Introduction

Although our healthcare needs differ by age and individual expectations, we all rely on adequate access to healthcare to sustain our overall well-being. According to a recent survey reported in the Italian newspaper la Republica (Oct 14, 2024), the quality of the health system is a greater cause of anxiousness for Italians than most other societal challenges, including war.

This concern is relatable – governments across the EU are grappling with meeting demands and managing rising health expenditures under public budget constraints. Furthermore, looming on the horizon is the substantial and consequential factor of demographic change affecting health systems from multiple directions. The Health at a Glance: Europe 2024: State of Health in the EU Cycle report indicates that the majority of EU countries are already facing shortages in medical workforces for doctors, nurses, and midwifes. As demands on services are raising at the same time as large cohorts of the workforce are nearing retirement, combating this shortfall is increasingly challenging.

An ageing EU population

The population of Europe is ageing. With approximately 20% of its inhabitants being at least 65 years of age, it is one of the oldest populations in the world, and this trend is likely to continue. Indeed, Eurostat projections indicate that the share of inhabitants aged 65+ will increase by half in the next fifty years (from 21% in 2021 to 31% in 2071).

As age is associated with a greater need for healthcare and long-term care, we can be relatively certain that an ageing population will require an expansion of the EU healthcare workforce.

In addition, the healthcare workforce is also ageing and it is affected by labour market dynamics such as emigration, dropouts and lack of replenishment from new graduates. Long-term demographic realities on the demand side and medium-term labour market dynamics on the supply side necessitate careful consideration in workforce planning.

In particular, for professions with lengthy education requirements, such as doctors and professional nurses, replenishment of the workforce is slow and resource planning requires a long-term perspective.

The delayed-effect dependency is already becoming evident in some regions, where the increasing age of the workforce has gone unaddressed, leading healthcare systems to the brink of facing acute shortages in human resources.

In several EU countries, large cohorts of practicing doctors and nurses are nearing retirement and deteriorating working conditions are pushing many to emigrate or transition to private rather than public jobs.

In the context of demographic change, effective healthcare workforce planning requires finding a balance between reasonably well predictable long-term trends and rapidly changing circumstances.

On one hand, it is underpinned by largely deterministic demographic processes that provide a stable foundation for future projections: it is certain that every year both healthcare workers and patients will age by one year. On the other hand, it is dependent on fluctuating supply and demand factors that respond to situational forces such as salaries, public expenditure decisions, health emergencies and economic crises.

A trend towards healthier ageing

The healthcare needs of older people tend to be greater compared to younger individuals. On average, older adults visit doctors and specialists more frequently and have a higher number of hospital stays. With older age comes also a higher risk of certain diseases. However, declining health is not an inevitable part of ageing. Epidemiological data from the past thirty years (1991-2021) reveal a noticeable reduction in the burden of ageing-related diseases. This trend towards healthier ageing is undoubtedly attributable to investments in healthcare and health systems, as well as advances in medical sciences. If sustained, what impact could it have on future healthcare workforces?

A tale of two futures

In this story, demographers envision a series of alternative futures by examining the interplay between a steadily ageing population and the fluctuating drivers of supply and demand in the healthcare workforce. With varying emphasis on the supply and demand factors in different scenarios, researchers use explorative statistical models to make projections and estimate the need for doctors and nurses in relation to the changing population structure of the EU over the next fifty years.

In the disease burden scenario, the researchers investigate how it would affect the supply of doctors and nurses, if the average health status, relative to age, were to remain at current levels while the population continues to age, as projected. In other words, how many doctors and nurses would be required to meet the needs of the population if it continues to age without improvement in overall health?

The disease burden with health ageing scenario takes in consideration the historical trend of decreasing levels of ageing-related disease. Assuming that this trend will continue its course towards a future of healthier ageing in an increasingly older population, how will this affect the need for doctors and nurses?

Two alternative futures emerge from the projections under these scenarios: one where the burden of age-associated diseases remains at current levels as the population grows older, leading to increasing demands on the health systems; and one where the positive effects of progressively healthier ageing offset the challenges brought about by demographic change.

The current influx of new graduates is already expanding the EU health workforce, but this may not be sufficient to meet the increasing needs resulting from demographic change. The scientists’ projections show that if the disease burden remains the same, the estimated proportional increase of older people would require the workforce to expand to accommodate their needs.

In numerical terms, by the year 2071, this change in the population would necessitate a 31% increase in the healthcare workforce for doctors and a 33% increase for nurses. At current levels of entry from graduations, the workforce will expand but it may not be sufficient to meet these needs.

A more positive outlook is linked to healthy ageing. When the demographic shift towards an older population is coupled with a continued trend towards healthier ageing, based on the projections, the need for doctors and nurses would decrease to an extent where the workforce could be reduced rather than expanded, compared to the 2021 stock.

Interestingly, the projections also highlight a concern for the more immediate future: in all scenarios, the most pressing need for action to expand the workforce through recruitment is concentrated within the upcoming years. Beyond 2036, the projections estimate an oversupply (if not adjusted), especially if ageing is accompanied by improved health.

In summary

These projections are approximations relative to the 2021 situation and cannot be viewed in absolute terms. However, they can help us better understand the potential impact of demographic changes on societal systems that are important to us all. They also illustrate the importance of applying a long-term perspective to workforce planning. By considering the gradual shifts in the age composition of the workforce, we can better prepare for the fluctuations of supply and demand.  

Further, the projections highlight the significance of continued investments in health improvement. The differentiating factor between the two alternative futures presented in this story is the trend of healthy ageing. Demographic studies such as this one can help us gain insight into how today’s health policies carry an impact beyond the foreseeable future. By preparing for demographic change, we can inform policy to effectively address some of the future challenges and alleviate our citizens’ concerns about healthcare.