Public employment and political pressure: The case of French hospitals

Clark, Andrew E.; Milcent, Carine

doi:10.1016/j.jhealeco.2011.07.007

Cited by 27 publications

(20 citation statements)

References 28 publications

(20 reference statements)

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“…There is some evidence that public hospitals are particularly sensitive to labor. Clark and Milcent (2011) find, for example, that public hospitals in France react to rising local unemployment rates by increasing employment, while private nonprofit hospitals show no similar pattern. This is also support for (Andrei Shleifer 1994), where unorganized voters mean public firms are more prone to capture by organized labor and political patronage.…”

Section: Prediction 2: Outsourcing and Bias-intensive Servicesmentioning

confidence: 94%

“…Services that are particularly labor-intensive could be salient to political overseers and regulators, either by satisfying their mission or through furthering political support. Local hospitals are run within the city or county government, and political principals may have a desire to disguise redistribution as public employment (Alesina, Baqir and Easterly 2000), (Clark and Milcent 2011). Other mechanisms for bias may be "Keynesian" employment policy or even capture by organized labor.…”

Section: Services and Biasmentioning

confidence: 99%

“…We also investigate labor-intensive services which may have particular importance to elected officials, regulators, or unions. (Alesina et al 2000, Clark andMilcent 2011). Table 5 presents the results on Prediction 2 for variants of Equation (1), where ownership type is interacted with an indicator for whether the service is physician-intensive (in column (1)) or labor-intensive (in column (2)).…”

Section: Prediction 2: Outsourcing and Bias-intensive Servicesmentioning

confidence: 99%

See 2 more Smart Citations

Cost versus control: Understanding ownership through outsourcing in hospitals

Dalton

Warren

2016

Journal of Health Economics

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For-profit hospitals in California contract out services much more intensely than either private nonprofit or public hospitals. To explain why, we build a model in which the outsourcing decision is a trade-off between net revenues and some non-monetary benefit to the manager, or "bias" in the manner of production. Since nonprofit firms must consume profits under restrictions, they trade off bias and income differently than forprofit firms. This difference is exaggerated in services where the benefits of controlling the details of production are particularly important but minimized when firms are hit with a fixed-cost shock. We test these predictions in a panel of California hospitals, finding evidence for each. These results suggest that a model of public or nonprofit make-or-buy decisions should be more than a simple relabeling of a model derived in the for-profit context. JEL Classification: I11, L24, L33

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Section: Prediction 2: Outsourcing and Bias-intensive Servicesmentioning

confidence: 94%

Section: Services and Biasmentioning

confidence: 99%

Section: Prediction 2: Outsourcing and Bias-intensive Servicesmentioning

confidence: 99%

See 1 more Smart Citation

Cost versus control: Understanding ownership through outsourcing in hospitals

Dalton

Warren

2016

Journal of Health Economics

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“…The above two results are found in Clark and Milcent (2011). However, the analysis there was cross-sectional, using only one year of data (1999).…”

Section: Introductionmentioning

confidence: 89%

“…Using 1999 cross-sectional data, Clark and Milcent (2011) found that hospital employment in France was consistently higher in public hospitals than in NFP or private hospitals. By matching in local labour-market information, they were also able to show that public-hospital employment was strongly positively correlated with the local unemployment rate, with no such relationship being found for the other hospital types.…”

Section: Hospital Employment and The Labour Marketmentioning

confidence: 99%

Ownership and hospital behaviour: Employment and local unemployment

Clark

Milcent

2018

Social Science & Medicine

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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 1,695 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 2 counter-cyclical. Poor local labour-market health then seems to trump financial incentives in determining employment in public hospitals.

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Price Changes in Regulated Healthcare Markets: Do Public Hospitals Respond and How?

et al. 2016

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This paper examines the behaviour of public hospitals in response to the average payment incentives created by price changes for patients classified in different Diagnosis Related Groups (DRGs). Using panel data on public hospitals located within the Italian region of Emilia-Romagna, we test whether a one-year increase in DRG prices induced public hospitals to increase their volume of activity, and whether a potential response is associated with changes in waiting times and/or length of stay. We find that public hospitals reacted to the policy change by increasing the number of patients with surgical treatments. This effect was smaller in the two years after the policy change than in later years, and for providers with a lower excess capacity in the pre-policy period, whereas it did not vary significantly across hospitals according to their degree of financial and administrative autonomy. For patients with medical DRGs, instead, there appeared to be no effect on inpatient volumes. Our estimates also suggest that an increase in DRG prices either decreased or had no impact on the proportion of patients waiting more than six months. Finally, we find no evidence of a significant effect on patients' average length of stay.JEL Classification: Analysis of health care markets (I11); Health production (I12); Government policy, regulation, public health (I18).

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Public employment and political pressure: The case of French hospitals

Cited by 27 publications

References 28 publications

Cost versus control: Understanding ownership through outsourcing in hospitals

Cost versus control: Understanding ownership through outsourcing in hospitals

Ownership and hospital behaviour: Employment and local unemployment

Price Changes in Regulated Healthcare Markets: Do Public Hospitals Respond and How?

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