The number and composition of people working in hospitals in OECD countries varies depending on the roles and functions that hospitals play in health systems, as well as on how different types of support services in hospitals are provided and accounted for. The roles and functions of hospitals vary notably regarding the extent to which outpatient specialist services are provided in or outside hospitals. In most countries with universal health coverage funded by the tax system (national health service systems), outpatient specialist services are typically provided in public hospitals. This is the case, for example, in Portugal, Spain, the United Kingdom and Nordic countries, Portugal and Spain. In other countries such as Australia, Austria, Belgium, Canada, France, Germany, Switzerland and the United States, most outpatient services are provided outside hospitals. In some Central and Eastern European countries (such as Estonia and Slovenia), most outpatient specialist services are provided in public hospitals, whereas these are provided in public multi-specialty clinics in others (such as Poland) or in private solo practices (as in Czechia).
In 2023, the number of people working in hospitals relative to the overall size of the population was at least twice as high in Switzerland, the United Kingdom, Norway, Denmark, the United States, Iceland and France as in Mexico, Chile, Hungary and Korea (Figure 8.17).
In all countries, nurses represent the largest category of care providers in hospitals. Nurses and midwives account for over one‑third (36%) of all hospital employment, on average across OECD countries. Doctors account for one in seven (14%) hospital workers on average across OECD countries, although in several countries this number underestimates the number of doctors who work at least part time in hospitals, since self-employed doctors with dual practices outside and in hospital are not counted.
Healthcare assistants (or nursing aides) accounted for about 10% of hospital workers on average across OECD countries, but there is wide variation across countries. Healthcare assistants accounted for over 20% of the hospital workforce in Portugal and Spain, and nearly 20% in France, while this category of workers is non-existent (or almost non-existent) in several other countries.
Other non-clinical staff account for about a quarter of all hospital workers on average across those OECD countries that are able to report these data. This share is particularly large in some countries. In the United States, 46% of people working in hospitals are non-clinical staff, and this proportion reaches 30% or more in Switzerland, Iceland, France and Türkiye. The large proportion of non-clinical staff has led to proposals in France to limit this share to no more than 25% of total hospital staff. The OECD data collection does not seek further information about different categories of non-clinical staff, but these may include at least three categories of workers: administrative staff, logistical staff (such as cleaning and catering staff), and IT and other technical support staff. It is important to bear in mind that some of the variations in the number and share of non-clinical staff across countries may be explained by the degree of externalisation of these services. In addition, the distinction between clinical and non-clinical staff may not always be clear-cut for certain categories of workers (such as medical-administrative assistants), limiting data comparability across countries.
Looking at trends over time for nurses (the most numerous category of clinical staff in hospitals), in several countries – including Canada, the United States, Mexico, Germany and Spain – the number of nurses working in hospitals increased steadily between 2013 and 2023, both before and after the pandemic. In Italy and the United Kingdom, there was no increase in the number of nurses working in hospitals between 2013 and 2017, but the number started to increase steadily from 2017 onward. By contrast, the increase was much more modest in France both before and after the pandemic (Figure 8.18).
