It is important to note that the supervision of healthcare professionals begins even before their training.
This supervision includes the monitoring and planning of the health care. The general idea is to ensure that the health needs of the population are met by avoiding both excesses and shortages of professionals in any given field.
What is planning ?
Planning the health care professional workforce is critical to ensuring the health of the population, in order to:
- guarantee that the supply and demand for care match
- avoid shortages
- anticipate abundance
All of these are essential to ensure quality of care, the well-being of our professionals, budgetary sustainability and the efficiency of social security. The Medical Offer Planning Commission was established in 1996 for this purpose. It is composed of representatives from universities, mutual health funds (Collège Intermutualiste), healthcare professions (professional organisations), the relevant ministries, the Communities, NIHDI and the FPS HFCSE.
Today, the information available to the planning commission is complex. The data is extracted from different databases, anonymised and analysed to provide the most detailed and realistic picture of the activity of health professionals in Belgium.
Planning was initially limited to doctors and dentists. Now, it extends to an ever-growing number of professionals. Like the needs of the population, planning is a dynamic and constantly improving process.
Medical Offer Planning Commission: consultativebodies.health.belgium.be
The planning stages
The figure below summarises the different steps taken by the Planning Commission for each profession, from the completion of the PlanCad to the writing of the recommendations.
THE PLANNING STAGES
DESCRIPTION OF THE ACTIVITY OF A PROFESSION IN THE BELGIAN EMPLOYMENT MARKET
While the register is very useful for the Planning Commission, providing a summary of everyone who has applied to a licensed professional activity, it is not sufficient for it to carry out its tasks.
This database does not show us the proportion of certified persons who are actually working, the extent to which this activity is carried out, in which sectors and in which geographical area.
However, the Planning Commission needs information on the activity of health professionals and on the level of this activity, so it can accurately monitor this workforce, prepare forecasts of its evolution and plan the supply of professionals, in particular by determining the quota of physicians and dentists. This is why Art. 99 of the law of 10 May 2015 provides for the possibility of linking register data with a series of other databases.
The "PlanCad" project, on this basis, links data from various sources to supplement e-CAD. These sources include:
the National Institute for Health and Disability Insurance (NIHDI),
the National Social Security Office (NSSO) for employee data,
the National Institute of Social Insurance for the Self-Employed (NISISE) for data on the self-employed.
The identification of individuals is made impossible by anonymisation. This linking allows relevant answers to be provided to questions related to the workforce of the professions.
For example :
The data used covers several years. This makes it possible to identify developments and estimate trends in future workforce development projections.
The health professions planning work involves reviewing available data to develop a numerical "forecast". Several workforce evolution scenarios are developed for each profession.
The workforce projection model is the working tool on which the forecast is based. It is of the "stock and flow" type. It starts with the premise that for each healthcare profession, there is demand and supply.
The demand comes from the population that requires healthcare. The supply is determined by the people in the healthcare sector who practise the profession in question.
The projection model has a number of parameters and takes account of international mobility, both at the beginning of studies and at the start of specialisations and professional practice. The scenarios anticipate the active professional population in Belgium, placed in a European and international context.
Several scenarios for the evolution of the workforce are developed, based on the current situation of a specific group of professionals and various assumptions about future developments.
In the baseline scenario, observed historical trends are used as a starting point and projections for the evolution of the number of active professionals are made "under unchanged conditions and policies". In these predictions, the number of active professionals is taken into account, minus exits (deaths, retirements), plus new graduates in Belgium, plus the flow of practitioners who have graduated abroad.
The evolution of the demand for care is estimated on the basis of the number of individuals, the structure of the population, according to age and sex, as well as the consumption of care.
Alternative scenarios are then developed. The parameters of the baseline model are adapted according to a series of hypotheses relating to the future evolution of the workforce, the context, the activity, the demand for care, etc. These hypotheses are developed by the various Planning Commission working groups.
NOTICE TO THE FEDERAL MINISTER OF PUBLIC HEALTH
Once the future scenarios have been completed, the Planning Commission prepares a recommendation. This recommendation reflects the evolution of the profession, the relationship between supply and demand, and any related issues and concerns. For professions subject to a quota, the Commission also drafts a notice setting the federal quota. This quota will be used to determine the number of physicians and dentists with a Belgian diploma who qualify to apply for an internship to obtain a professional title in a specialty in Belgium. To date, only physicians and dentists are subject to such a quota.
ACTIVE PROFESSIONALS IN RELATION TO ALL REGISTERED HEALTH CARE PROFESSIONALS
Firstly, we have the number of professionals entitled to provide services. This is the number registered as of 31 December 2021 in the annual statistics of professionals entitled to provide services. It includes all professionals domiciled in and outside Belgium.
Secondly, we have the number of professionals actually working in healthcare. The rate used to estimate active practitioners is that observed in the latest available publication on the activity of the profession (published or in progress).
ESTIMATED NUMBER OF ACTIVE WORKERS AS A PERCENTAGE OF ALL
HEALTHCARE PROFESSIONALS LICENSED TO PRACTISE
The difference in rates observed between the two communities for the health care workforce is mainly explained by the significant presence of foreign students in French Community education. Many foreign students come to train in French-speaking education and then return to practise in their country of origin without strengthening the workforce in Belgium. The French Community has issued a decree to limit this number.