирования и прогнозирования кадровых ресурсов здравоохранения в условиях обязательного соци-
ального медицинского страхования: Методические рекомендации. МЗ и СР РК. - Аста- g
на: 2016.- С.8. ^
ТУЙ1НД1 *
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Денсаульщ сак;таудаFы кадрльщ ресурстарды болжамдау - денсаульщ сак;таудаFы кадрльщ ресурстарды жоспарлаудын непзп компоненттершщ бiрi болып табылады.
Жоспарлаудын сапасы енбек нарьгеына жYргiзiлген талдау сапасымен тшелей байланы- ¡^
сты. Хальщаральщ тэжiрибеде болжамдаудьщ кептеген эдiстерi бар, б1ра; болжамдаудын ¡^
ен жещл api тез эдютершщ 6ipi тiркелген халы; санына байланысты болжамдау болып та-былады. Сонды;тан зерттеу ма;саты Алматы ;аласындаFы жалпы тэжipибелi дэpiгеpлеp ;ажеттшшн тipкелген халы; саны бойынша аны;тау болып табылады. Болжамдау Алматы ;аласы денсаулы; са;тау бас;армасынын а;паратына жэне Алматы ;аласынын 11 амбулаторлы;-поликлиникалы; уйымдарынын арасында жYpгiзiлген анкеталы; зерттеу нэтижесiне суйене отырып жYpгiзiлдi. Болжамдау SPSS Statistics баFдаpламасы ар;ылы эзipлендi. Тipкелген халы; саны есу тpендi аны;талFан поликлиникалаpFа болжамдау Хольт эдiсi бойынша жYpгiзiлдi, ал халы; саны темендеу тpендi аны;талFан поликлиникалаpFа болжамдау демпфирленген эдю ар;ылы жасалынды.
Зерттеу нэтижесше сэйкес 11 поликлиниканын жалпы тэжipибелi дэpiгеpлеpлiкпен айналысушылар лауазымдары бойынша ;ажеттшп 8,5, ал физикалы; тYЛFалаpы бойынша ;ажеттшп 14,5 екендш аны;талды. 2023 жылFа дейiнгi 11 поликлиника аpасындаFы 1 тэжipи6елi дэр^ерге 2000 халы; стандарты бойынша ;ажеттшк болжамы 304 керсетсе, 1 тэжipибелi дэpiгеpге 1500 халы; стандарты бойынша ;ажеттшк болжамы 405,5 екендiгi аны;талды. Тура сол сия;ты Алматы ;аласынын 1 тэжipи6елi дэpiгеpге 2000 халы; стандарты бойынша ;ажеттшк болжамы 1215 болса, 1 тэжipибелi дэpiгеpге 1500 халы; стандарты бойынша ;ажеттшк болжамы 1559 болатындыгеы болжанды.
Ктт свздер: болжамдау, кадрлыц ресурстар, жалпы тэж1рибел1 мешрбикелер, мешрбикелер.
АННОТАЦИЯ
Прогнозирование кадровых ресурсов здравоохранение - это один из основных компонентов планирования кадровых ресурсов здравоохранение. Качественное планирование зависит от качественной оценки рынка труда и прогноза потребностей населения. Существует множество видов прогнозирование, но одним из легких в применении видов прогнозирования является прогноз на основе количество прикрепленного населения. В связи с этим целью данного метода является прогнозирования потребности во врачах общей практики на основе количество населения, в рамках города Алматы. Прогноз сделан на базе статистических данных управления здравоохранения города Алматы и проведенного анкетирования среди 11 из 34 поликлиник города Алматы. Прогноз был осуществлен на основе программного обеспечения SPSS Statistics. Для поликлиник, где прикрепленное население имеет тенденцию роста, использовался метод Хольта, и для поликлиник, где прикрепленное население имеет тенденцию снижения, использовался демпфированный метод прогнозирования.
Результаты исследования показывают, что потребность во врачах общей практики среди 11 поликлиник в занятых должностях составил 8, 5 тогда как поребность в физических лицах, составил 14,5 ставок. Прогноз потребности в 11 поликлиник показывает что до 2023 года потребность во врачах общей практики при нормативе 2000 населения на 1 врача общей практики, составит 304, а при нормативе 1500 населения на 1врача общей практики, составит 405, 5. Оценка потребности во врачах общей практики в рамках « города Алматы показывает, что до 2023 года потребность во врачах общей практики при ¡^ нормативе 2000 населения на 1 врача общей практики, составит 1215. Потребность во врачах общей практики при нормативе 1500 населения на 1 врача общей практики, со® ставит 1559.
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^ Ключевые слова: прогнозирование, кадровые ресурсы здравоохранения, врачи об-
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щей практики, медицинские сестры.
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