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Saatja: SAM Rastai <[email protected]> Saadetud: 27.04.2023 08:27 Koopia: Diana Smaliukaitė <[email protected]> Teema: 10-1862. Questionnaire about measures to tackle shortages and unequal distribution of healthcare workforce Manused: image001.png; image002.png; image003.png; image004.png; image005.png; Shortages and unequal distribution of healthcare workforce.adoc; Shortages and unequal distribution of healthcare workforce.pdf; The questionnaire (1).docx Questionnaire about measures to tackle shortages and unequal distribution of healthcare workforce Lietuvos Respublikos sveikatos apsaugos ministerija Tel. +370 5 268 5110 Faks. +370 5 266 1402 sam.lrv.lt | [email protected] Pasitikėjimo telefonas 8 800 66 004 Šis laiškas, įskaitant jo priedus, yra konfidencialus ir yra skirtas tik tam asmeniui, kuriam jis yra adresuotas. Kopijuoti, viešinti ar kitaip panaudoti šį laišką ar laiško dalį ne pagal jo tikslinę paskirtį yra draudžiama. Apie ne Jums skirto laiško gavimą prašome nedelsiant informuoti siuntėją elektroniniu paštu ir ištrinti laišką bei visas jo kopijas, įskaitant visus laiško priedus. Informaciją apie asmens duomenų tvarkymą galima perskaityti čia: http://sam.lrv.lt/lt/asmens-duomenu-apsauga Elektroninio dokumento nuorašas LIETUVOS RESPUBLIKOS SVEIKATOS APSAUGOS MINISTERIJA MINISTRY OF HEALTH OF THE REPUBLIC OF LITHUANIA Budgetary institution, Vilniaus str. 33, LT-01506 Vilnius, Lithuania, phone: +370 5 266 1400, fax: +370 5 266 1402, e-mail: [email protected], http://www.sam.lt. Data are accumulated and stored in the Register of Legal Entities, code 188603472 -04-2023 No. (1.1.20E-18)10- QUESTIONNAIRE ABOUT MEASURES TO TACKLE SHORTAGES AND UNEQUAL DISTRIBUTION OF HEALTHCARE WORKFORCE Dear Sir or Madam, The Ministry of Health of the Republic of Lithuania is contacting you and asking to share good practices of your country with us. We the Ministry of Health of the Republic of Lithuania together with the PricewaterhouseCoopers Lithuania are currently implementing a Project titled "Support to improve the distribution of healthcare professionals and develop a competence assessment framework for healthcare workers in Lithuania" (contract ID REFORM/SC2022/110). The project has been commissioned by DG REFORM. One of the key components of the project is development of the strategy to attract health care professionals to underserved areas, thus improving their distribution throughout the country. Before we start developing the strategy we would like to explore and analyse the best practises of the other countries and to learn from them, according to that, we would like to ask you to answer the attached questionnaire. The questionnaire is to aid and inform conclusions in the second outcome of the DG Reform project. The second outcome will develop a strategy to attract health care professionals to underserved areas, thus improving their distribution throughout the country. To ensure that the strategy is feasible and provides the most efficient evidence-based measures, this survey seeks to collect experiences regarding healthcare workforce in other EU countries. Particularly, it aims to:  get information on whether your country is also facing challenges regarding the healthcare workforce, such as shortages and/or unequal distribution of healthcare professionals throughout the country (‘maldistribution’).  whether and if so, how, your country has designed and implemented measures to address these issues. We are conducting this survey to gain in-depth information which will be of essence for Lithuania in designing the policies that aim to ensure improvement in geographical maldistribution of our health care workforce, as well as increase attraction of health care professions, to guarantee that all inhabitants will have access to healthcare when they need it. We sincerely hope that you will find the time to fill out the attached questionnaire by 25 May 2023 and will help us grow. If you are not responsible for this topic, please redirect this request to the right colleague or institution. If you have any questions, please do not hesitate to ask [email protected]. Thank you for your precious time and collaboration. Sincerely, Vice-Minister Aurimas Pečkauskas Diana Smaliukaitė, phone: +370 5 219 3314, e-mail: [email protected] Questionnaire “Measures to counter health care workforce maldistribution and increase the attraction of health care professions” Project: “Support to improve the distribution of healthcare professionals and develop a competence assessment framework for healthcare workers in Lithuania” This project is carried out with funding from the European Union via the Structural Reform Support Programme and in cooperation with the Directorate General for Structural Reform Support of the European Commission. Aim of this questionnaire The questionnaire is to aid and inform conclusions in the second outcome of the DG Reform project “Support to improve the distribution of healthcare professionals and develop a competence assessment framework for healthcare workers in Lithuania” (specific contract ID REFORM/SC2022/110). In its first outcome, the project sought to equip Lithuanian authorities with an enhanced professional development system for the healthcare workforce via the development of the healthcare professionals’ skills and competency assessment model. The second outcome will develop a strategy to attract health care professionals to underserved areas, thus improving their distribution throughout the country. To ensure that the strategy is feasible and provides the most efficient evidence-based measures, this survey seeks to collect experiences regarding healthcare workforce in other EU countries. Particularly, it aims to:  get information on whether your country is also facing challenges regarding the healthcare workforce, such as shortages and/or unequal distribution of healthcare professionals throughout the country (‘maldistribution’)  whether and if so, how, your country has designed and implemented measures to address these issues The questionnaire is split into three parts:  General questions about the participant and the healthcare workforce maldistribution, as well as health professionals’ production  Policy overview asking for implemented policies to combat shortages and geographical maldistribution of physicians, nurses, and other health professionals, with the space to provide a more detailed information about the most successful policies  Main conclusions for your country providing space for you to share which measures you would recommend the most and which you found unsuccessful in dealing with shortages and geographical maldistribution of healthcare workforce We are conducting this survey to gain in-depth information which will be of essence for Lithuania in designing the policies that aim to ensure improvement in geographical maldistribution of our health care workforce, as well as increase attraction of health care professions, to guarantee that all inhabitants will have access to healthcare when they need it. The data collected from the survey will be used for the purposes of Outcome 2 of the “Support to improve the distribution of healthcare professionals and develop a competence assessment framework for healthcare workers in Lithuania” project. We sincerely thank you for finding the time to fill out this questionnaire. Section 1 – General questions 1. Which country do you represent? Please state your country 2. To which group would you categorise yourself? Please select the applicable option. National Health Care Authority ☐ Regional Health Care Authority ☐ Researcher ☐ Other – please specify below ☐ Other 3. What is your role in the organisation for which you are filling out the questionnaire? 4. Do you consider health care workforce shortage as an increasing issue in your country? Please select the applicable option. Yes ☐ No ☐ Optional (please specify) 5. According to your opinion, how severe is the shortage of staff for the following health professions? Please rank the following professions based on the severity of the problem with 1 meaning that there are no shortages of the professionals and 5 representing critical shortage of the professionals from the selected profession. Profession Ranking 1 2 3 4 5 low high Physicians ☐ ☐ ☐ ☐ ☐ Nurses and midwives ☐ ☐ ☐ ☐ ☐ Other health professionals (e.g., paramedics, pharmacists, etc.) ☐ ☐ ☐ ☐ ☐ 5.1 [OPTIONAL] Could you please name 3-5 specific professions (e.g., GPs) with the most severe shortages? 6. Do you consider geographical health care workforce maldistribution to be one of the key issues in your country’s health care system? Please select the applicable option. Yes ☐ No ☐ Optional (please specify) 7. According to your opinion, how severe is the geographical workforce maldistribution issue regarding the following health professions? Please rank the following professions based on the severity of the problem with 1 meaning that there are no shortages of the professionals in any region and 5 representing critical shortage of the professionals from the selected profession. Profession Ranking 1 2 3 4 5 low high  Physicians ☐ ☐ ☐ ☐ ☐ Nurses and midwives ☐ ☐ ☐ ☐ ☐ Other health professionals (e.g., paramedics, pharmacists, etc.) ☐ ☐ ☐ ☐ ☐ 8. According to your opinion, which type of health care poses the biggest issue in terms of its distribution in the geographic network? Please rank the provided types of care on the scale of 1-5 with 1 symbolising the ideal geographic distribution and presence and 5 representing a strong issue in terms of access and maldistribution. Type of care Ranking 1 2 3 4 5 low high Primary care (includes general practitioners, gynaecologists, ☐ ☐ ☐ ☐ ☐ physiotherapists, etc.) Secondary care (includes outpatient specialist practices, e.g., ☐ ☐ ☐ ☐ ☐ cardiologist office, etc.) Tertiary care ☐ ☐ ☐ ☐ ☐ Section 2 – Policy overview This section is concerned with the specific policies which have been introduced in your country in relation to healthcare workforce attraction and geographical maldistribution. The policy focus is divided by the professionals they are aimed at (physicians, nurses, midwives, and other health professionals) and by the type of issue they seek to address, into the following categories: financial incentives and non-financial incentives (education & training, infrastructure, regulatory, innovative, and other). At the end, there is a possibility to provide any other policies which your country uses and were not mentioned, as well as space for description of 1- 3 policies with the highest impact which were implemented in your country, and you consider them best practices. 9. Does your country have a national or regional legislative act which defines the approach for reducing health care workforce shortages or unequal geographical distribution of such staff? Yes, for health care workforce shortages ☐ Yes, for health care workforce maldistribution ☐ Yes, for both ☐ No ☐ [OPTIONAL] If you answered yes, please provide a link(s) to the regulation in the space below. 10. Has your country introduced any formalised measures to combat the geographical maldistribution of health care workers and health care workforce shortages? Please select the applicable option. Yes, for health care workforce shortages ☐ Yes, for health care workforce maldistribution ☐ Yes, for both ☐ No ☐ Not yet, however, they are already planned and in design stage ☐ [OPTIONAL] If you answered yes, please provide a link to the strategy containing the measures in the space below. 11. Does your country have a policy which limits training places for individual specialisations? (E.g., quota for cardiologists, GPs, anaesthesiology nurses, etc.) Please select the applicable option. Yes ☐ No ☐ [OPTIONAL] If you answered yes, please provide a link to the policy in the space below. Section 2.1.1 – Financial incentives or measures aimed at physicians Please select whether the policies listed are used in your country, proposed (measure already discussed and approved) or not used at all. Policy Used Not used Proposed Tax breaks (e.g., physicians working in rural and underserved regions receive ☐ ☐ ☐ an income tax exemption for 5 years) Stipends/scholarships distributed during the studies for ☐ ☐ ☐ physicians, contingent upon a contract of them practicing in an underserved district for selected number of years One-off financial contribution for setting up a practice in ☐ ☐ ☐ underserved areas  Additional monthly or annual payments to physicians in ☐ ☐ ☐ underserved, rural or remote areas (e.g., for carrying out a certain number of consultations for the vulnerable social groups, to allow them to hire additional staff or hosting an intern at the practice or working past the retirement age in underserved area, stabilisation allowance to doctors working in group practices in underserved areas or for education of new practitioners in the rural or remote practice) Various subsidies (e.g., transport, housing, education, additional training ☐ ☐ ☐ and upskilling, subsides for practitioners working in areas with a sufficient number of physicians who offer consultations in underserved areas, etc.) Please provide additional policies implemented by your country [OPTIONAL] Please provide links for the policies which you have selected from the list above Section 2.1.2 – Non-financial incentives for physicians Policy Used Not used Proposed Education and training policies Targeted advertisement (e.g., workshops to secondary school students ☐ ☐ ☐ regarding the medical profession, local “role models” for rural care advertising the profession, etc.) Increase of the number of medical students at universities (e.g., ☐ ☐ ☐ elimination of numerus clausus for medical programmes to ensure for higher physician numbers, quotas for medical students from rural background, focus on STEM subjects in the curriculum, etc.) Recruitment of medical students with rural background (e.g., ☐ ☐ ☐ reaching out to medical students with rural background during their studies, recruitment events, incentives for such students, etc.) Promotion of the rural care to existing physicians (e.g., alumni ☐ ☐ ☐ network approach – finding out which physicians could be interested in transferring to rural regions, fast-tracked general practitioner (GP) specialisation for rural regions, etc.) Increase in the training places (e.g., training places for general ☐ ☐ ☐ practitioners, the most underserved specialties, etc.) Training and continued education (e.g., continuing education and ☐ ☐ ☐ training opportunities in rural medical interdisciplinary clusters, rural general practitioner “role models” offering mentoring to new physicians in the rural areas) Please provide additional policies implemented by your country in the line below [OPTIONAL] Please provide links for the policies which you have selected from the list above in the line below Infrastructural policies Improvements in the local care delivery infrastructure (e.g., remote ☐ ☐ ☐ integrated care centres, coordination of medical professions at regional level, local investments into transport and infrastructure) Infrastructural measures (e.g., nursery or kindergarten by the health care ☐ ☐ ☐ facilities, availability of rental accommodation near the workplace, leisure activities provided, such as subsidised gym, availability of mental health care, etc.) Please provide additional policies implemented by your country in the line below [OPTIONAL] Please provide links for the policies which you have selected from the list above in the line below Regulatory policies Legislation for easier entry of foreign-educated physicians (EU ☐ ☐ ☐ or non-EU) into rural practice compared to non-rural placements (e.g., reduction of moratorium time for foreign educated doctors if they work in a rural or remote location, easier process of obtaining citizenship, etc.)  Legislation which allows the relevant Authority not to issue ☐ ☐ ☐ licences for medical practices, in places where the network is already full Legislation allowing the state to allocate health care personnel ☐ ☐ ☐ according to the regional needs on a temporary basis Please provide additional policies implemented by your country in the line below [OPTIONAL] Please provide links for the policies which you have selected from the list above in the line below Innovative policies Digital solutions (e.g., telehealth service used for monitoring of long-term ☐ ☐ ☐ health conditions for patients in underserved areas, medical terminals at pharmacies, etc.) Working arrangements (e.g., flexible working hours, less mandatory working hours in the rural practices, better organisation of care – multi- professional teams) Please provide additional policies implemented by your country in the line below [OPTIONAL] Please provide links for the policies which you have selected from the list above in the line below Policies introducing additional capacities Temporary contracts and mobile care provision (e.g., short-term ☐ ☐ ☐ GPs in underserved regions, deputy physician schemes whereby medical students in their final year can assist doctors during seasonal influxes, GPs travelling around the region where there is low density of physicians, mobile acute care units, etc.) New professions to alleviate GP workload (e.g., “hospital ☐ ☐ ☐ practitioners” or medical assistants or expanded roles of certain health care professionals such as paramedics) Please provide additional policies implemented by your country in the line below [OPTIONAL] Please provide links for the policies which you have selected from the list above in the line below Section 2.1.3 – Details of policies aimed at attraction, recruitment, and retainment of physicians in underserved regions, applied in your country In the boxes provided below, please write detailed information about 1-3 policies which have been applied by your country and had the most significant impact on the recruitment and retainment of physicians in the most critical regions. Policy no. 1 Name of the E.g., “Landarztprämie” – Rural physician premium policy initiative Link to the E.g., Sample link information about the policy/legislation if applicable Scope ☐ ☐ ☐ National Regional Municipal  What type of E.g., general practitioners (GPs) physician is targeted Description E.g., The rural physician premium is intended to provide financial compensation for these special challenges and thus encourage the decision to set up a practice, establish medical care centers and set up branches in the rural physician premium area. The amount of the rural physician premium for a branch office of physicians or for the establishment of an MVZ is up to 60,000 euros. If a branch is formed, the amount of the rural physician premium is up to 15 000 euros. The amount of the rural doctor's premium for a branch office of psychotherapists and for the establishment of an MVZ with the specialty of psychotherapy is up to 20 000 euros. To be eligible, the physician has to set up a practice in an underserved area and carry out medical activity for at least 60 months from the cut-off date. How long has this E.g., the incentive has been active since 2014 and is set to continue up until the incentive been in GP network is optimal at all underserved regions. place? Was it evaluated? Choose an item. Target E.g., establishment of 800 GP practices Impact E.g., within 7 years of the programme, we were able to support start-ups of 752 practices and practice branches. These included 555 for GPs and 112 for psychotherapists. Budget E.g., 6.9 million EUR annually Source of funding E.g., own funding by the Ministry of Health Barriers in E.g., issues with promoting the incentive at medical schools, low attractiveness implementation of the scheme for physicians, etc. Policy no. 2 Name of the policy initiative Link to the information about the policy/legislation if applicable Scope ☐ ☐ ☐ National Regional Municipal What type of physician is targeted Description How long has this incentive been in place? Was it evaluated? Choose an item. Target  Impact Budget Source of funding Barriers in implementation Policy no. 3 Name of the policy initiative Link to the information about the policy/legislation if applicable Scope ☐ ☐ ☐ National Regional Municipal What type of physician is targeted Description How long has this incentive been in place? Was it evaluated? Choose an item. Target Impact Budget Source of funding Barriers in implementation Section 2.2.1 – Financial incentives aimed at nurses, midwives, and other health professionals Please select whether the policies listed are used in your country, proposed (measure already discussed and approved) or not used at all. Policy Used Not used Proposed Increased salary for working in a remote or rural region ☐ ☐ ☐ Start-up bonuses for nurses who choose to work in remote or ☐ ☐ ☐ rural regions Extra paid holiday leave ☐ ☐ ☐ Tax exemptions (e.g., exception from income tax, lower tax band, exemption ☐ ☐ ☐ from electricity tax, etc.) Write-off of the student loans for practicing in an underserved ☐ ☐ ☐ area  Coverage of commuting expenses ☐ ☐ ☐ Please provide additional policies implemented by your country in the line below [OPTIONAL] Please provide links for the policies which you have selected from the list above in the line below Section 2.2.2 – Non-financial incentives and measures aimed at nurses, midwives, and other health professionals Policy Used Not used Proposed Education and training policies Advertisement of the profession (e.g., workshops, more exposure to ☐ ☐ ☐ practice at specialised secondary schools) Stipends or scholarships provided during university or graduate ☐ ☐ ☐ school with the condition of working several years in the selected underserved district post-graduation Rural skills curriculum at nursing programmes (e.g., leadership, ☐ ☐ ☐ prevention, end of life care, etc.) and the role of “community champions” who mentor nurses in rural area relevant skills Recruitment of nursing students with rural background (e.g., ☐ ☐ ☐ targeted schemes, regular events, networks of rural health professionals, etc.) Expanded competencies (e.g., allowance to issues prescriptions, care for ☐ ☐ ☐ chronic conditions) New specialisation of advanced practice nurses offered (nurses ☐ ☐ ☐ can specialise in chronic conditions and supplement huge portion of the prevention and follow-up care usually done by a GP) Please provide additional policies implemented by your country in the line below [OPTIONAL] Please provide links for the policies which you have selected from the list above in the line below Regulatory policies Legislation allowing the state to allocate health care personnel ☐ ☐ ☐ according to the regional needs on a temporary basis Regulation for easier entry of the foreign medical workers into ☐ ☐ ☐ the country and the system, provided that they work in an underserved area (e.g., more points in the immigration point system, less strict requirements, etc.) Please provide additional policies implemented by your country in the line below [OPTIONAL] Please provide links for the policies which you have selected from the list above in the line below Infrastructural policies Work and educational opportunities for spouses and children, ☐ ☐ ☐ alongside assistance with housing Infrastructural measures (e.g., nursery or kindergarten by the health care ☐ ☐ ☐ facilities, availability of rental accommodation near the workplace, leisure activities provided, such as subsidised gym, availability of mental health care, etc.)  Please provide additional policies implemented by your country in the line below [OPTIONAL] Please provide links for the policies which you have selected from the list above Innovative policies Flexibility and work-life balance (e.g., offering more flexible working ☐ ☐ ☐ hours, prevention of burn out, new models of care organisation, more holidays, etc.) Please provide additional policies implemented by your country in the line below [OPTIONAL] Please provide links for the policies which you have selected from the list above in the line below Section 2.2.3 – Details of policies aimed at attraction, recruitment and retainment of nurses and other health professionals in underserved regions, applied in your country In the boxes provided below, write detailed information about 1-3 policies which have been applied by your country and had a significant impact on the recruitment and retainment of nurses or other health professionals in the most critical regions. Policy no. 1 Name of the policy initiative Link to the information about the policy/legislation if applicable Scope ☐ ☐ ☐ National Regional Municipal Type of ☐ ☐ ☐ ☐ healthcare Nurses Nurse assistants Pharmacists Midwives professional Other (please specify) targeted Description How long has this incentive been in place? Was it evaluated? Choose an item. Target Impact Budget Source of funding Barriers in implementation Policy no. 2  Name of the policy initiative Link to the information about the policy/legislation if applicable Scope ☐ ☐ ☐ National Regional Municipal Type of ☐ ☐ ☐ ☐ healthcare Nurses Nurse assistants Pharmacists Midwives professional Other (please specify) targeted Description How long has this incentive been in place? Was it evaluated? Choose an item. Target Impact Budget Source of funding Barriers in implementation Policy no. 3 Name of the policy initiative Link to the information about the policy/legislation if applicable Scope ☐ ☐ ☐ National Regional Municipal Type of ☐ ☐ ☐ ☐ healthcare Nurses Nurse assistants Pharmacists Midwives professional Other (please specify) targeted Description How long has this incentive been in place? Was it evaluated? Choose an item. Target Impact Budget Source of funding Barriers in implementation Section 3 – Main conclusions for your country If you were to recommend one measure implemented in your country, which one would it be? Measure aimed at production to combat shortages Measure aimed at recruitment and retainment in underserved areas Which measure(s) that you have trialled in your country would you not recommend trying in other systems / countries, as their impact has been insignificant compared to the resources used for its (their) implementation? Would it be acceptable to you for us to contact you with further questions, in case something is unclear, or we would like to find out more information about a particular measure? Yes ☐ No ☐ If you chose yes, please provide a contact email address for the relevant person in the box below.  DETALŪS METADUOMENYS Dokumento sudarytojas (-ai) Lietuvos Respublikos sveikatos apsaugos ministerija Dokumento pavadinimas (antraštė) Questionnaire about measures to tackle shortages and unequal distribution of healthcare workforce Dokumento registracijos data ir numeris 2023-04-27 Nr. 10-1862 Dokumento gavimo data ir dokumento gavimo - registracijos numeris Dokumento adresatas (-ai) Pagal adresatų sąrašą Dokumento specifikacijos identifikavimo žymuo ADOC-V1.0 Parašo paskirtis Pasirašymas Parašą sukūrusio asmens vardas, pavardė ir pareigos Aurimas Pečkauskas Viceministras Parašo sukūrimo data ir laikas 2023-04-27 08:13 Parašo formatas Trumpalaikio galiojimo (XAdES-T) Laiko žymoje nurodytas laikas 2023-04-27 08:13 Informacija apie sertifikavimo paslaugų teikėją EID-SK 2016 Sertifikato galiojimo laikas 2018-06-28 17:36 - 2023-06-27 23:59 Parašo paskirtis Registravimas Parašą sukūrusio asmens vardas, pavardė ir pareigos Andrius Lukminas patarėjas Parašo sukūrimo data ir laikas 2023-04-27 08:19 Parašo formatas Trumpalaikio galiojimo (XAdES-T) Laiko žymoje nurodytas laikas 2023-04-27 08:19 Informacija apie sertifikavimo paslaugų teikėją ADIC CA-A Sertifikato galiojimo laikas 2023-02-08 11:35 - 2026-02-07 11:35 Informacija apie būdus, naudotus metaduomenų - vientisumui užtikrinti Pagrindinio dokumento priedų skaičius 1 Pagrindinio dokumento pridedamų dokumentų skaičius 0 Pridedamo dokumento sudarytojas (-ai) - Pridedamo dokumento pavadinimas (antraštė) The questionnaire.docx Pridedamo dokumento registracijos data ir numeris - Programinės įrangos, kuria naudojantis sudarytas Elpako v.20230425.2 elektroninis dokumentas, pavadinimas Informacija apie elektroninio dokumento ir elektroninio Tikrinant dokumentą nenustatyta jokių klaidų (2023-04-27) (-ių) parašo (-ų) tikrinimą (tikrinimo data) Elektroninio dokumento nuorašo atspausdinimo data ir ją 2023-04-27 nuorašą suformavo Andrius Lukminas atspausdinęs darbuotojas Paieškos nuoroda - Papildomi metaduomenys - -930275 -991235 0 0 Questionnaire “Measures to counter health care workforce maldistribution and increase the attraction of health care profession s ” Project: “Support to improve the distribution of healthcare professionals and develop a competence assessment framework for healthcare workers in Lithuania” 100329 4676060 0 0 2110740 4469130 0 0 4184015 4606925 0 0 Aim of this questionnaire The questionnaire is to aid and inform conclusions in the second outcome of the DG Reform project “Support to improve the distribution of healthcare professionals and develop a competence assessment framework for healthcare workers in Lithuania” (specific contract ID REFORM/SC2022/110 ) . In its first outcome, the project sought to equip Lithuanian authorities with an enhanced professional development system for the healthcare workforce via the development of the healthcare professionals’ skills and competency assessment model . The second outcome will develop a strategy to attract health care professionals to underserved areas, thus improving their distribution throughout the country . To ensure that the strategy is feasible and provides the most efficient evidence-based measures, this survey seeks to collect experiences regarding healthcare workforce in other EU countries. Particularly , it aims to : get information on whether your country is also fac ing challeng es regarding the healthcare workforce, such as shortages and/or unequal distribution of healthcare professionals throughout the country (‘ mal distribution’) w hether and if so, how, your country has design ed and implement ed measures to address the se issues The questionnaire is split into three parts: General questions about the participant and the healthcare workforce maldistribution , as well as health professionals’ production Policy overview asking for implemented policies to combat shortages and geographical maldistribution of physicians, nurses, and other health professionals , with the space to provide a more detailed information about the most successful policies Main conclusions for your country providing space for you to share which measures you would recommend the most and which you found unsuccessful in dealing with shortages and geographical maldistribution of healthcare workforce We are conducting this survey to gain in-depth information which will be of essence for Lithuania in designing the policies that aim to ensure improvement in geographical maldistribution of our health care workforce, as well as increase attraction of health care professions, to guarantee that all inhabitants will have access to healthcare when they need it. The data collected from the survey will be used for the purposes of Outcome 2 of the “Support to improve the distribution of healthcare professionals and develop a competence assessment framework for healthcare workers in Lithuania” project. We sincerely thank you for finding the time to fill out this questionnaire. Section 1 – General questions Which country do you represent? Please state your country To which group would you categorise yourself? Please select the applicable option. National Health Care Authority ☐ Regional Health Care Authority ☐ Researcher ☐ Other – please specify below ☐ Other What is your role in the organisation for which you are filling out the questionnaire? Do you consider health care workforce shortage as an increasing issue in your country? Please select the applicable option. Yes ☐ No ☐ Optional (please specify) According to your opinion, how severe is the shortage of staff for the following health professions? Please rank the following professions based on the severity of the problem with 1 meaning that there are no shortages of the professionals and 5 representing critical shortage of the professionals from the selected profession. Profession Ranking 1 low 2 3 4 5 high Physicians ☐ ☐ ☐ ☐ ☐ Nurses and midwives ☐ ☐ ☐ ☐ ☐ Other health professionals (e.g., paramedics, pharmacists, etc.) ☐ ☐ ☐ ☐ ☐ [OPTIONAL] Could you please name 3-5 specific professions (e.g., GPs) with the most severe shortages? Do you consider geographical health care workforce maldistribution to be one of the key issue s in your country’s health care system? Please select the applicable option. Yes ☐ No ☐ Optional (please specify ) According to your opinion, h ow severe is the geographical workforce maldistribution issue regarding the following health professions? Please rank the following professions based on the severity of the problem with 1 meaning that there are no shortages of the professionals in any region and 5 representing critical shortage of the professionals from the selected profession. Profession Ranking 1 low 2 3 4 5 high Physicians ☐ ☐ ☐ ☐ ☐ Nurses and midwives ☒ ☐ ☐ ☐ ☐ Other health professionals (e.g., paramedics, pharmacists, etc.) ☐ ☐ ☐ ☐ ☐ According to your opinion, w hich type of health care poses the biggest issue in terms of its distribution in the geographic network ? Please rank the provided types of care on the scale of 1-5 with 1 symbolising the ideal geographic distribution and presence and 5 representing a strong issue in terms of access and maldistribution. Type of care Ranking 1 low 2 3 4 5 high Primary care (includes general practitioners, gynaecologists, physiotherapists , etc. ) ☐ ☐ ☐ ☐ ☐ Secondary care (includes outpatient specialist practices, e.g., cardiologist office , etc. ) ☐ ☐ ☐ ☐ ☐ Tertiary care ☐ ☐ ☐ ☐ ☐ Section 2 – Policy overview This section is concerned with the specific policies which have been introduced in your country in relation to healthcare workforce attraction and geographical maldistribution . The policy focus is divided by the professionals they are aimed at (physicians, nurses , midwives, and other health profession al s) and by the type of issue they seek to address , into the following categories: financial incentives and non-financial incentives (education &amp; training, infrastructure, regulatory, innovative, and other) . At the end, there is a possibility to provide any other policies which your country uses and were not mentioned, as well as space for description of 1-3 policies with the highest impact which were implemented in your country, and you consider them best practices. Does your country have a national or regional legislative act which defines the approach for reducing health care workforce shortages or unequal geographical distribution of such staff? Yes , for health care workforce shortages ☐ Yes, for health care workforce maldistribution ☐ Yes, for both ☐ No ☐ [OPTIONAL] If you answered yes, please provide a link(s) to the regulation in the space below . Has your country introduced any formalised measures to combat the geographical maldistribution of health care workers and health care workforce shortages ? Please select the applicable option. Yes , for health care workforce shortages ☐ Yes, for health care workforce maldistribution ☐ Yes, for both ☐ No ☐ Not yet, however, they are already planned and in design stage ☐ [OPTIONAL] If you answered yes, please provide a link to the strategy containing the measures in the space below . Does your country have a policy which limits training places for individual specialisations? (E.g., quota for cardiologists, GPs, anaesthesiology nurses, etc.) Please select the applicable option. Yes ☐ No ☐ [OPTIONAL] If you answered yes, please provide a link to the policy in the space below . Section 2.1.1 – Financial incentives or measures aimed at physicians Please select w hether the policies listed are used in your country, proposed ( measure already discussed and approved) or not used at all. Policy Used Not used Proposed Tax breaks (e.g., physicians working in rural and underserved regions receive an income tax exemption for 5 years) ☐ ☐ ☐ Stipends/scholarships distributed during the studies for physicians, contingent upon a contract of them practicing in an underserved district for selected number of years ☐ ☐ ☐ One-off financial contribution for setting up a practice in underserved areas ☐ ☐ ☐ Additional monthly or annual payments to physicians in underserved, rural or remote areas (e.g., for carrying out a certain number of consultations for the vulnerable social groups , to allow them to hire additional staff or hosting an intern at the practice or working past the retirement age in underserved area , stabilisation allowance to doctors working in group practices in underserved areas or for education of new practitioners in the rural or remote practice ) ☐ ☐ ☐ Various subsidies (e.g., transport, housing, education, additional training and upskilling, subsides for practitioners working in areas with a sufficient number of physicians who offer consultations in underserved areas, etc.) ☐ ☐ ☐ [OPTIONAL] Please provide additional policies implemented by your country Please provide links for the policies which you have selected from the list above Section 2.1.2 – Non-financial incentives for physicians Policy Used Not used Proposed Education and training policies Targeted advertisement ( e.g., workshops to secondary school students regarding the medical profession, local “role models” for rural care advertising the profession, etc.) ☐ ☐ ☐ Increase of the number of medical students at universities (e.g., elimination of numerus clausus for medical programmes to ensure for higher physician numbers , quotas for medical students from rural background , focus on STEM subjects in the curriculum, etc. ) ☐ ☐ ☐ Recruitment of medical students with rural background (e.g., reaching out to medical students with rural background during their studies, recruitment events, incentives for such students, etc.) ☐ ☐ ☐ Promotion of the rural care to existing physicians (e.g., alumni network approach – finding out which physicians could be interested in transferring to rural regions , fast-tracked general practitioner (GP) specialisation for rural regions, etc. ) ☐ ☐ ☐ Increase in the training places (e.g., training places for general practitioners, the most underserved specialties, etc.) ☐ ☐ ☐ Training and continued education (e.g., continuing education and training opportunities in rural medical interdisciplinary clusters , rural general practitioner “role models” offering mentoring to new physicians in the rural areas) ☐ ☐ ☐ [OPTIONAL] Please provide additional policies implemented by your country in the line below Please provide links for the policies which you have selected from the list above in the line below Infrastructur al policies Improvements in the local care delivery infrastructure (e.g., remote integrated care centres, coordination of medical professions at regional level, local investments into transport and infrastructure) ☐ ☐ ☐ Infrastructural measures (e.g., nursery or kindergarten by the health care facilities, availability of rental accommodation near the workplace, leisure activities provided, such as subsidised gym, availability of mental health care, etc.) ☐ ☐ ☐ [OPTIONAL] Please provide additional policies implemented by your country in the line below Please provide links for the policies which you have selected from the list above in the line below Regulatory policies Legislation for easier entry of foreign-educated physicians (EU or non-EU) into rural practice compared to non-rural placements (e.g., reduction of moratorium time for foreign educated doctors if they work in a rural or remote location , easier process of obtaining citizenship, etc.) ☐ ☐ ☐ Legislation which allows the relevant Authority not to issue licences for medical practices, in places where the network is already full ☐ ☐ ☐ Legislation allowing the state to allocate health care personnel according to the regional needs on a temporary basis ☐ ☐ ☐ [OPTIONAL] Please provide additional policies implemented by your country in the line below Please provide links for the policies which you have selected from the list above in the line below Innovative policies Digital solutions (e.g., telehealth service used for monitoring of long-term health conditions for patients in underserved areas , medical terminals at pharmacies, etc.) ☐ ☐ ☐ Working arrangements (e.g., flexible working hours, less mandatory working hours in the rural practices, better organisation of care – multi-professional teams) [OPTIONAL] Please provide additional policies implemented by your country in the line below Please provide links for the policies which you have selected from the list above in the line below Policies introducing additional capacities Temporary contracts and mobile care provision (e.g., short-term GPs in underserved regions, deputy physician schemes whereby medical students in their final year can assist doctors during seasonal influxes, GPs travelling around the region where there is low density of physicians, mobile acute care units, etc.) ☐ ☐ ☐ New professions to alleviate GP workload (e.g., “hospital practitioners” or medical assistants or expanded roles of certain health care professionals such as paramedics ) ☐ ☐ ☐ [OPTIONAL] Please provide additional policies implemented by your country in the line below Please provide links for the policies which you have selected from the list above in the line below Section 2.1. 3 – Details of policies aimed at attraction, recruitment, and retainment of physicians in underserved regions, applied in your country In the box es provided below, please write detailed information about 1-3 policies which have been applied by your country and had the most significant impact on the recruitment and retainment of physicians in the most critical regions. Policy no. 1 Name of the policy initiative E.g., “ Landarztprämie ” – Rural physician premium Link to the information about the policy /legislation if applicable E.g., Sample link Scope ☐ ☐ ☐ National Regional Municipal What type of physician is targeted E.g., general practitioners (GPs) Description E .g., The rural physician premium is intended to provide financial compensation for these special challenges and thus encourage the decision to set up a practice, establish medical care centers and set up branches in the rural physician premium area. The amount of the rural physician premium for a branch office of physicians or for the establishment of an MVZ is up to 60,000 euros. If a branch is formed, the amount of the rural physician premium is up to 15 000 euros. The amount of the rural doctor's premium for a branch office of psychotherapists and for the establishment of an MVZ with the specialty of psychotherapy is up to 20 000 euros. To be eligible, the physician has to set up a practice in an underserved area and carry out medical activity for at least 60 months from the cut-off date. How long has this incentive been in place? E.g., the incentive has been active since 2014 and is set to continue up until the GP network is optimal at all underserved regions. Was it evaluated? Choose an item. Target E .g., establishment of 800 GP practices Impact E .g., within 7 years of the programme, we were able to support start-ups of 752 practices and practice branches. These included 555 for GPs and 112 for psychotherapists. Budget E.g., 6.9 million EUR annually Source of funding E.g., own funding by the Ministry of Health Barriers in implementation E.g., issues with promoting the incentive at medical schools, low attractiveness of the scheme for physicians, etc. Policy no. 2 Name of the policy initiative Link to the information about the policy/legislation if applicable Scope ☐ ☐ ☐ National Regional Municipal What type of physician is targeted Description How long has this incentive been in place? Was it evaluated? Choose an item. Target Impact Budget Source of funding Barriers in implementation Policy no. 3 Name of the policy initiative Link to the information about the policy/legislation if applicable Scope ☐ ☐ ☐ National Regional Municipal What type of physician is targeted Description How long has this incentive been in place? Was it evaluated? Choose an item. Target Impact Budget Source of funding Barriers in implementation Section 2.2.1 – Financial incentives aimed at nurses , midwives , and other health professionals Please select whether the policies listed are used in your country, proposed (measure already discussed and approved) or not used at all. Policy Used Not used Proposed Increased salary for working in a remote or rural region ☐ ☐ ☐ Start-up bonuses for nurses who choose to work in remote or rural regions ☐ ☐ ☐ Extra paid holiday leave ☐ ☐ ☐ Tax exemptions (e.g., exception from income tax, lower tax band, exemption from electricity tax , etc. ) ☐ ☐ ☐ Write-off of the student loans for practicing in an underserved area ☐ ☐ ☐ Coverage of commuting expenses ☐ ☐ ☐ [OPTIONAL] Please provide additional policies implemented by your country in the line below Please provide links for the policies which you have selected from the list above in the line below Section 2.2.2 – Non-financial incentives and measures aimed at nurses , midwives , and other health professionals Policy Used Not used Proposed Education and training policies Advertisement of the profession (e.g., workshops, more exposure to practice at specialised secondary schools) ☐ ☐ ☐ Stipends or scholarships provided during university or graduate school with the condition of working several years in the selected underserved district post-graduation ☐ ☐ ☐ Rural skills curriculum at nursing programmes (e.g., leadership, prevention, end of life care, etc.) and the role of “community champions” who mentor nurses in rural area relevant skills ☐ ☐ ☐ Recruitment of nursing students with rural background (e.g., targeted schemes, regular events, networks of rural health professionals, etc.) ☐ ☐ ☐ Expanded competencies (e.g., allowance to issues prescriptions, care for chronic conditions) ☐ ☐ ☐ New specialisation of advanced practice nurses offered (nurses can specialise in chronic conditions and supplement huge portion of the prevention and follow-up care usually done by a GP) ☐ ☐ ☐ [OPTIONAL] Please provide additional policies implemented by your country in the line below Please provide links for the policies which you have selected from the list above in the line below Regulatory policies Legislation allowing the state to allocate health care personnel according to the regional needs on a temporary basis ☐ ☐ ☐ Regulation for easier entry of the foreign medical workers into the country and the system, provided that they work in an underserved area (e.g., more points in the immigration point system, less strict requirements, etc.) ☐ ☐ ☐ [OPTIONAL] Please provide additional policies implemented by your country in the line below Please provide links for the policies which you have selected from the list above in the line below Infrastructur al policies Work and educational opportunities for spouses and children, alongside assistance with housing ☐ ☐ ☐ Infrastructural measures (e.g., nursery or kindergarten by the health care facilities, availability of rental accommodation near the workplace, leisure activities provided, such as subsidised gym, availability of mental health care, etc.) ☐ ☐ ☐ [OPTIONAL] Please provide additional policies implemented by your country in the line below Please provide links for the policies which you have selected from the list above Innovative policies Flexibility and work-life balance (e.g., offering more flexible working hours, prevention of burn out, new models of care organisation, more holidays, etc.) ☐ ☐ ☐ [OPTIONAL] Please provide additional policies implemented by your country in the line below Please provide links for the policies which you have selected from the list above in the line below Section 2.2. 3 – Details of policies aimed at attraction, recruitment and retainment of nurses and other health professionals in underserved regions, applied in your country In the boxes provided below, write detailed information about 1 - 3 policies which have been applied by your country and had a significant impact on the recruitment and retainment of nurses or other health professionals in the most critical regions. Policy no. 1 Name of the policy initiative Link to the information about the policy/legislation if applicable Scope ☐ ☐ ☐ National Regional Municipal Type of healthcare professional targeted ☐ ☐ ☐ ☐ Nurses Nurse assistants Pharmacists Midwives Other (please specify) Description How long has this incentive been in place? Was it evaluated? Choose an item. Target Impact Budget Source of funding Barriers in implementation Policy no. 2 Name of the policy initiative Link to the information about the policy/legislation if applicable Scope ☐ ☐ ☐ National Regional Municipal Type of healthcare professional targeted ☐ ☐ ☐ ☐ Nurses Nurse assistants Pharmacists Midwives Other (please specify) Description How long has this incentive been in place? Was it evaluated? Choose an item. Target Impact Budget Source of funding Barriers in implementation Policy no. 3 Name of the policy initiative Link to the information about the policy/legislation if applicable Scope ☐ ☐ ☐ National Regional Municipal Type of healthcare professional targeted ☐ ☐ ☐ ☐ Nurses Nurse assistants Pharmacists Midwives Other (please specify) Description How long has this incentive been in place? Was it evaluated? Choose an item. Target Impact Budget Source of funding Barriers in implementation Section 3 – Main conclusions for your country If you were to recommend one measure implemented in your country, which one would it be? Measure aimed at production to combat shortages Measure aimed at recruitment and retainment in underserved areas Which measure(s) that you have trialled in your country would you not recommend trying in other systems / countries , as their impact has been insignificant compared to the resources used for its (their) implementation? Would it be acceptable to you for us to contact you with further questions, in case something is unclear, or we would like to find out more information about a particular measure? Yes ☐ No ☐ If you chose yes, please provide a contact email address for the relevant person in the box below .