Nurses' retention and hospital characteristics in New South Wales, CHERE Discussion Paper No 52

Nursing shortages are commonly observed features of hospital systems in Australia, Europe and the United States. To date there has been very little research on the effects of hospital characteristics on the retention of the nursing staff. In this paper we match individual data on registered nurses (RNs) working in the public sector in NSW in 1996 to the hospital in which they work. We analyze the annual retention probability for these RNs using the nurses? personal characteristics as well as the characteristics of the hospitals. It is found that the type of hospital per se does not help explain the retention probability of the nurses employed in the premise but the hospital characteristics do. Hospital characteristics include measures of size, complexity, intensity, expenditures and staffing levels. The results suggest that the effects of these variables are complex. For example, complexity of the work as measured by admissions from emergency increase retention while high cost procedures and large ANDRG weights reduce retention. Higher levels of expenditures (at constant staffing levels) increase retention except for expenditures on visiting medical officers which reduce retention. The effects on the expected retention probability are very large and significant. One implication of our findings is that simply increasing staffing levels is unlikely to achieve much impact on nurses? retention levels unless problem areas of the job are also addressed.Medical workforce

Healthy, wealthy and insured? The role of self-assessed health in the demand for private health insurance, CHERE Working Paper 2006/2

Both adverse selection and moral hazard models predict a positive relationship between risk and insurance; yet the most common finding in empirical studies of insurance is that of a negative correlation. In this paper we investigate the relationship between ex ante risk and private health insurance using data from the 2001 Australian National Health Survey (NHS). The Australian health system provides a setting where the relationship between risk and insurance is more transparent than many other institutional frameworks; private health insurance is not tied to employment; community rating limits the actions of insurers; and private coverage is high for a country providing free public hospital treatment. We find a strong positive association between self-assessed health and private health cover. We use the detailed information available in the NHS to investigate whether we can identify factors responsible for the negative correlation between risk (lower SAHS) and insurance cover. However this relationship persists despite the inclusion of a large set of controls for personal and socio-economic characteristics, risk-related behaviours, objective health measures and an index of mental health. The opposite effect of self-assessed health and long-term conditions on coverage suggests that SAHS is capturing factors such as personality or risk preferences.Private health insurance, self-assessed health, Australia

Hips and hearts: The variation in incentive effects of insurance across hospital procedures

The separate identification of effects due to incentives, selection and preference heterogeneity in insurance markets is the topic of much debate. In this paper, we investigate the presence and variation in moral hazard across health care procedures. The key motivating hypothesis is the expectation of larger causal effects in the case of more discretionary procedures. The empirical approach relies on an extremely rich and extensive dataset constructed by linking survey data to administrative data for hospital medical records. Using this approach we are able to provide credible evidence of large moral hazard effects but for elective surgeries only

Is there a crisis in nursing retention in New South Wales?

Background: There is a severe shortage of nurses in Australia. Policy makers and researchers are especially concerned that retention levels of nurses in the health workforce have worsened over the last decade. There are also concerns that rapidly growing private sector hospitals are attracting qualified nurses away from the public sector. To date no systematic analysis of trends in nursing retention rates over time has been conducted due to the lack of consistent panel data. Results: A 1.4 percentage point improvement in retention has led to a 10% increase in the overall supply of nurses in NSW. There has also been a substantial aging of the workforce, due to greater retention and an increase in mature age entrants. The improvement in retention is found in all types of premises and is largest in nursing homes. There is a substantial amount of year to year movement in and out of the workforce and across premises. The shortage of nurses in public hospitals is due to a slowdown in entry rather than competition from the rapidly growing private sector hospitals. Policy Implications: The finding of an improvement (rather than a worsening) in retention suggests that additional improvements may be difficult to achieve as further retention must involve individuals more and more dissatisfied with nursing relative to other opportunities. Hence policies targeting entry such as increased places in nursing programs and additional subsidies for training costs may be more effective in dealing with the workforce shortage. This is also the case for shortages in public sector hospitals as retention in nursing is found to be relatively high in this sector. However, the large amount of year to year movements across nursing jobs, especially among the younger nurses, also suggests that policies aimed at reducing job switches and increasing the number who return to nursing should also be pursued. More research is needed in understanding the relative importance of detailed working conditions and the problems associated with combining family responsibilities and nursing jobs. © 2008 Doiron et al; licensee BioMed Central Ltd

The impact of job loss on family dissolution

The impact of involuntary job displacements on the probability of divorce is analysed using discrete duration models. The analysis uses the sample of couples from the British Household Panel Survey and distinguishes between types of displacements. Results show that couples in which the husband experiences a job loss are more likely to divorce. Redundancies have small, positive, often insignificant and short-lived effects while dismissals and temporary job endings have larger positive impacts. This is consistent with the interpretation of redundancies as capturing negative income shocks while other types of job loss also convey new information about potential future earnings and match quality

Wage and employment contracts as equilibria to a bargaining game : an empirical analysis

The object of this research is to study how unions and firms divide the surplus or rents available to them. Many instruments are used in practice to make this division, but standard micro data only includes two: wages and employment. I use a new approach to study wage and employment contracts as I consider them equilibrium points in a noncooperative bargaining game. This work is an extension of wage-employment determination models, the extension being the incorporation of a bargaining model, specifically, a Rubinstein bargaining game. Given the objective functions of the two players, the wage and employment equations are specified by the equilibrium conditions for the game. Also, additional determinants of the contracts are identified. One of the characteristics of the model is that the wage and employment contracts are affected by the relative strike costs of the two negotiating parties even in the absence of strikes. The data involve the B.C. wood products industry and the IWA, a powerful union believed to have been successful at capturing rents. The data include input and output quantities and prices and equations representing input demands and output supply are estimated simultaneously with the negotiated wage and employment equations. Four estimation models are derived corresponding to two bargaining frameworks and two sets of assumptions on the firms' technology. The two bargaining frameworks correspond to two polar cases that have been assumed in the wage-employment determination literature: in one case, the wage is set through bargaining while the employment level is chosen by the firm, in the second case, both the wage and employment level are negotiated. In one pair of models, output is treated as exogenous to the bargaining while in the second set of models, output is endogenous and capital is exogenous. The bargaining game is successfully implemented in the sense that technology and union utility parameters are generally reasonable and comparable to previous estimates. Also, the determinants of relative strike costs enter significantly in the estimation. The union is seen to care about employment as well as the wage with slightly more weight being placed on the employment level. Rent maximization is always rejected. Bargaining powers are calculated at each data point and results indicate that the 1980's recession increased the relative power of the union. The hypotheses of equal bargaining powers and complete union bargaining power are tested and rejected. Also, the proportion of rents captured by the firm is found to be a poor indicator of its bargaining power. Although the qualitative results mentioned above are robust across the four models, parameter values are generally sensitive to both the technology assumptions and the bargaining framework. Ignoring the simultaneity of wages, employment and other variables chosen by the firm can be very misleading. Finally, the model in which both wages and employment are negotiated consistently performs better than the framework in which employment is unilaterally set by the firm.Arts, Faculty ofVancouver School of EconomicsGraduat

Bargaining Power and Wage-Employment Contracts in a Unionized Industry.

Input and output data are used in conjunction with negotiated.wages and employment to estimate a fully specified bargaining model between a labor union (the International Woodworkers of America) and representatives from the British Columbia wood products industry. Bargaining powers are modeled as functions of exogenous variables believed.to have influenced the parties' relative strike costs. The estimated bargaining powers are plotted over time and compared to the proportion of rents captured by each party. Parameters of the union utility function and the firms' technology are also estimated and hypothesis tests are conducted on various aspects of the model. Copyright 1992 by Economics Department of the University of Pennsylvania and the Osaka University Institute of Social and Economic Research Association.