Periodic Reporting for period 3 - HealthcareLabour (Empirical evidence on the impact of the labour market on the production of healthcare and health)
Berichtszeitraum: 2021-10-01 bis 2023-03-31
The focus on the research is labour markets in healthcare and the effect of the behaviour of key employees in these markets on the quality, quantity and distribution of health. The growing body of economic theory on motivation and incentives (for example, Besley and Ghatak 2005, Benabou and Tirole 2006, Delfgaauw and Dur 2010, Francois 2000) has proved important in helping us to understand the factors that affect the behaviour of public service suppliers. However, empirical tests of this literature remain relatively rare. The aim is to fill this gap.
The focus of my research is on the micro-foundations: the role of key agents in contributing to the persistent variability in productivity, the take-up of innovation, and the variability in quality within and between healthcare suppliers and the implications for users of healthcare. The issues addressed are important in any labour market in which human capital is central to production and where there are market failures which mean government intervention is important and society cares about critical outputs. The focus to date has been on the behaviour of two groups - senior clinicians and management - both of whom are central in the production of healthcare. Similar agents are found in all areas of public (and many private) services production, so our findings will have implications more generally for public service production.
The size of the healthcare sector in the economy; the importance of the output to social wellbeing, the ability to exploit policy changes to create ‘natural’ experiments and the availability of large administrative datasets makes healthcare an ideal test-bed. Healthcare accounts for at least 10% of GDP in almost all OECD countries and this proportion is steadily rising. Thus understanding how healthcare production can be improved is key to social welfare and, because healthcare is often paid for by the public purse, to the fiscal position of the government.
The focus of my research is on the micro-foundations: the role of key agents in contributing to the persistent variability in productivity, the take-up of innovation, and the variability in quality within and between healthcare suppliers and the implications for users of healthcare. The issues addressed are important in any labour market in which human capital is central to production and where there are market failures which mean government intervention is important and society cares about critical outputs. The focus to date has been on the behaviour of two groups - senior clinicians and management - both of whom are central in the production of healthcare. Similar agents are found in all areas of public (and many private) services production, so our findings will have implications more generally for public service production.
The size of the healthcare sector in the economy; the importance of the output to social wellbeing, the ability to exploit policy changes to create ‘natural’ experiments and the availability of large administrative datasets makes healthcare an ideal test-bed. Healthcare accounts for at least 10% of GDP in almost all OECD countries and this proportion is steadily rising. Thus understanding how healthcare production can be improved is key to social welfare and, because healthcare is often paid for by the public purse, to the fiscal position of the government.
Over the period the research has progressed on several fronts.
The first strand of research is a set of projects that focus on the use of networks and information in adoption of medical innovations. The medical care sector is an important source and user of technology and its uptake has important effects on costs and outcomes. Networks are important in shaping individual and firm behaviour, including technology adoption, in many industries and many settings (e.g. Bloom et al. 2013). In the medical setting, networks are common as physicians spend long periods in training and work alongside other physicians. Despite this, there is little empirical research on the effect of medical networks in explaining variation in adoption of innovation. The first set of papers has focused on the impact of physician networks in the adoption of innovation. Initial research focused on selection of the innovation, assembling details data sets, undertaking interviews with physicians about their networks. From this, a descriptive paper on the role of physician networks on the uptake of innovative surgery for cancer treatment has been published.
Three other papers are now either discussion papers or close to this stage. The first examines the effect of physician networks on the uptake of information spreading policies adopted by regulatory authorities. The second examines the effect of known and unknown networks on adoption behaviour. For this paper, we have exploited new methodologies to estimate the effect of unknown networks in a dynamic setting, adapting an approach developed by Gautier and Rose (2019). A third paper examines a different set of innovations and whether responses to news are associated with better patient outcomes.
The second strand of research examines the impact of senior hospital managers on productivity. There is a small but growing literature on the impact of management in the public sector: my research focuses on one of the most complex types of organisation often found in the public sector, hospitals. In this research we have sought to utilise a number of methodologies used to examine the value of bosses. The research is in progress.
The first strand of research is a set of projects that focus on the use of networks and information in adoption of medical innovations. The medical care sector is an important source and user of technology and its uptake has important effects on costs and outcomes. Networks are important in shaping individual and firm behaviour, including technology adoption, in many industries and many settings (e.g. Bloom et al. 2013). In the medical setting, networks are common as physicians spend long periods in training and work alongside other physicians. Despite this, there is little empirical research on the effect of medical networks in explaining variation in adoption of innovation. The first set of papers has focused on the impact of physician networks in the adoption of innovation. Initial research focused on selection of the innovation, assembling details data sets, undertaking interviews with physicians about their networks. From this, a descriptive paper on the role of physician networks on the uptake of innovative surgery for cancer treatment has been published.
Three other papers are now either discussion papers or close to this stage. The first examines the effect of physician networks on the uptake of information spreading policies adopted by regulatory authorities. The second examines the effect of known and unknown networks on adoption behaviour. For this paper, we have exploited new methodologies to estimate the effect of unknown networks in a dynamic setting, adapting an approach developed by Gautier and Rose (2019). A third paper examines a different set of innovations and whether responses to news are associated with better patient outcomes.
The second strand of research examines the impact of senior hospital managers on productivity. There is a small but growing literature on the impact of management in the public sector: my research focuses on one of the most complex types of organisation often found in the public sector, hospitals. In this research we have sought to utilise a number of methodologies used to examine the value of bosses. The research is in progress.
The research has applied ideas more broadly used in the labour economics literature to the healthcare sector. It has been possible due to extensive use of matched administrative data sets and ideas from outside the field of health economics. It has extended understanding our understanding of the role played by networks for physicians, with a focus on adoption of innovation. It has also raised important issues as to the impact of management of complex organisations in public sector. The intention for the next phase of the project is to extend this research to:
1. Understand the impact of responding to political priorities on the behaviour of top managers in the public sector and the outcomes for service users
2. Complement the analysis of the effect of networks on innovation adoption with an analysis of the effect of team work. Here the focus will be on team production by nurses and the effects on patient outcomes
3. Examine the effect of absences of senior doctors on patient outcomes
1. Understand the impact of responding to political priorities on the behaviour of top managers in the public sector and the outcomes for service users
2. Complement the analysis of the effect of networks on innovation adoption with an analysis of the effect of team work. Here the focus will be on team production by nurses and the effects on patient outcomes
3. Examine the effect of absences of senior doctors on patient outcomes