Abstract
Concern abounds about whether the health care workforce is sufficient to meet changing demands spurred by the Affordable Care Act (ACA). We project that by 2022 the health care industry needs three to four million additional workers, forty percent of which is related to demand growth under the ACA. We project faster job growth in the ambulatory care sector, especially in home health care. Given the current profile, we expect that the future health care workforce will be increasingly female, young, racially/ethnically diverse, not US-born, at or below the poverty level and at a low level of educational attainment.
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References
Association of American Medical Colleges. (2010). The impact of health care reform on the future supply and demand for physicians updated projections through 2025 [Internet]. Washington, DC: Association of American Medical Colleges. [cited 2014 Jul 18]. 2 pp. Available from: https://www.aamc.org/download/158076/data/updated_projections_through_2025.pdf.
Bodenheimer, T. S., & Smith, M. D. (2013). Primary care: Proposed solutions to the physician shortage without training more physicians. Health Affairs (Millwood), 32(11), 1881–1886.
Bureau of Labor Statistics. (2013a). Projections methodology [Internet]. Washington, DC: Bureau of Labor Statistics. [cited 2014 Jul 25; updated 2014 Jan 2]. Available from: www.bls.gov/emp/ep_projections_methods.htm.
Bureau of Labor Statistics. (2013b). Table 2.1. Employment by major industry sector [Internet]. Washington, DC: Bureau of Labor Statistics. [updated 2013 Dec 19, cited 2014 Jul 18]. Available from: http://www.bls.gov/emp/ep_table_201.htm.
Bureau of Labor Statistics. (2014). Table 1.9 2012–22 Industry-occupation matrix data, by industry [Internet]. Washington, DC: Bureau of Labor Statistics. [cited 2014 Jul 25; updated 2013 Dec 19]. Available from: http://www.bls.gov/emp/ep_table_109.htm.
Centers for Medicare and Medicaid Services. (2014). Projections of national health expenditures: Methodology and model specification [Internet]. Baltimore, MD: Centers for Medicare and Medicaid Services. [cited 2015 Jan 29; updated 2014 Sep 3]. Available from: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/ProjectionsMethodology.pdf.
Congressional Budget Office. (2013). Table 1. CBO’s May 2013 estimate of the effects of the Affordable Care Act on health insurance coverage [Internet]. Washington, DC: Congressional Budget Office. [cited 2014 Jul 18]. 3 pp. Available from: http://www.cbo.gov/sites/default/files/cbofiles/attachments/43900-2013-05-ACA.pdf.
Cuckler, G. A., Sisko, A. M., Keehan, S. P., Smith, S. D., Poisal, J. A., Wolfe, C. J., et al. (2013). National health expenditure projections, 2012–22: Slow growth until coverage expands and economy improves. Health Affairs (Millwood), 32(1), 1820–1831.
Feldman, R., Parente, S. T., Abraham, J., Christianson, J. B., & Taylor, R. (2005). Health savings accounts: Early estimates of national take-up. Health Affairs (Millwood), 24(6), 1582–1591.
Final Report (April, 2013). Contract No. OA-393-2012-0001 from the Office of the Actuary (OACT), United States Department of Health and Human Services.
Frogner, B. (2010). The missing technology: An international comparison of human capital investment in health care. Applied Health Economics and Health Policy, 8(6), 361–371.
Frogner, B., & Spetz J. (2015). Exit and entry of workers in long-term care. San Francisco. CA: UCSF Health Workforce Research Center on Long-Term Care.
Frogner, B., & Spetz, J. (2013). Affordable Care Act of 2010: Creating job opportunities for racially and ethnically diverse populations [Internet]. Washington, DC: Joint Center for Political and Economic Studies. [cited 2014 Jul 25]. Available from: http://jointcenter.org/content/affordable-care-act-2010-creating-job-opportunities-racially-and-ethnically-diverse.
Henderson, R. (2013). Industry employment and output projections to 2022. Monthly Labor Review. December: 1–34.
National Center for Health Workforce Analysis, Health Resources and Services Administration. (2013). Projecting the Supply and Demand for Primary Care Practitioners Through 2020 [Internet]. Rockville, MD: US Department of Health and Human Services. [cited 2014 Aug 30]. 37 pp. Available from: http://bhpr.hrsa.gov/healthworkforce/supplydemand/usworkforce/primarycare/projectingprimarycare.pdf.
Parente, S., Feldman, R., Abraham, J. M., & Xu, W. (2011). Consumer response to a national marketplace for individual insurance. Journal of Risk and Insurance, 78(2), 389–411.
Parente, S. T., & Feldman, R. (2013). Micro-simulation of private health insurance and Medicaid take-up following the U.S. Supreme Court decision upholding the Affordable Care Act. Health Services Research, 48(2 Pt 2), 826–849.
Ricketts, T. C., & Fraher, E. P. (2013). Reconfiguring health workforce policy so that education, training, and actual delivery of care are closely connected. Health Affairs (Millwood), 32(110), 1874–1880.
Rother, J., & Lavizzo-Mourey, R. (2009). Addressing the nursing workforce: A critical element for health reform. Health Affairs (Millwood), 28(4), w620–w624. doi:10.1377/hlthaff.28.4.w620.
Rubenfire, A. (2015). Healthcare could gain from Obama’s free community college bid. Modern Healthcare. [cited 2015 Jan 29; updated 2015 Jan 9]. Available from: http://www.modernhealthcare.com/article/20150109/NEWS/301099948.
Ruggles, J., Alexander, T., Genadek, K., Goeken, R., Schroeder, M. B., & Sobek, M. (2010). Integrated public use microdata series: Version 5.0 [Machine-readable database]. Minneapolis, MN: Minnesota Population Center, University of Minnesota. [cited 2014 Jul 25]. Available from: https://usa.ipums.org/usa/.
Spetz, J., Frogner, B., Lucia, L., & Jacobs, K. (2014). The impact of the affordable care act on new jobs. Berkeley, CA: Center for Labor Research and Education. [cited 2014 Jul 25]. Available from: http://www.bigideasforjobs.org/wp-content/uploads/2012/03/Spetz_Lee_Final.pdf.
Spetz, J. (2012). Health reform and the health care workforce [Internet]. Houston, TX: James A. Baker III Institute for Public Policy. [cited 2014 Jul 25]. Available from: http://bakerinstitute.org/files/1399/.
Stone, R., & Harahan, M. F. (2010). Improving the long-term care workforce serving older adults. Health Affairs (Millwood), 29(1), 109–115.
Williams, T. (2014). Seeking new start, finding steep cost; workforce investment act leaves many jobless and in debt. New York Times (New York Edition). Aug 17; Sect A:1.
Wood, C.A. (2011). Employment in health care: A crutch for the ailing economy during the 2007–09 recession. Monthly Labor Review, April:13–19.
Wyatt, I. D. (2010). Evaluating the 1996–2006 employment projections. Monthly Labor Review, September: 33–69.
Acknowledgments
This work was conducted with the support of the Joint Center for Political and Economic Studies. We acknowledge the support of the Health Systems Innovation Network, LLC for the use and adaptation of the ARCOLA model for this research.
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Technical Appendix
Technical Appendix
Modified assumptions of the ARCOLA model
Following is a brief discussion the model, and the updated assumptions and modifications we made for the purposes of this study. We assumed that the ACA will unfold as legislated and made the following adjustments to the ARCOLA model. First, we updated the model from the original plan characteristics defining the low, medium and high preferred provider organizations (PPOs) to reflect the likely “metallic” choices that are part of the ACA. Combining our knowledge of health insurance with the likely changes to the benefit design of the metallic plan choices, we made the following assumptions: (1) platinum plans would be equivalent to a high PPO option; (2) gold plans would map to a medium PPO option; (3) silver plans would map to a low PPO option; and (4) bronze plans would map to high-deductible health plans (HDHP). We also assumed premiums would increase by 4–8 % depending on the plan choice.
Second, we incorporated Medicaid expansion for states opting in for the expansion as of November, 2013. We used data from the Kaiser Family Foundation on benefit coverage and cost of acute-care Medicaid programs by state to simulate the expansion of the Medicaid population. Third, we factored in the health status of an individual (specifically for those with chronic conditions) assuming a person’s health status may predict which plan he or she chooses. To do this, we created a dummy variable to denote the presence of chronic illness. Since a sick person will likely drive premiums up, incorporating this variable into the model allowed for a more accurate adjustment to overall premiums and cost sharing.
After all adjustments were made, we then used claims data as well data from ehealthinsurance.com to estimate premiums offered and resulting take-up of insurance in the private health insurance market including the Medicare Advantage market, as well as estimate take-up of insurance under the Medicare Fee-for-Service sector. We then used a multi-payer insurance claims database to measure utilization of health services by type of insurance in order to develop demand projections within each health care sector.
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Frogner, B.K., Spetz, J., Parente, S.T. et al. The demand for health care workers post-ACA. Int J Health Econ Manag. 15, 139–151 (2015). https://doi.org/10.1007/s10754-015-9168-y
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DOI: https://doi.org/10.1007/s10754-015-9168-y