Reports > State Responses to Health
Worker Shortages: Results of 2002 Survey of States > Discussion
- For the
most part, states have become involved in addressing health worker
shortages not because of their roles in financing and regulation
of health and education, which are extensive, but in response
to general concerns with the impact on access and quality. Although
the health and education sectors have a major stake in the health
workforce and they have undertaken many efforts to address shortages,
their actions alone have not been successful in preventing or
reversing the shortages. Given the failure of the marketplace
and the health and education sectors to produce a supply of health
workers to meet the demand, the public has turned to state government
to provide leadership. States clearly have a major role to play
in addressing health worker shortages.
- For the
most part, the state responses to date have been relatively modest
and narrowly focused. The responses have generally been designed
to stimulate the production of new workers, such as through scholarships,
loan repayment, and the marketing of health careers. States have
also provided some additional reimbursement, particularly through
the Medicaid program for long term care paraprofessionals.
- With few
exceptions, states do not appear to be addressing problems of
retention or trying to improve productivity. This likely reflects
the difficulty for government to influence internal health facility
operations. States do not appear to be seeking to change licensure
or scope of practice regulations, which is also a sensitive area
to most professions.
- Although
there is some inevitable duplication and redundancy in having
each state explore and develop their own policy responses, there
appear to be major benefits to the processes states are going
through. This includes development of solutions and programs consistent
with each state's health and education systems and increased collaboration
between the health and education sectors and between labor and
management which can foster effective policy development and implementation.
The development of individual state policies also fosters innovation
and creativity.
- In light
of the significant amount of activity at the state level, the
early stage of development, and the need for continued attention
to health workforce issues by states, there would appear to be
major benefits to collaboration and information sharing among
states. A major investment in the evaluation of the impact and
effectiveness of the alternative policies and strategies would
also seem to be appropriate and very valuable. The federal government
and foundations could play an important role in collecting and
disseminating information across states and in supporting evaluations
of responses to workforce shortages.
- Responding
to health worker shortages is an opportunity to address other
important issues, including the quality of care, the lack
of diversity in many professions, and the quality of life for
many workers. Overworked and frustrated workers contribute to
errors and poor outcomes. Increasing worker satisfaction, using
technology to assist workers and patients, and re-designing jobs
and tasks to reduce burnout and errors will not only increase
retention but also improve quality of care and the quality of
lives of workers. Building career ladders will help diversify
the workforce and address the current inequities.
The marketplace for health workers is often slow and inefficient,
but it does respond. For example, in response to the publicity
around nursing shortages, enrollment in nursing programs is rising,
and health facilities are developing initiatives to increase retention.
Thus, it is likely that some of the health worker shortages will
subside in the next few years as the marketplace responds. While
this is good news, the demographics of America will make it very
difficult to increase the supply in future years when the demand
is likely to rise rapidly as the baby boom generation ages. For
this reason, it is critical that the assessment of health workforce
needs and the development of systems to address health workforce
needs not be viewed as temporary issues but as long range issues
that will require continuing attention and policy making structures
to assure an adequate supply of health workers.
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