Future requirements for and supply of ophthalmologists for an aging population in Singapore

Human Resources for Health

Desmond Quek³  Ecosse Lamoureux³  Victoria Koh⁴  Andrew Phua⁴  Nicola Lew⁴  David B. Matchar⁵  Thiyagarajan Jayabaskar¹  Chong Pan¹  Steffen Bayer⁴  Dirk De Korne²  John P. Ansah⁴ 

[1] Singapore National Eye Centre, 11 Third Hospital Ave, Singapore 168751, Singapore;Institute of Health Policy & Management, Erasmus University Rotterdam, Burg Oudlaan 50, Rotterdam, 3000 DR, Netherlands;Singapore Eye Research Institute, 20 College Road, Singapore 169856, Singapore;Signature Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore;Department of Medicine, Duke University Medical Center, Durham 27710, NC, USA

关键词: Singapore;    Ophthalmologists;    Simulation modeling;    System dynamics;    Workforce projections;   

Others  :  1234442
DOI  :  10.1186/s12960-015-0085-4

 received in 2015-04-21, accepted in 2015-11-02,  发布年份 2015

【 摘 要 】

Background

Singapore’s population, as that of many other countries, is aging; this is likely to lead to an increase in eye diseases and the demand for eye care. Since ophthalmologist training is long and expensive, early planning is essential. This paper forecasts workforce and training requirements for Singapore up to the year 2040 under several plausible future scenarios.

Methods

The Singapore Eye Care Workforce Model was created as a continuous time compartment model with explicit workforce stocks using system dynamics. The model has three modules: prevalence of eye disease, demand, and workforce requirements. The model is used to simulate the prevalence of eye diseases, patient visits, and workforce requirements for the public sector under different scenarios in order to determine training requirements.

Results

Four scenarios were constructed. Under the baseline business-as-usual scenario, the required number of ophthalmologists is projected to increase by 117% from 2015 to 2040.

Under the current policy scenario (assuming an increase of service uptake due to increased awareness, availability, and accessibility of eye care services), the increase will be 175%, while under the new model of care scenario (considering the additional effect of providing some services by non-ophthalmologists) the increase will only be 150%. The moderated workload scenario (assuming in addition a reduction of the clinical workload) projects an increase in the required number of ophthalmologists of 192% by 2040.

Considering the uncertainties in the projected demand for eye care services, under the business-as-usual scenario, a residency intake of 8–22 residents per year is required, 17–21 under the current policy scenario, 14–18 under the new model of care scenario, and, under the moderated workload scenario, an intake of 18–23 residents per year is required.

Conclusions

The results show that under all scenarios considered, Singapore’s aging and growing population will result in an almost doubling of the number of Singaporeans with eye conditions, a significant increase in public sector eye care demand and, consequently, a greater requirement for ophthalmologists.

【 授权许可】

   
2015 Ansah et al.

【 图 表 】

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【 参考文献 】

• [1]Wong TY, Loon S-C, Saw S-M. The epidemiology of age related eye diseases in Asia. Br J Ophthalmol. 2006; 90:506-11.
• [2]Asher MG, Nandy A. Singapore’s policy responses to ageing, inequality and poverty: an assessment. Int Soc Sec Rev. 2008; 61(1):41-60.
• [3]Zheng Y, Cheng CY, Lamoureux EL, Chiang PP, Rahman Anuar A, Wang JJ et al.. How much eye care services do Asian populations need? Projection from the Singapore Epidemiology of Eye Disease (SEED) study. Invest Ophthalmol Vis Sci. 2013; 54(3):2171-7.
• [4]World Economic Outlook Database. International Monetary Fund. 2014. http://www.imf.org/external/pubs/ft/weo/2014/02/weodata/weorept.aspx?pr.x=81&pr.y=11&sy=2013&ey=2013&scsm=1&ssd=1&sort=country&ds=.&br=1&c=576&s=NGDPD%2CNGDPDPC%2CPPPGDP%2CPPPPC%2CLP&grp=0&a=#notes. Accessed March 2015.
• [5]Market share statistics for ophthalmology in the public sector hospitals. 2012.
• [6]Forrester JW. Industrial dynamics. M.I.T. Press, Cambridge; 1961.
• [7]Homer JB, Hirsch GB. System dynamics modeling for public health: background and opportunities. Am J Public Health. 2006; 96(3):452-8.
• [8]Sterman J. Business dynamics: systems thinking and modeling for a complex world. Irwin/McGraw-Hill, Boston; 2000.
• [9]Ishikawa T, Ohba H, Yokooka Y, Nakamura K, Ogasawara K. Forecasting the absolute and relative shortage of physicians in Japan using a system dynamics model approach. Hum Resourc Health. 2013; 11:41. BioMed Central Full Text
• [10]Masnick K, McDonnell G. A model linking clinical workforce skill mix planning to health and health care dynamics. Hum Resourc Health. 2010; 8:11. BioMed Central Full Text
• [11]Senese F, Tubertini P, Mazzocchetti A, Lodi A, Ruozi C, Grilli R. Forecasting future needs and optimal allocation of medical residency positions: the Emilia-Romagna Region case study. Human Resources for Health. 2015;13(7). doi:10.1186/1478-4491-13-7.
• [12]Barber P, López-Valcárcel BG. Forecasting the need for medical specialists in Spain: application of a system dynamics model. Human Resources for Health. 2010;8(24). doi:10.1186/1478-4491-8-24.
• [13]Prescott PA. Forecasting requirements for health care personnel. Nurs Econ. 1991; 9(1):18.
• [14]Birch S, Kephart G, Tomblin-Murphy G, O’Brien-Pallas L, Alder R, MacKenzie A. Human resources planning and the production of health: a needs-based analytical framework. Canadian Public Policy / Analyse de Politiques. 2007; 33:S1-S16.
• [15]Birch S, Lavis J, Markham B, Woodward C, O’Brien-Pallas L. Nursing requirements for Ontario over the next twenty years: development and application of estimation methods. Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton; 1994.
• [16]Eyles J, Birch S. A population needs-based approach to health-care resource allocation and planning in Ontario: a link between policy goals and practice? Can J Public Health / Revue Canadienne de Sante’e Publique. 1993; 84(2):112-7.
• [17]Edwards N. Population health: determinants and interventions. Can J Public Health / Revue Canadienne de Sante’e Publique. 1999; 90(1):10-1.
• [18]Hall TL, Mejía A, Organization WH. Health manpower planning: principles, methods, issues. Switzerland: World Health Organization; 1978
• [19]O’Brien-Pallas L, Baumann A, Donner G, Murphy GT, Lochhaas-Gerlach J, Luba M. Forecasting models for human resources in health care. J Adv Nurs. 2001; 33(1):120-9.
• [20]World Health Organization. Models and tools for health workforce planning and projections. Geneva: World Health Organization; 2010.
• [21]Pan C-W, Wong TY, Lavanya R, Wu R-Y, Zheng Y-F, Lin X-Y et al.. Prevalence and risk factors for refractive errors in Indians: the Singapore Indian Eye Study (SINDI). Invest Ophthalmol Vis Sci. 2011; 52(6):3166-73.
• [22]Lavanya R, Jeganathan SE, Zheng Y, Raju P, Cheung N, Tai ES et al.. Methodology of the Singapore Indian Chinese Cohort (SICC) Eye Study: quantifying ethnic variations in the epidemiology of eye diseases in Asians. Ophthalmic Epidemiol. 2009; 16(6):325-36.
• [23]Rosman M, Zheng Y, Lamoureux E, Saw S, Aung T, Tay W et al.. Review of key findings from the Singapore Malay Eye Study (SiMES-1). Singapore Med J. 2012; 53(2):82-7.
• [24]Singapore Department of Statistics. Key indicators of resident households. Singapore: Singapore Department of Statistics; 2010.
• [25]Ansah JP, Matchar DB, Love SR, Malhotra R, Do YK, Chan A et al.. Simulating the impact of long-term care policy on family eldercare hours. Health Serv Res. 2013; 48(2 PART2):773-91.
• [26]Eberlein RL, Thompson JP, Matchar DB. Chronological ageing in continuous time. 30th International Conference of the System Dynamics Society; 2012. System Dynamics Society, Albany; 2012.
• [27]Thompson JP, Riley CM, Eberlein RL, Matchar DB. Future living arrangements of Singaporeans with age-related dementia. Int Psychogeriatr. 2012; 24(10):1592-9.
• [28]Phan TP, Alkema L, Tai ES, Tan KHX, Yang Q, Lim W-Y et al. Forecasting the burden of type 2 diabetes in Singapore using a demographic epidemiological model of Singapore. BMJ Open Diabetes Research and Care. 2014;2. doi:10.1136/bmjdrc-2013-000012
• [29]Singapore Medical Council. Singapore Medical Council annual reports. Singapore: Singapore Medical Council; 2014.
• [30]Gray SF, Spry PG, Brookes ST, Peters TJ, Spencer IC, Baker IA et al.. The Bristol shared care glaucoma study: outcome at follow up at 2 years. Br J Ophthalmol. 2000; 84(5):456-63.
• [31]O’Connor PM, Alex Harper C, Brunton CL, Clews SJ, Haymes SA, Keeffe JE. Shared care for chronic eye diseases: perspectives of ophthalmologists, optometrists and patients. Med J Aust. 2012; 196(10):646.
• [32]Marjoram P, Molitor J, Plagnol V, Tavaré S. Markov chain Monte Carlo without likelihoods. Proc Natl Acad Sci U S A. 2003; 100(26):15324-8.
• [33]A sustainable population for a dynamic Singapore: population white paper. NPTD, Singapore; 2013.
• [34]Government of Singapore. Pioneer generation package - overview. 2015. https://www.pioneers.sg/en-sg/pages/overview.aspx. Accessed 17 Nov 2015.
• [35]Standard Chartered Bank. Standard Chartered launches Mobile Eye Clinic - Singapore’s first comprehensive eye care on-the-move for senior citizens. 2014. https://www.sc.com/sg/press-releases/en/_pdf/2014/Press_release_Standard%20Chartered_Mobile_Eye%20Clinic_27Sep2014_FINAL.pdf. Accessed 5 November 2014.
• [36]SingHealth. Singapore National Eye Centre opens new clinic in Balestier. 2008. http://www.singhealth.com.sg/DoctorsAndHealthcareProfessionals/Medical-News/2008/Pages/Singapore-National-Eye-Centre-opens-new-clinic-in-Balestier.aspx. Accessed 5 November 2014.
• [37]Teo Z. Educational profile of Singapore resident non-students, 2002–2012. Report No.: ISSN 0218–6810 Contract No.: March 2013.