Zarnett Dara, Coyte Peter C, Nauenberg Eric, Doran Diane, Laporte Audrey
Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON.
Healthc Policy. 2009 Feb;4(3):e129-44.
In 1997, Ontario implemented a competitive bidding process for purchasing home care services, with the twin objectives of lowering costs and increasing service quality. The authors of this study performed regression analyses to ascertain the relationship between measures of competition, profit status of providers and nursing wages for community-based RNs and LPNs between 1995/1996 and 2000/2001. Using the Herfindahl-Hirschman Index as a measure of competition, we observed that only RN wages significantly increased as competition in home care increased. Furthermore, for-profit agencies paid significantly lower RN wages than their not-for-profit counterparts. By contrast, LPN wages declined over the sample period and did not differ markedly across provider types. The relative distribution of for-profit and not-for-profit agencies changed dramatically over the study period, with large increases in the number and volume of for-profit contracts. The results indicate that (a) greater competition in the home care sector resulted in upward pressure on RN wages independent of the profit status of the provider and (b) the increase appears to have been constrained by the increased presence of for-profit providers over the study period. The results highlight the role of profit status in provider behaviour, even in the context of publicly funded home care services. This finding has implications for both provider mix and the remuneration of nurses.
1997年，安大略省实施了家庭护理服务采购的竞争性招标程序，旨在实现降低成本和提高服务质量这两个目标。本研究的作者进行了回归分析，以确定1995/1996年至2000/2001年期间竞争措施、供应商盈利状况与社区注册护士（RN）和执业护士（LPN）的护理工资之间的关系。以赫芬达尔-赫希曼指数作为竞争的衡量标准，我们观察到，随着家庭护理竞争的加剧，只有注册护士的工资显著提高。此外，营利性机构支付给注册护士的工资明显低于非营利性机构。相比之下，在整个样本期内，执业护士的工资有所下降，且不同类型供应商之间的差异并不明显。在研究期间，营利性和非营利性机构的相对分布发生了巨大变化，营利性合同的数量和规模大幅增加。结果表明：（a）家庭护理部门竞争加剧导致注册护士工资面临上行压力，且与供应商的盈利状况无关；（b）这一增长似乎受到研究期间营利性供应商数量增加的限制。研究结果凸显了盈利状况在供应商行为中的作用，即使是在公共资助的家庭护理服务背景下。这一发现对供应商结构和护士薪酬都有影响。
