Taiwan Pediatric Workforce in an Era of National Health Insurance and Nadir Birth Rates: A Systemic Thinking Approach
Date Issued
2012
Date
2012
Author(s)
Wu, Mei-Hwan
Abstract
Introduction: Pediatrics is an established specialty for more than 200 years. Pediatricians take care of the illness of pediatric population (aged 0-18 years) and the child-to-pediatrician ratio is associated with child health indexes. In Taiwan, in an era of declining birth rates and single health care payer (national health insurance) system, the pediatric workforce is changing and may overreact to the declining demand. The overreaction would be further amplified due to the delay of workforce maturation.
Methods: We extracted the data of population and pediatric workforce from national and academic society databases. A systemic strategic thinking was completed by adopting a systemic dynamic approach (commercial software, Vensim).
Results: The child-to-pediatrician ratio in Taiwan was 1742/1000 live births in 2011 and was associated with infant mortality (p=0.005, r2 =0.989, child-to-pediatrician ratio = -484+545.5*infant mortality). The child-to-pediatrician ratio for Millennium Development Goals (MDG) (3.91/1000 live births) and target (Japan, 2.50/1000 live births) levels of infant mortality was estimated at 1649 and 1153, respectively. The data of workforce in 2010s already showed an overreaction. By strategic systemic thinking, the scenario of pediatric health care could be depicted by loops of reinforcement and balance loops. Specific population SD mathematic models predict that the base pediatric population in Taiwan would decrease steadily until 2020s and the fertile age adults would also decrease and worsen the number of newborns. The SD model of workforce also predicts the maturation stages and the supply of pediatricians in each year. The gaps between the desired pediatricians for the base, MDG and target deficits would appear in late 2010s, and was present in all years for the target level of infant mortality.
Conclusions: In an era of low birth rate, aging population and single payer health care system, the trend of pediatric workforce had been modified and overreacted due to time delay in Taiwan. To elucidate the complex interaction of declining pediatric population (decreasing demand) and the delay in pediatrician workforce career path, we developed SD models for both population and workforce. Simulation validated the effectiveness. Severe workforce shortage would appear in late 2020s in spite of decreased pediatric population. With intervention, simulation by SD models may predict the effectiveness and provide sound evidence for policy makers in national health care.
Subjects
System dynamics
pediatrician
workforce
SDGs
Type
thesis
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