Wages and work conditions as determinants for physicians’ work decisions

It is not uncommon that publicly employed physicians also have income from work outside the hospital, often termed moonlighting. There is little empirical evidence of such activity. In this paper we investigate which factors that may influence physicians’ choice of work between the public hospital sector and elsewhere. An exceptionally high wage increase in 1996 for one group of hospital physicians (assistant physicians) serves as a natural experiment, and we analyse whether wages in general and this reform in particular have affected physicians’ external earnings. For assistant physicians we find that higher wages at public hospitals affect negatively both the decisions to earn income externally, and level of income once active. For consultant physicians, on the other hand, there was no such response to the wage increase. Several hospital specific factors representing job specific work characteristics also matter for physicians’ decisions to moonlight.Physicians; wages; job characteristics; moonlighting; panel data.

Works Councils and Environmental Investment: Theory and Evidence from German Panel Data

Firms may underinvest in local environmental protection even from the private viewpoint of its owners and employees, but works councils may help mitigate this problem. We show that increases in environmental investments when councils are present could be employee-led, firm-led, or jointly-led. We test these alternatives with German panel data using a random effects probit model, and find a strong and robust relationship between investments in improving local environmental quality and council activities. This effect is largest and most significant when the council is active in environmental matters, and when management views employee participation as productive. With the exception of product innovation, we generally do not find analogous effects on investments that reduce environmental impacts more remote from the workplace, or for other types of investment. We conclude that the higher environmental investments in establishments with councils are largely employee-led or jointly-led; but the significant effect of management attitudes toward participation suggests that genuine management-employee cooperation and the tradeoffs it implies is taking place.

Prioritization and patients' rights: Analysing the effect of a reform in the Norwegian Hospital Sector

The right to equal treatment, irrespective of age, gender, ethnicity, socio-economic status and place of resident, is an important principle for several health care systems. A reform of the Norwegian hospital sector may be used as a relevant experiment for investigating whether centralization of ownership and management structures will lead to more equal prioritization practices over geographical regions. One concern was variation in waiting times across thecountry. The reform was followed up in subsequent years by some other policy initiatives that also aimed at reducing waiting lists. Prioritization practice is measured by a method that takes departure in recommended maximum waiting times from medical guidelines. We merge the information from the guidelines with individual patient data on actual waiting times. This way we can monitor whether each patient in the available register of actual hospital visits has waited shorter or longer than what is considered medically acceptable by the guideline. The results indicate no equalisation between the five new health regions, but we find evidence of more equal prioritization within four of the health regions. Our method of measuring prioritizations allows us to analyse how prioritization practice evolved over time after the reform, thus covering some further initiatives with the same objective. The results indicate that an observed reduction in waiting times after the reform have favoured patients of lower prioritization status, something we interpret as a general worsening of prioritization practices over time.Prioritization; waiting time; hospital reform

Unemployment, labour force composition and sickness absence. A panel data study

Sickness absence tends to be negatively correlated with unemployment. This may suggest disciplining effects of unemployment but may also reflect changes in the composition of the labour force. A panel of Norwegian register data for the years 1990-1995 is used to analyse sickness absences lasting more than two weeks. We estimate fixed effects models of the probability of absence and the number of days on sick leave conditional on absence. The county unemployment rate is found to affect the probability of absence negatively. When restricting the sample to workers who are present in the whole sample period, the negative relationship between absence and unemployment remains. The evidence on duration goes in the same direction. This indicates that the revealed procyclical variation in sickness absence is not driven by changes in the composition of the labour force.Sickness absence; unemployment; panel data.

Sickness Absence and Business Cycles

Absenteeism is affected by the sickness benefit system. Countries with generous compensation during sick leaves also experience high numbers of sick leave. Sick leaves may vary over the business cycle due to unemployment disciplining effects or changes in labour force composition. The latter hypothesis maintains that sickness may be pro-cyclical due to employment of `marginal' workers with poorer health when demand increases. Using individual records of labour force participants in Norway, we investigate the explanatory factors behind differing spells of work absence at different stages of the business cycle. We find no indication that new entrants explain increases in absence, on the other hand workers who stay in the labour force increase absences when the economy improves. Thus there is some evidence that unemployment has a disciplining effect.

Will Increased Wages Reduce Shortage of Nurses? A Panel Data Analysis of Nurses' Labor Supply

Shortage of nurses is a problem in several countries. It is an unsettled question whether increasing wages constitute a viable policy for extracting more labor supply from nurses. In this paper we use a unique matched panel data set of Norwegian nurses covering the period 1993-1997 to estimate wage elasticities. This data includes detailed information on 18,066 individuals over 5 years totaling 56,832 observations. The estimated elasticity when controlling for individual and time invariant fixed effects is significantly positive but not very high in magnitude. Individual and institutional features are significant and important for working hours. We have also access to information about contractual arrangements. It turns out that shift work is important for hours of work, and that omitting information about this common phenomenon will underestimate the wage effect.Nurses, labor supply, panel data, selection

The Impact of Different Prioritisation Policies on Waiting Times: A Comparative Analysis of Norway and Scotland

We compare the distributional consequences of two different waiting times initiatives. The primary focus of Scotland’s recent waiting time reforms has been on reducing maximum waiting times through the imposition of high profile national targets. In Norway, the focus has been on appropriate prioritisation of referrals to hospital based on disease severity, the expected benefit of the treatment and cost-effectiveness. We use large, national administrative datasets from before and after each of these reforms and assign priority groups based on the maximum waiting times stipulated in Norwegian medical guidelines. To equalise case-mix over time, we use Exact Matching to weight the pre-reform patients to the patient composition in the post-reform period. We regress patient-level waiting times on patient characteristics and on a post-reform indicator interacted with the patient’s priority group. The analysis shows that the least-prioritised patients benefited most from both reforms. This was at the cost of longer waiting times for patients that should have been given higher priority in Norway, while Scotland’s high priority patients remained unaffected. This comparative analysis indicates that blanket waiting times initiatives may be more effective in reducing waiting times while preserving prioritisation between patients with different health needs.Waiting times; prioritisation; Norway; Scotland

Skill Mix and Patient Outcomes: A Multi-country Analysis of Heart Disease and Breast Cancer Patients

Policymakers are becoming aware that increasing the size of the healthcare workforce is no longer the most viable way to address the increasing demand for healthcare. Consequently, a focus of recent healthcare workforce reform has been extending existing roles and creating new roles for health professionals. However, little is known of the influence on outcomes from this variation in labour inputs within hospital production functions. Using a unique combination of primary and administrative data, this paper provides evidence of associations between the composition of care delivery teams and patient outcomes. The primary data enabled the construction of a task component-based measure of skill mix. This novel measure of skill mix has the advantage of capturing how workforce planning can restructure the relative input of nurses or physicians into task components while keeping the overall level of staff fixed. The analysis focuses on specific care pathways and individual hospitals, thus controlling for an under-investigated source of heterogeneity. Additionally, stratifying by country (England, Scotland, and Norway) enabled analysis of skill mix within different health systems. We provide evidence that variations in labour inputs within the breast cancer and heart disease care pathways are associated with both positive and adverse outcomes. The results illustrate the scope for substitution of task components within care pathways as a potential method of healthcare reform

Skill Mix and Patient Outcomes : A multi-country Analysis of Heart disease and breast cancer patients

Acknowledgments: The authors also wish to thank Jan Abel Olsen and participants at the 2019 winter meeting of the Health Economists’ Study Group for helpful comments on an earlier draft of this paper. We would also like to thank all those who supported and guided this work both within the MUNROS research project team and as members of the external advisory board. The European Commission funded this research programme ‘Healthcare Reform: The iMpact on practice, oUtcomes and cost of New ROles for health profeSsionals (MUNROS), under the European Community’s Seventh Framework Programme (FP7 HEALTH-2012-INNOVATION-1) grant agreement number HEALTH-F3-2012- 305467EC. HERU is supported by the Chief Scientist Office (CSO) of the Scottish Government Health and Social Care Directorates (SGHSC). The views expressed here are those of the Unit and not necessarily those of the CSO.Peer reviewedPostprin

Digital Health Transformation of Integrated Care in Europe: Overarching Analysis of 17 Integrated Care Programs

Background: Digital health tools comprise a wide range of technologies to support health processes. The potential of these technologies to effectively support health care transformation is widely accepted. However, wide scale implementation is uneven among countries and regions. Identification of common factors facilitating and hampering the implementation process may be useful for future policy recommendations. Objective: The aim of this study was to analyze the implementation of digital health tools to support health care and social care services, as well as to facilitate the longitudinal assessment of these services, in 17 selected integrated chronic care (ICC) programs from 8 European countries. Methods: A program analysis based on thick descriptions including document examinations and semistructured interviews with relevant stakeholders of ICC programs in Austria, Croatia, Germany, Hungary, the Netherlands, Norway, Spain, and the United Kingdom was performed. A total of 233 stakeholders (ie, professionals, providers, patients, carers, and policymakers) were interviewed from November 2014 to September 2016. The overarching analysis focused on the use of digital health tools and program assessment strategies. Results: Supporting digital health tools are implemented in all countries, but different levels of maturity were observed among the programs. Only few ICC programs have well-established strategies for a comprehensive longitudinal assessment. There is a strong relationship between maturity of digital health and proper evaluation strategies of integrated care. Conclusions: Notwithstanding the heterogeneity of the results across countries, most programs aim to evolve toward a digital transformation of integrated care, including implementation of comprehensive assessment strategies. It is widely accepted that the evolution of digital health tools alongside clear policies toward their adoption will facilitate regional uptake and scale-up of services with embedded digital health tools