Forecasting needs on general practitioners on the basis of attached population in outpatient clinics of almaty city

AnnotAtion

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.

General 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 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:

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).

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 shows that the turnover rate of general practitioners is 22.3%, while the rate of recruitment was only 18.9%. These data show that outpatient organizations lose 3.4% of general practitioners per year. The turnover rate of nurses is 19.6%, while the rate of hiring is only 10.9%. As a result, the loss in nurses is 8.7% per year, which is higher than that 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

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

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).

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

 

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.

Outpatient clinics and number of general practitioner

Staff standard for 1general practitioner

2015

2016

2017

2018

2019

2020

2021

2022

2023

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 (30)

2000 pop.

33,2

33,8

30,4

32,3

32,2

32,2

32,2

32,2

32,2

1500 pop.

44,2

45,2

40,5

43

42,9

42,9

42,9

42,9

42,9

9 (17)

2000 pop.

15,7

16,4

17,4

17,6

18,1

18,7

19,2

19,8

20,3

1500 pop.

20,9

21,8

23,2

23,4

24,2

24,9

25,6

26,4

27,1

10

(18)

2000 pop.

18,4

17,8

18,8

21,2

22,7

24,2

25,7

27,2

28,7

1500 pop.

24,5

23,7

25

28,2

30,2

32,2

34,2

36,3

38,3

11

(16)

2000 pop.

15,3

19,3

18,4

20,6

21,1

23,6

25,1

26,7

28,2

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 1general 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 1general 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 1general practitioners to 2000 population

-

-

39

46,1

49,2

54,5

56,9

63

67,1

Deficit in staff standard 1general 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.

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

forecasted need for general practitioners for Almaty city will be 1,215 positions.

The forecasted need on general practitioners will be 1416 positions, with a staff standard of 1500 populations per 1

general practitioner, by 2023. Taking into account all losses, the total forecasted need for general practitioners for Almaty city will be 1569 positions. Forecasted need on general 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

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.

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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Year: 2019
City: Almaty
Category: Medicine