Determinants of labour shortages in the health sector: a comprehensive analysis across Health Workforce Regimes

This chapter investigates the structural determinants of health workforce shortages across the EU-27 from 2015 to 2024. Departing from traditional neoclassical or individual behavioural models, it adopts a political economy approach to argue that labour shortages are deeply embedded in the institutional arrangements of welfare states. Using cluster analysis on Eurostat data, the study empirically identifies three distinct "Health Workforce Regimes": Low-Resource, Staff-Intensive, and High-Investment. The findings reveal that the European health workforce crisis is not monolithic but manifests as three specific structural failures: a crisis of investment in the Low-Resource regime, flexibility in the Staff-Intensive regime, and complexity in the High-Investment regime. While some countries like Czechia, Lithuania and Slovenia show positive convergence toward Western standards, others remain structurally trapped in a cycle of low investment and "brain drain": Bulgaria, Romania, Hungary, Poland, Greece. The chapter concludes that effective policy must be regime-specific, prioritizing workforce governance over simple recruitment.