August 2014 Commonwealth of Australia 2014



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Demand methodology


Demand projections employed the utilisation method – which measures expressed demand, and are based on service utilisation patterns as they currently exist for five-year age and gender cohorts. The utilisation approach makes no assumptions about potential (or unmet) demand.

Utilisation patterns were calculated based on ARCPOH NDTIS data on visits and services provided between 1994 and 2010. This was matched against age and gender cohorts, and once mapped was projected against future demographic structures.

Table 6 shows the demand rates based on visits, services and services per visit used in the modelling.

Table : Utilisation patterns for oral health



Item

1994-1996

1996-1999

1999-2002

1994 - 2002

2002-2008

2002-2010

2008-2010

1994-2010

Total visits

-1.99%

7.44%

-0.63%

1.97%

3.24%

3.13%

2.80%

2.55%

Total services

0.65%

5.47%

12.56%

6.82%

5.07%

4.89%

4.36%

5.85%

Services per visit

2.70%

-1.84%

13.27%

4.75%

1.77%

1.70%

1.51%

3.22%

Source: HWA analysis of ARCPOH data

Scenarios


Scenario modelling is used to demonstrate the impact of potential policy options on future workforce supply and demand. These ‘alternative futures’ are modelled and measured by varying input parameters. The general method used is to present a comparison scenario, where current trends are assumed to continue into the future, and use this to compare with a range of alternative scenarios. The alternative scenarios are generated by altering parameters in the model, with the flow through effect to the future workforce measured through the impact relative to the comparison scenario.

The impact of these scenarios is measured by comparing their workforce projection results with the comparison scenario – a technical construct where current trends are assumed to continue into the future. The comparison scenario is not a prediction of the future; it is based on utilisation patterns as they currently exist; does not account for any unmet need; and should be interpreted as a ‘do nothing’ scenario, which assumes known policy settings are held constant as their future levels cannot be predicted. This allows an assessment of the effects of other changes which may impact the workforce. In the comparison scenario, the total growth in visits between 1994 and 2010 (2.55 per cent, see Table 6) was used to calculate baseline projections for demand for oral health services.

Eight alternative scenarios were developed for AFHW – Oral Health. It is important to note the scenarios are not predictions of what will happen over the period to 2025 – each provides an estimate of a likely outcome given the set of conditions upon which it is based. The scenarios were developed based on consultation with stakeholders, and follow the similar vein as those in Health Workforce 2025 – Doctors, Nurses and Midwives Volumes 1 to 3.45,46,47

These scenarios reflect potential policy options for the government, industry and education sectors to influence health workforce outcomes, as well as possible external shocks to the oral health workforce.


Medium self-sufficiency


This scenario presents the results of moving towards a 50 per cent reduction in net international migration (both temporary and permanent), and a 50 per cent reduction in the number of international students graduating Australian dental programmes, by 2025 (starting from the number of migrants and international graduates in the base year, 2012).

Productivity


This scenario presents the impact on workforce supply and demand projections of a five per cent productivity gain over the projection period. In this scenario, the productivity gain is not attributed to any particular measure, but could include gains achieved through workforce reforms such as changing models of care, adjustments to skill mix, health professionals working to their full scope of practice and technology changes. In the modelling, an increase in productivity is represented by reducing demand, because the ability to produce more with less requires fewer people to deliver a given quantum of services. Given the nature of oral health service delivery in Australia, a five per cent productivity gain may sound low to some stakeholders, but this needs to take into account improvements in both the public and private sectors.

Low demand


This scenario models the impact of a reduction in demand that may stem from the effects of health reform measures and other systemic changes that would lower the use of oral health services by the general population, or a reduction in the demand for particular categories of oral health practitioners. For the purposes of modelling, one per cent was used (which is less than the comparison scenario demand).

High demand


This scenario models the impact of increase in demand for oral health services or an increase in demand for particular categories of oral health practitioners by the general population. The level of growth in oral health services provided between 1994 and 2010, 5.85 per cent (Table ), has been used as the growth rate to model this scenario.

Undersupply


An assumption in the workforce projections is that supply and demand are in balance in the first year. There is no quantitative measure of the pre-existing workforce position (whether it is in shortage, balance or supply exceeds demand), however the consensus among stakeholders is that the oral health workforce is in undersupply in some areas, such as the public sector and in rural and remote areas.

Therefore, this scenario was developed to illustrate the impact on the workforce where a five per cent undersupply is assumed in the initial year of modelling.


Oversupply


Similar to the undersupply scenario, as there is no quantitative measure of the pre-existing workforce position (whether it is in shortage, balance or supply exceeds demand) of the oral health workforce, this scenario models the assumption that there is an existing workforce imbalance in the base year of the projections, with workforce supply higher than demand. There was consensus among stakeholders that, despite any geographic and sectoral mal-distribution in the oral health workforce, some areas of oral health practitioners’ supply exceeds demand.

The scenario demonstrates the impact on the workforce where a five per cent oversupply is assumed in the initial year of modelling.


Graduate reduction


This scenario models the effects of a ten per cent reduction in the number of graduates (both domestic and international) of Australian dental programmes. In the comparison scenario, the number of graduates was projected to 2017, based on recent trends in the number of graduates, the number of students currently enrolled in dental programmes, and their expected years of completion. This number was then held constant from 2017 to 2025. In the graduate reduction scenario, a ten per cent reduction in the projected number of graduates to 2017 was calculated, and the reduced number of expected graduates in 2017 was held constant to 2025.

In this scenario, the reduction in graduate numbers is not attributed to any particular measure, but could include a reduction due to a cap in student numbers or a reduction in the number of students electing to enter or complete dental programmes.


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