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Article Dans Une Revue Social science & medicine Année : 2018

Ownership and hospital behaviour: Employment and local unemployment

Résumé

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.
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Dates et versions

halshs-01884165 , version 1 (07-01-2019)

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Andrew E. Clark, Carine Milcent. Ownership and hospital behaviour: Employment and local unemployment. Social science & medicine, 2018, 202, pp.151 - 161. ⟨10.1016/j.socscimed.2018.02.027⟩. ⟨halshs-01884165⟩
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