Sisteminis gydytojų skaičiaus ir jų teikiamų sveikatos priežiūros paslaugų poreikio modeliavimas

Ensuring of balance of requirement and demand of health care services as well as planning of human resources for health (HRH) are main functions of health care systems. They are complex challenges which can be solved not only by means of administrative management but scientific research as well. HRH consist the majority of costs in health care systems, therefore its planning should not be just sporadic event or reaction to crisis, but rather effective, long-term and permanent process. Aim. To design the package of measures, which would enable to provide forecasts about HRH supply and requirement at national, regional, and municipal level. Material and methods. Data on fulfilling of restructuring plans were reported by counties and collected by ministry of health. Analysis included both factual and achievements indicators in 2002 and 2005 as set in restructuring plans. HRH in terms of plans were described in following indicators: number of GPs, GP municipal coverage, number of physicians specialists, and number of nursing specialists. This was analysed at national and counties levels. Data on number of physicians and services in Alytus county were drawn from regional patients funds database. Data on number of physicians and services at national level, major and minor counties were achieved from national health information center. Demographic indicators and forecasts were based on national department of statistics. Results. Following the restructuring plans, GP municipal coverage was increasing while number of physicians specialists was decreasing. In 2002–2008, the population of Lithuania decreased, while the number of services and physicians was increasing. For 2015 it is forecasted that in Alytus county the number of services will change depending on specialities and population subgroups. Conclusions. Changes of HRH supply in 2002–2005 show that restructuring of health care settings was not the only factor influencing HRH supply and therefore not all indicators set in restructuring plans were achieved. The population in 2002–2008 decreased while number of in-patient visits was increasing. This study revealed that changes in total number of physicians through 2002–2008 were determined by increasing requirement of health care services in major counties and other factors in minor counties. Thus, the total number of physicians in minor counties stood almost stable. In this period, the number of GPs and their services considerably increased. Evaluation of new model of balance between supply and requirement of health services showed that multivariate regression functions can be used in forecasting the requirement. This model enables to forecast requirement of certain specialities and use it at national, regional, municipal, and local (health care setting) levels. Institutions in charge of supply of physicians can use this model in planning of adequate number of physicians. Comparison of forecasts based on this new systemic model of balance in supply and requirement and forecasts based on NIVEL model designed in the Netherlands shows that the former model accounts more the demand of health care services than the latter