Xu Lili, Sharma Hari, Wehby George L
Department of Health Management and Policy, College of Public Health, The University of Iowa, Iowa City, Iowa, USA.
National Bureau of Economic Research, Cambridge, Massachusetts, USA.
Health Serv Res. 2023 Jun;58(3):744-752. doi: 10.1111/1475-6773.14125. Epub 2023 Jan 6.
To estimate the effect of nursing home closure on local employment, overall, and by rurality.
We obtained 2008-2018 county-level data from the Quarterly Workforce Indicators, Medicare Provider of Services, Area Health Resource, and Urban Influence Codes files. From 2008 to 2018, 878 counties experienced at least one nursing home closure, and 2055 counties did not experience a closure.
Using a difference-in-difference study design, we compare the changes of total employment, health sector employment and non-health sector employment over time between counties with and without a nursing home closure. We utilize the variation in the year and quarter of nursing home closures to estimate subsequent employment changes as well as employment trends before closure. We also account for contemporaneous events including nursing home entries and hospital entries and closures, and evaluate heterogeneity by rurality.
We include data on nursing home closure from the Medicare Provider of Service file. Quarterly county-level employee counts were obtained from the Quarterly Workforce Indicators provided by the Census Bureau. County-level demographic data were obtained from the Area Health Resource Files. We use Urban Influence Codes from the Economic Research Service, Department of Agriculture, to classify metropolitan, micropolitan, and rural (noncore) counties.
Health sector employment decreased by about 3.2%-4.1% (p < 0.01) in counties with a nursing home closure. The reduction was largest in rural counties (approximately 7.2%-9.4%, p < 0.01). The reduction in health sector employment persisted over time, particularly in rural counties. Overall, there was no discernable effect on non-health sector employment.
Nursing home closure is associated with a persistent decline in health sector employment, particularly in rural counties, suggesting a reduction in the health care workforce and in the ability to sustain health care services supply, particularly in rural areas.
评估疗养院关闭对当地就业的影响，包括总体影响以及按农村地区划分的影响。
我们从《劳动力季度指标》《医疗保险服务提供商》《地区卫生资源》和《城市影响代码》文件中获取了2008 - 2018年的县级数据。2008年至2018年期间，878个县至少有一家疗养院关闭，2055个县没有经历疗养院关闭。
采用差异 - 差异研究设计，我们比较了有和没有疗养院关闭的县之间，随着时间推移总就业、卫生部门就业和非卫生部门就业的变化。我们利用疗养院关闭的年份和季度差异来估计随后的就业变化以及关闭前的就业趋势。我们还考虑了同期事件，包括疗养院开业、医院开业和关闭，并按农村地区评估异质性。
我们纳入了《医疗保险服务提供商》文件中关于疗养院关闭的数据。县级季度员工计数来自人口普查局提供的《劳动力季度指标》。县级人口数据来自《地区卫生资源文件》。我们使用美国农业部经济研究局的《城市影响代码》对大都市、微型都市和农村（非核心）县进行分类。
在有疗养院关闭的县，卫生部门就业减少了约3.2% - 4.1%（p < 0.01）。农村县的减少幅度最大（约7.2% - 9.4%，p < 0.01）。卫生部门就业的减少在一段时间内持续存在，特别是在农村县。总体而言，对非卫生部门就业没有明显影响。
疗养院关闭与卫生部门就业的持续下降有关，特别是在农村县，这表明医疗保健劳动力减少，维持医疗保健服务供应的能力下降，特别是在农村地区。
