medecolМедицина и экологияMedicine and ecology2305-60452305-6053Карагандинский медицинский университетmedecol-244Research ArticleОРГАНИЗАЦИЯ И ЭКОНОМИКА ЗДРАВООХРАНЕНИЯORGANIZATION AND ECONOMICS OF HEALTHОЦЕНКА ЧУВСТВИТЕЛЬНОСТИ МОДЕЛИ ПРОГНОЗИРОВАНИЯ КАДРОВЫХ РЕСУРСОВ ПМСПESTIMATION OF THE SENSITIVITY OF THE HUMAN RESOURCES FORECASTING MODEL FOR PHCХаринА. Д.KharinA. D.noemail@neicon.ruКойчубековБ. К.KoichubekovB. K.noemail@neicon.ruОмаркуловБ. К.OmarkulovB. K.noemail@neicon.ruМедицинский университет КарагандыКазахстанKaraganda medical universityKazakhstan20200709202104134142Copyright © Харин А.Д., Койчубеков Б.К., Омаркулов Б.К., 20212021Харин А.Д., Койчубеков Б.К., Омаркулов Б.К.Kharin A.D., Koichubekov B.K., Omarkulov B.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medecol.qmu.kz/jour/article/view/244

Целью исследования послужило изучение влияния ряда факторов на прогнозирование потребности во врачах общей практики в Казахстане до 2030 г. Для этого проведен анализ чувствительности модели. Модель прогнозирования кадровых ресурсов разработана по методологии системной динамики. Анализ чувствительности (метод Монте-Карло) был проведен для учета изменений в количестве врачей общей практики под влиянием следующих параметров модели: увольнения по причине достижения пенсионного возраста, увольнения по другим причинам, а также приток кадров за счет внутренних мигрантов. Для каждого параметра рассчитывалась относительная чувствительность. Результаты свидетельствуют, что созданная модель наименее чувствительна к параметру «выход на пенсию», но очень чувствительна к показателю текучести кадров. Это одна из основных проблем первичной медико-санитарной помощи. Данный параметр имеет большой потенциал для управления потоком рабочей силы. Прием на работу внутренних мигрантов (кроме выпускников вузов) - еще один фактор, который оказывает значительное влияние на прогнозы. Чувствительность к этому параметру сопоставима с чувствительностью к оттоку кадров. Также осуществлена оценка влияния всех трех параметров одновременно. Если реализуется наиболее вероятный сценарий, то рынок предложений практически полностью покроет потребности во врачах общей практики с небольшим дефицитом от 68 до 305 врачей.

Our aim was to explore the effect of the uncertainty of some parameters on total General Practitioner supply in Kazakhstan to 2030. System dynamics simulation was used to develop model for General Practitioner workforce forecasting. Sensitivity analysis (Monte Carlo method) was performed to account for changes in the number of General Practitioners as each and set of model parameters is varied. Three key input parameters were explored: retirement rate, attrition rate, recruitment rate. For each parameter relative sensitivity was calculated. Created model is the least sensitive to the parameter of the retirement rate, but is very sensitive to attrition rate. Staff turnover is one of the main problems of primary health care. The attrition rate parameter has great potential for controlling the flow of labor. The level of recruitment (other than new General Practitioners) is another factor that has a significant impact on forecasting General Practitioners. The sensitivity to this parameter is comparable to the sensitivity to the rate of depletion. We believe that measures taken to reduce dropouts will simultaneously increase recruitment. We also evaluated the effect of all three parameters simultaneously. If the most likely scenario is realized, then the proposal of a General Practitioner will almost completely cover the needs with a small deficit of 68 to 305 doctors. If the high limit or low limit scenarios in the labor market are implemented, Healthcare Ministry will face serious problems.

системная динамикаоценка чувствительностипрогнозирование кадровых ресурсовобщественное здравоохранениеsystem dynamicssensitivity assessmenthuman resource forecastingpublic healthReferencesSmits M. Proceedings of the 23-rd Blede Conference'e Trust: Implications for the Individual, Enterprises and Society' /M. Smits, V. Slenter, J. Geurts //Improving manpower planning in health care. - Pucihar, 2010. - P. 144-154.Smits M. Proceedings of the 23-rd Blede Conference'e Trust: Implications for the Individual, Enterprises and Society' /M. Smits, V. Slenter, J. Geurts //Improving manpower planning in health care. - Pucihar, 2010. - P. 144-154.Committee, A.H.W.A., Nursing Workforce Planning In Australia - A Guide To The Process And Methods Used by the Australian Health Workforce Committee. 2004, AHWAC: Sydney, http://www.healthworkforce.health.nsw.gov.au/amwac/pdf/nurse_plan_20041.pdfCommittee, A.H.W.A., Nursing Workforce Planning In Australia - A Guide To The Process And Methods Used by the Australian Health Workforce Committee. 2004, AHWAC: Sydney, http://www.healthworkforce.health.nsw.gov.au/amwac/pdf/nurse_plan_20041.pdfBirch S. Health human resource planning for the new millennium: inputs in the production of health, illness, and recovery in populations //Can. J. Nursing Res. - 2002. - V. 33. - P. 109-114.Birch S. Health human resource planning for the new millennium: inputs in the production of health, illness, and recovery in populations //Can. J. Nursing Res. - 2002. - V. 33. - P. 109-114.Hall T. H. Why plan human resources for health? //Hum. Resour. Dev. - 1998. - V. 2. -P. 77-86.Hall T. H. Why plan human resources for health? //Hum. Resour. Dev. - 1998. - V. 2. -P. 77-86.Barer M. Toward integrated medical resource policies for Canada, in Report to the Federal /M. Barer, G. Stoddart //Provincial Territorial Conference of Deputy Ministers of Health. -Ontario, 1991. - P. 214-216.Barer M. Toward integrated medical resource policies for Canada, in Report to the Federal /M. Barer, G. Stoddart //Provincial Territorial Conference of Deputy Ministers of Health. -Ontario, 1991. - P. 214-216.Dussault, G. B. Assessing future health workforce needs-Investing in Europe's health workforce of tomorrow: Scope for innovation and collaboration /G. B. Dussault, J. Sermeus, W. Padaiga. - Geneva, 2010. - 234 p.Dussault, G. B. Assessing future health workforce needs-Investing in Europe's health workforce of tomorrow: Scope for innovation and collaboration /G. B. Dussault, J. Sermeus, W. Padaiga. - Geneva, 2010. - 234 p.Forte G. J. U.S physician workforce forecasting: a tale of two states //Cahiers de Sociologie et de Demographie Medicales. - 2006. -V. 46 (2). - P. 123-148.Forte G. J. U.S physician workforce forecasting: a tale of two states //Cahiers de Sociologie et de Demographie Medicales. - 2006. -V. 46 (2). - P. 123-148.Lavis, J. N. The answer is.., now what was the question? Applying alternative approaches to estimating nurse requirements /J. N. Lavis, S. Birch //Can. J. Nurs. Adm. - 1997. - V. 10 (1). - P. 24-44.Lavis, J. N. The answer is.., now what was the question? Applying alternative approaches to estimating nurse requirements /J. N. Lavis, S. Birch //Can. J. Nurs. Adm. - 1997. - V. 10 (1). - P. 24-44.Roberfroid D. L. Physician supply forecast: better than peering in a crystal ball /D. L. Roberfroid, Ch. Stordeur, S. //Hum. Resour. Health. - 2009. - V. 7 (10). - P. 16-18.Roberfroid D. L. Physician supply forecast: better than peering in a crystal ball /D. L. Roberfroid, Ch. Stordeur, S. //Hum. Resour. Health. - 2009. - V. 7 (10). - P. 16-18.Schofield D. Modelling demand for medical services in Australia /D. Schofield, I. Mcrae, R. Shrestha //International Medical Workforce Conference. - Edinburgh, 2008. - P. 78-82.Schofield D. Modelling demand for medical services in Australia /D. Schofield, I. Mcrae, R. Shrestha //International Medical Workforce Conference. - Edinburgh, 2008. - P. 78-82.Schofield D. R. Access to general practionionar services among underserved Australians: a microsimulation study /D. Schofield, R. Shrestha, E. Callander //Hum. Resour. Health. - 2012. - V. 10. - P. 567-571.Schofield D. R. Access to general practionionar services among underserved Australians: a microsimulation study /D. Schofield, R. Shrestha, E. Callander //Hum. Resour. Health. - 2012. - V. 10. - P. 567-571.O'Brien-Pallas L. Health human resource planning in home care: How to approach it - That is the question //Health. Pap - 2000. - V. 1 (4). - P. 53-59.O'Brien-Pallas L. Health human resource planning in home care: How to approach it - That is the question //Health. Pap - 2000. - V. 1 (4). - P. 53-59.Rafiei S. Organization., W.H., Models and Tools for Health Workforce Planning and Projections /S. Rafiei, S. Abdollahzade, F. Hashemi // Human Resources for Health Observer. - Geneva, 2010. - P. 890-893.Rafiei S. Organization., W.H., Models and Tools for Health Workforce Planning and Projections /S. Rafiei, S. Abdollahzade, F. Hashemi // Human Resources for Health Observer. - Geneva, 2010. - P. 890-893.Scott A. Alternative approaches to health workforce planning. - Queensland, 2011. -148 p.Scott A. Alternative approaches to health workforce planning. - Queensland, 2011. -148 p.Solutions D.C.f.H. Better health care worker demand projections: A twenty first century approach. - Bipartisan, 2013. - 234 p.Solutions D.C.f.H. Better health care worker demand projections: A twenty first century approach. - Bipartisan, 2013. - 234 p.The Complexities of National Health Care Workforce Planning. - Bipartisan, 2011. - 68 p.The Complexities of National Health Care Workforce Planning. - Bipartisan, 2011. - 68 p.Buske L. Projected physician supply // CMAJ. - 1998. - V. 158. - P. 1584.Buske L. Projected physician supply // CMAJ. - 1998. - V. 158. - P. 1584.Health human resources planning and the production of health /S. Birch, G. Kephart, G. Tomblin-Murphy et al. //Development of an analytical framework for needs-based health human resources planning. - Ontario: McMaster University; 2007. - 164 p.Health human resources planning and the production of health /S. Birch, G. Kephart, G. Tomblin-Murphy et al. //Development of an analytical framework for needs-based health human resources planning. - Ontario: McMaster University; 2007. - 164 p.Ship P. J. Health personnel projections, The methods and their uses, studies on country experiences. WHO/EDUC/ 89.198. Division of Health Manpower Development. - Geneva, 1989. - 92 p.Ship P. J. Health personnel projections, The methods and their uses, studies on country experiences. WHO/EDUC/ 89.198. Division of Health Manpower Development. - Geneva, 1989. - 92 p.Joyce C. More doctors, but not enough: Australian medical workforce supply 2001 - 2012 /C. Joyce, J. McNeil, J. Stoelwinder //Med. J. Aust. - 2006. - V. 184. - P. 441-446.Joyce C. More doctors, but not enough: Australian medical workforce supply 2001 - 2012 /C. Joyce, J. McNeil, J. Stoelwinder //Med. J. Aust. - 2006. - V. 184. - P. 441-446.Song F. Stochastic simulation and sensitivity analysis: estimating future demand for health resources in China /F. Song, T. Rathwell // World Health Stat. - 1994. - V. 47. - P. 149-156.Song F. Stochastic simulation and sensitivity analysis: estimating future demand for health resources in China /F. Song, T. Rathwell // World Health Stat. - 1994. - V. 47. - P. 149-156.Medical Training Review Panel. Seventh Report. Canberra: Commonwealth Department of Health and Ageing, 2003. Available at: http://www.health.gov.au/internet/wcms/Publishing.nsf/Content/health-workforce-education-mtrp7thr.htm (accessed Mar 2006).Medical Training Review Panel. Seventh Report. Canberra: Commonwealth Department of Health and Ageing, 2003. Available at: http://www.health.gov.au/internet/wcms/Publishing.nsf/Content/health-workforce-education-mtrp7thr.htm (accessed Mar 2006).Australian Bureau of Statistics. Population projections, Australia, 2002 - 2101. - Canberra: ABS, 2003. - 324 p.Australian Bureau of Statistics. Population projections, Australia, 2002 - 2101. - Canberra: ABS, 2003. - 324 p.A systematic review of physician retirement planning /M. P. Silver, A. D. Hamilton, A. Biswas et al. //Hum. Resour. Health. - 2016. - V. 14. - P. 67.A systematic review of physician retirement planning /M. P. Silver, A. D. Hamilton, A. Biswas et al. //Hum. Resour. Health. - 2016. - V. 14. - P. 67.Kollar E. Ethics and policy of medical brain drain: a review /E. Kollar, A. Buyx //Swiss Med. Wkly. - 2013. - V. 143: w13845Kollar E. Ethics and policy of medical brain drain: a review /E. Kollar, A. Buyx //Swiss Med. Wkly. - 2013. - V. 143: w13845Serour G. I. Healthcare workers and the brain drain //Int. J. Gynaecol. Obstet. - 2009. - V. 106. - P. 175-178.Serour G. I. Healthcare workers and the brain drain //Int. J. Gynaecol. Obstet. - 2009. - V. 106. - P. 175-178.Ono T. Health Workforce Planning in OECD Countries: A review of 26 projection models from 18 countries /T. Ono, G. Lafortune, M. Schoenstein //OECD Health Working Papers. -2013. - V. 62. - P. 78-85.Ono T. Health Workforce Planning in OECD Countries: A review of 26 projection models from 18 countries /T. Ono, G. Lafortune, M. Schoenstein //OECD Health Working Papers. -2013. - V. 62. - P. 78-85.Republican Center for Healthcare Development [Internet]. Nur-Sultan: The Association; [cited 2020 Jun 07]. National Healthcare Personnel Management Policy. Available from: http://www.rcrz.kz/files/nauka/%d0%9d%d0%b0%d1%86%d0%b8%d0%be%d0%bd%d0%b0%d0%bb%d1%8c%d0%bd%d0%b0%d1%8f%20%d0%bf%d0%be%d0%bb%d0%b8%d1%82%d0%b8%d0%ba%d0%b0%20%d1%83%d0%bf%d1%80%d0%b0%d0%b2%d0%bb%d0%b5%d0%bd%d0%b8%d1%8f%20%d0%9a%d0%a0%d0%97.pdfRepublican Center for Healthcare Development [Internet]. Nur-Sultan: The Association; [cited 2020 Jun 07]. National Healthcare Personnel Management Policy. Available from: http://www.rcrz.kz/files/nauka/%d0%9d%d0%b0%d1%86%d0%b8%d0%be%d0%bd%d0%b0%d0%bb%d1%8c%d0%bd%d0%b0%d1%8f%20%d0%bf%d0%be%d0%bb%d0%b8%d1%82%d0%b8%d0%ba%d0%b0%20%d1%83%d0%bf%d1%80%d0%b0%d0%b2%d0%bb%d0%b5%d0%bd%d0%b8%d1%8f%20%d0%9a%d0%a0%d0%97.pdf

The authors declare that there are no conflicts of interest present.