The following question was asked to HOPE Members:
1. In the context of the financial and economic crisis, what have been the direct interventions and/or the indirect effects on healthcare professionals (wages reduction, stop recruitment…)?
Dr Ulrike Schermann-Richter
Federal Ministry of Health
So far, no consequences of the crisis can be highlighted concerning the work of healthcare professionals. The number of hospital staff (FTE) is constantly increasing. However, for the future, more rigorous negotiations on contracts between public health insurance funds and healthcare providers regarding tariffs, budget caps or any other commitments and measures on cost containment have to be expected.
Mrs Eva M Weinreich-Jensen
In order to curtail spending and keep spending within budgets in 2012, several regions have been forced to lay off healthcare workers, including healthcare professionals. This has been the consequence of both the financial crisis and the need to scale down healthcare spending to achieve long-term fiscal sustainability.
Dr Urmas Sule
Estonian Hospital Federation
In 2010, healthcare providers were forced to diminish the wages of health care workers because of the budget cuts in the end of 2009 and at the beginning of 2010. In 2011, the wages were increased to the same level as 2008 and, in the autumn of 2012, Estonia experienced the first strike of healthcare workers in the history of Estonia. As the budget of HIF has increased in 2011 and 2012, the doctors, nurses and nursing care workers decided to demand rise of minimum wages and proposed to sign a very voluminous collective agreement between Hospitals Association and Healthcare workers unions. The strike lasted 25 days and ended with a pre-agreement that states that, from 1st March 2013, the minimum wages of doctors will increase by 11%, nurses by 17.5% and nursing care workers by 23%.
Dr Aino-Liisa Oukka
Oulu University Hospital
The number of personnel has increased steadily since the end of 1990’s and in the near future, Finland will experience a deficit of the workforce due to ageing. However, to govern the expenses, most hospitals and primary care units have to limit the recruitment of temporary workforce. Some municipalities and hospital districts have also encouraged personnel to take paid free leave, at least in the administrative level.
Mr Gérard Vincent
French Hospital Federation (FHF)
Mr Yves-Jean Dupuis
French Federation of Non-Profit Hospitals (FEHAP)
The various measures undertaken to reduce public spending have resulted in decreasing the money devoted for hospitals, which has immediate consequences on unemployment.
In 2011 and 2012, many hospitals had to cut their workforce in order to reduce expenses: more and more public hospitals were forced not to replace staff. Meanwhile, the salaries in the public sector are frozen. In the private non-profit sector, the crisis has led to many layoff plans, and even (in a few cases) to hospital closure.
The cost-containing measures have dramatic impacts on the workforce organisation, with a risk of damaging healthcare quality.
Even if the French healthcare system will benefit from the policy implemented to increase the numerus clausus for doctors, geographical inequalities are more and more striking, both within and between regions.
Dr György Harmat
Heim Pál Children’s Hospital
In the context of the financial and economic crisis, the direct intervention in progress on hospital workforce is the development of the career model based on homogenous career groups, together with the renewal of the professional training system.
To retain residents in work in the country, a scholarship program was introduced, ensuring that participating residents receive a monthly grant of HUF100,000 in addition to their wages if they commit themselves to remain in full-time employment in Hungary for a period of time equal to their participation in the scholarship program and if they do not accept any direct payments from the patients.
Based on a Government decision in spring 2012, a differentiated wage increase to health professionals (with the exception of GPs) took place in the course of August, with a retrospective legal effect from January 2012, while the Government also decided to increase the per capita financing for GPs, health visitors and nurses involved in primary care.
Mr Joe Caruana
Ministry of Health, the Elderly and Community Care
The increase in public recurrent expenditure has allowed the recruitment of new graduates in nursing and other healthcare professions. As described above, the Government is committed to ensure that financial resources available are well spent and, therefore, in this area, action is being taken to ensure that the overtime expenditure is better controlled.
Mr Robbert Smet
NVZ Vereniging van Ziekenhuizen
Over 90% of the health labour force is privately organised. Therefore, direct recruitment stops through government actions are basically impossible. In addition, the Government has announced that, from 2016, it will cut budget allowances meant for improvement of labour conditions (salaries in the first place). Although, for example, hospitals are themselves responsible for pay levels and other labour conditions of their personnel, there is a threat that labour conditions might suffer.
Mr Simon Vrhunec
Association of Health Institutions of Slovenia
With regard to the public sector, in 2009 the recommendation of the Government of the Republic of Slovenia was implemented concerning the non-replacement of retired employees and non-renewal of temporary employment contracts. However, due to the shortage of key operators (especially doctors), this orientation was not implemented in the field of healthcare.
Furthermore, some measures were taken to limit the remuneration of public employees. In 2009, the amount of performance-related bonus associated with an increased amount of work was reduced so that, on aggregate, it cannot exceed 30% of a public employee’s basic wage.
In January 2010, the wages of all public employees were partly adjusted to inflation, which means that they increased by 0.2%. In July 2010 this adjustment involved an increase by 0.65% and, in January 2011, by 0.55%.
In July 2012, the elimination of wage disparities was carried out and the salaries of all public sector employees were decreased by 8%. As agreed, public sector employees are not entitled to regular work-performance pay, at least until 2014. In 2012, the share of funds intended for the payment of market performance bonus was decreased by 10% (to 50%).
Before 2012, public hospitals hired and dismissed employees independently within the frame of financial stability of operation. In May 2012, the Public Finance Balance Act was adopted and, since then, all public healthcare institutes are constrained concerning hiring new employees. First, they have to get authorisation of the funder (that is Ministry of Health or local municipality) and then, of governing councils of institutes.
Mrs Sara C Pupato Ferrari
Institute for Health Care Management (INGESA)
A package of measures was adopted in 2010 to cut spending by €15 billion between 2010 and 2011 through: