REMUNERATION OF DOCTORS

AND NURSES:

PROGRESS AND PERSISTING ISSUES

Joint session of Health Data Correspondents and Health Accounts Experts

Paris, 17 October 2013

• Remuneration levels of doctors and nurses affect: – Attractiveness/retention in these professions

– Health spending in the country

• Difficult data collection

• Review of data availability and comparability

Background

1. Doctor remuneration

– Definitions, results , limitations

2. Nurse remuneration

– Definitions, results , limitations

3. Comparisons with other workers in the country

Outline

• Average gross annual income, including social security contributions and income taxes payable by the employee

1. Doctor remuneration - Definition

Includes Excludes

- Extra formal payments, bonuses, overtime, etc.

- Income for private practice (for salaried)

- Salaried work (for self-employed)

- Social contributions payable by the employer (for salaried)

- Practice expenses (for self-employed)

- Doctors in training

• Includes only:

– fully-qualified physicians

– Full-time workers

• Distinguishes between:

– GPs and Specialists (all specialties combined)

– Salaried and Self-employed

1. Doctor remuneration - Definition

• Main sources:

– Health insurance schemes (BEL, FRA)

– Salary registers (NLD)

– Ad-hoc studies and surveys (CZE, DNK, DEU, ITA)

1. Doctor remuneration - Data collection

1. Doctor remuneration – Results

Source: OECD Health Statistics 2013

Slovenia

Spain

Turkey 5

United Kingdom 6

1. Physicians in training are included (resulting in an underestimation). 2. Data include practice expenses (resulting in an overestimation). 3.

Data on salaried doctors relate only to public sector employees who tend to receive lower remuneration than those working in the private

sector (resulting in an underestimation). 4. Remuneration of self-employed physicians is net income rather than gross income (resulting in

an underestimation). 5. Figures are net income rather than gross income (resulting in an underestimation). 6. Specialists in training are

included (resulting in an underestimation).

Mexico 3

Netherlands 3

New Zealand

Norway

Poland

Slovak Republic

Greece

Hungary 3

Iceland 3

Ireland

Israel

Italy

Czech Republic ¹

Denmark

Estonia

Finland

France 4

Germany 1

Australia ¹

Austria

Belgium 2

Canada

Chile 3

Remuneration of doctors, US$ PPP, 2011 (or nearest year)

55

127

32

73

29

89

66

43

89

46

48

86

84

116

105

136

136

82

173

143

38

79

76

156

0 100 200 300

USD PPP, thousands

Salaried

Self-employed

General practitioners (GPs)

88

48

127

43

107

85

113

74

34

88

211

103

93

54

143

119

88

34

71

108

207

180

278

213

138

254

83

87

0100200300

USD PPP, thousands

Salaried

Self-employed

Specialists

Underestimation:

• Payments for overtime work, bonuses, other supplementary excluded (AUT for GPs, IRL and NZL for salaried specialists, FRA, ITA, PRT, SVK and SWE);

• Incomes from private practices for salaried doctors excluded (e.g. CZE, HUN, PRT, SVN, ISL, IRL and SWE for specialists);

• Informal payments excluded (e.g. GRC and HUN);

• Public sector only (CHL, DNK, HUN, NOR and SVK);

• Net income rather than gross income (FRA and TUR);

• Physicians in training included (AUS, CZE, DEU, and GBR for specialists)

• Part-time workers included (AUS, AUT, BEL, NLD, and for GPs).

Overestimation:

• Practice expenses included for self-employed GPs (BEL)

1. Doctor remuneration – data limitations

1. Doctor remuneration – Results

1. The growth rate for the Netherlands is for self-employed GPs and specialists.

Source: OECD Health Statistics 2013

Growth in the remuneration of GPs and specialists, 2005-2011 (or nearest year)

3.7

2.2

5.5

3.7

2.7

1.7

0.3

5.4

4.4 4.4

3.9

0.2

3.6

4.54.7

2.7

3.0

5.3

4.44.2

0

1

2

3

4

5

6

GPs Specialists

Average annual growth rate(%, in nominal terms)

• No data – Japan (no split between GPs and specialists)

– Korea (why?)

– Switzerland (reliability of source)

• Lack of recent data – United States (2001)

– Sweden (2002)

– Luxembourg, Portugal (both 2005)

• Serious data comparability issues – Belgium (Practice expenses included)

– France (Net income rather than gross)

– Germany (Physicians in training included)

– United Kingdom (Specialists in training included)

1. Doctor remuneration – data limitations

• Average gross annual income, including social security contributions and income taxes payable by the employee

• Salaried nurses working in hospitals

2. Nurse remuneration - Definitions

Includes Excludes

- Extra formal payments, bonuses, overtime, etc.

- Any supplementary income

- Social contributions payable by the employer

- Care workers without certification in nursing (Nursing aides)

- Midwives - Nurse managers

• Main sources:

– Hospital reports (AUS, GRC)

– Labour force or earnings surveys (CAN, CZE, FIN, DEU, ITA, JPN,USA)

– Payroll data (DNK, IRL)

2. Nurse remuneration - Data collection

2. Nurse remuneration – Results

1. Data refer to registered ("professional") nurses in the United States, Australia and Canada (resulting in an overestimation).

Source: OECD Health Statistics 2013.

Remuneration of hospital nurses, USD PPP, 2011 (or nearest year)

17

18

20

23

23

24

28

34

36

36

37

39

40

42

44

45

46

46

47

47

49

50

51

52

54

56

64

70

82

0 20 40 60 80 100

Hungary

Slovak Republic

Estonia

Czech Republic

Poland

Turkey

Mexico

Slovenia

Greece

France

Italy

Finland

Iceland

Japan

United Kingdom

Israel

Spain

Netherlands

Chile

Germany

New Zealand

Belgium

Canada ¹

Norway

Denmark

Australia ¹

Ireland

United States ¹

Luxembourg

USD PPP, thousands

x 4

Overestimation: • Registered/“professional” nurses only (e.g., in

AUS, CAN and USA).

Underestimation: • Nurses working part-time included(e.g. BEL);

• Additional income (overtime payments and bonuses) and informal payments excluded (e.g. ITA, PRT and SVN);

• Public sector only, health assistants and nurse assistants included (NZL).

2. Nurse remuneration – data limitations

2. Nurse remuneration – Results

Source: OECD Health Statistics 2013 .

Growth in the remuneration of hospital nurses, 2005-2011 (or nearest year)

n.a.

4.2

n.a.

6.2

5.4

0.7

8.6

2.3

4.8

2.9

4.4

8.4

3.8

4.6

5.55.0 4.8

5.9

4.24.5

7.8

-2.8

-1.7

-0.5 -0.3-0.1

0.2

1.21.7 2.0

2.5 2.7 2.8 2.9 3.0

3.3 3.5 3.6

4.5 4.8 4.8 5.1

-6

-4

-2

0

2

4

6

8

10

2005-2008 2008-2011Average annual growth rate(%, in nominal terms)

13.8

-6.1

• No data – Austria, Korea, Sweden, Switzerland.

• Lack of recent data – Portugal (2005)

– France (2009)

• Data comparability issues – Registered nurses (AUS, CAN, USA)

2. Nurse remuneration – data limitations

• Current indicator: – Ratio to average wage of all workers

– Data extracted from the Labour Force Survey database

• Possible new indicator: – Ratio to average wage of tertiary-educated

workers

– Data extracted from the Education database

3. Comparing remuneration level of doctors

and nurses with other workers in the country

1. Physicians in training included (resulting in an underestimation). 2. Practice expenses included (resulting in an over-estimation). 3.

Remuneration of self-employed physicians is net income, not gross income (resulting in an underestimation). 4. Public sector

employees only (resulting in an underestimation). 5. Specialists in training included (resulting in an underestimation).

Source: OECD Health Statistics 2013 , http://dx.doi.org/10.1787/health-data-en.

Remuneration of doctors, ratio to average wage of all workers, 2011 (or nearest year)

Poland

Slovak Republic

Slovenia

Spain

United Kingdom 5

Hungary 4

Ireland

Israel

Italy

Netherlands

Norway

Denmark

Estonia

Finland

France 3

Germany 1

Greece

Australia ¹

Austria

Belgium 2

Canada

Czech Republic ¹2.6

1.6

1.8

1.4

2.0

1.9

2.2

1.8

2.3

2.0

1.9

1.7

2.7

2.3

3.0

2.7

2.1

3.0

3.0

3.4

0 2 4 6Ratio to average wage of all

workers in each country

Salaried

Self-employed

General practitioners (GPs)

n.a.

n.a.

n.a.

n.a.

n.a.

2.3

2.6

2.1

2.6

2.2

2.8

2.6

1.6

3.7

3.1

2.6

3.0

1.8

1.6

2.4

2.3

2.3

4.3

4.2

4.7

3.6

5.3

0246Ratio to average wage of all

workers in each country

Salaried

Self-employed

6.2

Specialists

//

n.a.

Spain

United Kingdom

Remuneration of doctors, ratio to average wage of tertiary-educated

workers, 2011 (or nearest year)

New Zealand

Norway

Poland

Slovak Republic

Slovenia

Greece

Hungary

Ireland

Israel

Italy

Netherlands

Czech Republic

Denmark

Estonia

Finland

France

Germany

Australia

Austria

Belgium

Canada

Chile 1.2

2.0

1.2

1.4

0.9

1.8

1.3

1.4

1.2

1.8

2.4

1.7

1.5

1.6

1.9

2.4

2.1

1.8

2.3

2.0

3.1

0 2 4 6

Ratio to earnings for workers with tertiary education

Salaried

Self-employed

General practitioners (GPs)

n.a.

n.a.

n.a.

n.a.

n.a.

n.a.

1.8

1.2

2.0

1.6

2.1

1.9

1.7

2.6

1.0

2.8

2.8

1.6

2.0

2.7

1.3

1.0

1.9

2.6

2.2

3.7

2.5

5.0

3.8

2.8

3.0

3.6

0246

Ratio to earnings workers with tertiary education

Salaried

Self-employed

Specialists

n.a.

Source: OECD Health Statistics 2013

Remuneration of hospital nurses, ratio to average wage, 2011 (or nearest year)

1. Data refer to registered ("professional") nurses in the United States, Australia and Canada (resulting in an over-estimation).

0.8

0.8

0.9

1.0

1.0

1.0

1.0

1.0

1.0

1.0

1.1

1.1

1.1

1.1

1.1

1.1

1.1

1.2

1.2

1.2

1.2

1.3

1.41.4

0.0 0.5 1.0 1.5

Hungary

Slovak Republic

United Kingdom

France

Finland

Netherlands

Estonia

Slovenia

Norway

Italy

Czech Republic

Denmark

Japan

Ireland

Belgium

Canada ¹

Poland

Germany

Australia ¹

Spain

Greece

United States ¹

Israel

Luxembourg

Ratio to average wage of all workers in

each country

0.5

0.5

0.6

0.6

0.7

0.7

0.7

0.7

0.7

0.7

0.8

0.8

0.8

0.8

0.9

0.9

0.9

0.9

0.9

1.0

1.0

1.1

1.1

1.2

1.2

0.0 0.5 1.0 1.5

Hungary

Slovak Republic

Czech Republic

Netherlands

Italy

Germany

Poland

Ireland

Estonia

Norway

France

Slovenia

Finland

Denmark

United Kingdom

Canada ¹

Luxembourg

Belgium

United States ¹

Chile

Australia ¹

New Zealand

Spain

Israel

Greece

Ratio to average wage of tertiary-

educated workers in each country

• COMMENT on the possibility to fill data gaps and improve the comparability of data submitted;

• COMMENT on possible adjustments to national data submissions to improve comparability (along the lines of adjustments made in the Dutch report);

• COMMENT on the use of the average income of tertiary-educated workers only to compare the remuneration levels of doctors and nurses.

National Correspondents are invited to: