Health workforce across European Countries
manifesto for a european health union

Imbalances of health workforce across the EU27 - Scoreboard (LTSS Methodology)

The Long-Term Services and Support (LTSS) Methodology [1] summarizes the 2017 levels of the 23 indicators used in the country reports in relation to the following dimensions: staff and skills, education, migration, working conditions, and outlook. The trends include 13 indicators classified into staff and skills, working conditions, and other conditions. Other conditions include the subdimensions of workforce projection, ageing, and expected health expenditures as percent of GDP. Because of missing indicator values for education and migration, the Figure below does not show “trends” for all dimensions. The country values are grouped into four quartiles (top, second, third, fourth quartile). Dark areas indicate the top quartile and better results. The composite scores shown in the Figure below are derived by grouping the variables and giving each indicator the same weight.

Figure: Scoreboard of HWF summary indicators, LTSS Approach, migration negatively weighted

Figure: Scoreboard of HWF summary indicators, LTSS Approach, migration negatively weighted

No country has dark blue fields in all eight columns shown in the Figure above. Only Belgium and Germany reach the top quartile in five columns with the highest rank. Austria reaches the highest ranks in the top quartile in two columns, Estonia and Hungary do so in the top quartile in three columns. The ranking in the top quartile depends on the total number of points the country reached. The maximum value is 24 equals 3x8. Belgium gets 18 points, Germany and Austria get each 17 points. Hungary and Estonia reach both 14 points.

In the second quartile, Romania, Denmark, and the Netherlands get each 13 points, followed by Finland, France, and Lithuania with 12 points each. In the third quartile fall Slovenia, Czechia, Spain, and Greece, with points between 12 and 11. In the bottom quartile are the countries Italy, Portugal, Ireland, Latvia, and Poland rated between 9 and 7 points.

The position of the country depends very much on the selected dimensions and the polarity of the indicators towards the objectives. For example, if the higher country’ shares of foreign doctors and nurses are positively weighted, Hungary and Estonia will lose their position in the top quartile. A higher share of foreign-trained health professions from EU-MS means a greater integration of the EU health labour and education market while a lower share indicates a greater self-sustainability. The efficiency of health systems is another dimension not yet reflected in the present scoring in the Figure above. For example, Poland and Latvia managed to have one of the highest productivity growth rates in the period 2007 – 2017. Their position would therefore change in an expanded assessment framework.

The scoring and ranking methodology of the LTSS Scorecard provides one possible framework for summarizing and assessing the various imbalances of health workforce across MS. Another assessment framework already used by the European Commission (EC) is the Employment Performance Monitor (EPM) and the Social Policy Performance Monitor (SPPM).


[1] Reinhard S. et al. (2017), Picking Up The Pace Of Change. Long-Term Services and Supports State Scorecard 2017 Edition A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers. AARP Public Policy Institute, 2017. url:

[2] BASYS (2022), Health workforce demand and supply across the European Union, Summary report, Augsburg May 2022.

The summary report can be downloaded here: BASYS 2022 - HWF Summary Report.pdf

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