Paris School of Economics (PSE), CNRS, IZA, France.
Paris School of Economics (PSE), CNRS, France.
Soc Sci Med. 2018 Apr;202:151-161. doi: 10.1016/j.socscimed.2018.02.027. Epub 2018 Mar 1.
In this paper, we address two issues: i) how hospital employment changes with local unemployment, according to the type of hospital ownership, and ii) whether this relationship changed after the implementation of a pro-competitive reform that made hospitals more similar. A 2006-2010 French panel of 1695 hospitals over five waves allows us to consider within-hospital employment changes. We first find that higher local unemployment is associated with greater employment in State-owned hospitals, but not for any other hospital ownership type: French local authorities then seem to respond to depressed local labour markets by increasing employment in State-owned hospitals. After the full implementation of the pro-competitive reform hospital funding became based only on activity and no longer on some historical budget. Theoretically, the new reimbursement system should break the relationship between public-hospital employment and local unemployment. Our results reveal that the reform worked as expected in less-deprived areas: reducing employment and eliminating the correlation between local unemployment and State-owned hospital employment. However, in higher-unemployment areas, public-hospital employment remains counter-cyclical. Poor local labour-market health then seems to trump financial incentives in determining employment in public hospitals.
在本文中，我们解决了两个问题：i）根据医院所有权类型，医院就业如何随当地失业率变化，ii）在实施使医院更趋同质化的竞争促进型改革后，这种关系是否发生了变化。一项针对 2006-2010 年法国 1695 家医院的面板数据和五个波次的调查使我们能够考虑医院内就业变化。我们首先发现，较高的当地失业率与国有医院的就业增加有关，但与其他任何医院所有权类型无关：法国地方当局似乎通过增加国有医院的就业来应对当地劳动力市场的低迷。在竞争促进型改革的全面实施后，医院资金的拨付仅基于活动，不再基于某些历史预算。从理论上讲，新的报销制度应该打破公立医院就业与当地失业率之间的关系。我们的结果表明，改革在贫困程度较低的地区取得了预期效果：减少了就业，消除了当地失业率与国有医院就业之间的相关性。然而，在失业率较高的地区，公立医院的就业仍然与经济周期呈反方向变化。当地劳动力市场健康状况不佳似乎压倒了决定公立医院就业的财务激励。
