This paper studies the growing presence of private equity (PE) acquirers in the hospital industry. We examine employment, operational efficiency and patient outcomes at hospitals acquired by PE firms. While the total employment at target hospitals significantly declines, the proportion of physicians and nurses in the total workforce (skilled worker ratio) increases for hospitals acquired by a publicly traded PE backed hospital. Employment cuts also occur in hospitals acquired by non-PE acquirers, but skilled worker ratio does not increase in those hospitals. PE-backed acquirers, especially publicly traded ones, are also uniquely associated with reductions in overhead costs. Consistent with PE acquirers increasing skilled worker ratio, patient satisfaction scores do not decline at PE-acquired hospitals and even improve along some dimensions. In contrast, patient satisfaction significantly worsens at hospitals acquired by non-PE acquirers. Examining real patient outcomes, we find that PE acquirers are not associated with higher mortality and readmission rates at target hospitals than non-PE acquirers. Overall, our paper provides a comprehensive look at the role of PE acquirers in the hospital industry, and documents nuanced differences between PE and non-PE acquirers, as well as between PE backed acquirers with and without access to public capital markets.
{"title":"Private Equity in the Hospital Industry","authors":"Janet Gao, Merih Sevilir, Yong Seok Kim","doi":"10.2139/ssrn.3924517","DOIUrl":"https://doi.org/10.2139/ssrn.3924517","url":null,"abstract":"This paper studies the growing presence of private equity (PE) acquirers in the hospital industry. We examine employment, operational efficiency and patient outcomes at hospitals acquired by PE firms. While the total employment at target hospitals significantly declines, the proportion of physicians and nurses in the total workforce (skilled worker ratio) increases for hospitals acquired by a publicly traded PE backed hospital. Employment cuts also occur in hospitals acquired by non-PE acquirers, but skilled worker ratio does not increase in those hospitals. PE-backed acquirers, especially publicly traded ones, are also uniquely associated with reductions in overhead costs. Consistent with PE acquirers increasing skilled worker ratio, patient satisfaction scores do not decline at PE-acquired hospitals and even improve along some dimensions. In contrast, patient satisfaction significantly worsens at hospitals acquired by non-PE acquirers. Examining real patient outcomes, we find that PE acquirers are not associated with higher mortality and readmission rates at target hospitals than non-PE acquirers. Overall, our paper provides a comprehensive look at the role of PE acquirers in the hospital industry, and documents nuanced differences between PE and non-PE acquirers, as well as between PE backed acquirers with and without access to public capital markets.","PeriodicalId":104577,"journal":{"name":"HEN: Labor & Workforce (RN","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115378406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The COVID-19 economic crisis differs from past recessions in terms of the sectors and occupations that are being hit first. In this paper we propose a model with sectoral and occupational heterogeneity and non-homothetic preferences over sectors. That is, households' consumption bundles depend on income and they cut consumption on high income-elastic sectors when labor income falls. We first document that contact intensive occupations are concentrated in just a few, high-income-elasticity sectors. By contrast, production/manufacturing occupations are distributed widely across sectors. We then compare a COVID-19 type shock affecting service sectors first to a more ``standard" recession affecting manufacturing in our model calibrated to match the U.S. economy. Our main result is that the increase in labor income inequality in the COVID-19 recession is one and a half times the increase in a normal recession due to the fact that contact intensive service workers are low income and work mainly in high income-elasticity sectors.
{"title":"Sector-Specific Shocks and the Expenditure Elasticity Channel During the COVID-19 Crisis","authors":"Ana Danieli, Jane Olmstead-Rumsey","doi":"10.2139/ssrn.3593514","DOIUrl":"https://doi.org/10.2139/ssrn.3593514","url":null,"abstract":"The COVID-19 economic crisis differs from past recessions in terms of the sectors and occupations that are being hit first. In this paper we propose a model with sectoral and occupational heterogeneity and non-homothetic preferences over sectors. That is, households' consumption bundles depend on income and they cut consumption on high income-elastic sectors when labor income falls. We first document that contact intensive occupations are concentrated in just a few, high-income-elasticity sectors. By contrast, production/manufacturing occupations are distributed widely across sectors. We then compare a COVID-19 type shock affecting service sectors first to a more ``standard\" recession affecting manufacturing in our model calibrated to match the U.S. economy. Our main result is that the increase in labor income inequality in the COVID-19 recession is one and a half times the increase in a normal recession due to the fact that contact intensive service workers are low income and work mainly in high income-elasticity sectors.","PeriodicalId":104577,"journal":{"name":"HEN: Labor & Workforce (RN","volume":"136 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133987356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In 2006 the World Health Organization identified 57 countries with critical shortage of health workforce. A number of cross-country studies have explored the effect of the health workforce density on countries’ health outcomes. However, little is known about the factors driving health workforce density. The objective of this study was to identify the factors affecting the density of health workforce, which would provide broader understanding of the underlying causes of this crisis and help formulate appropriate policies in order to mitigate the challenge. This study analysed data from 183 UN member countries to assess the association between the various demographic, economic and political factors and the health workforce density. Out of 183 countries, 66 (36%) had a heath workforce density below the WHO recommended threshold of 2.3 per 1,000 people. The adult literacy rate (p-value<0.01), total health expenditure (p-value<0.01) and social stability (p-value=0.04) are statistically significant. Total health expenditure had the greatest (33%) effect on the density of health workforce, followed by literacy rates (25%) and social stability (11%). This cross-country study provides a snapshot of the potential factors affecting health workforce density. Two of the three significant factors (adult literacy rate and social stability) are not directly related to countries’ health system, which indicates that a holistic and integrated approach is required in order to alleviate the health workforce crisis. Further studies triangulating various quantitative and qualitative data would extend the understanding of the topic.
{"title":"Factors Affecting Health Worker Density: Evidence from a Quantitative Cross-Country Analysis","authors":"R. Zaman, I. Gemmell, T. Lievens","doi":"10.2139/ssrn.2541690","DOIUrl":"https://doi.org/10.2139/ssrn.2541690","url":null,"abstract":"In 2006 the World Health Organization identified 57 countries with critical shortage of health workforce. A number of cross-country studies have explored the effect of the health workforce density on countries’ health outcomes. However, little is known about the factors driving health workforce density. The objective of this study was to identify the factors affecting the density of health workforce, which would provide broader understanding of the underlying causes of this crisis and help formulate appropriate policies in order to mitigate the challenge. This study analysed data from 183 UN member countries to assess the association between the various demographic, economic and political factors and the health workforce density. Out of 183 countries, 66 (36%) had a heath workforce density below the WHO recommended threshold of 2.3 per 1,000 people. The adult literacy rate (p-value<0.01), total health expenditure (p-value<0.01) and social stability (p-value=0.04) are statistically significant. Total health expenditure had the greatest (33%) effect on the density of health workforce, followed by literacy rates (25%) and social stability (11%). This cross-country study provides a snapshot of the potential factors affecting health workforce density. Two of the three significant factors (adult literacy rate and social stability) are not directly related to countries’ health system, which indicates that a holistic and integrated approach is required in order to alleviate the health workforce crisis. Further studies triangulating various quantitative and qualitative data would extend the understanding of the topic.","PeriodicalId":104577,"journal":{"name":"HEN: Labor & Workforce (RN","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125086916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We estimate a dynamic discrete choice model of Registered Nurses’ labor supply with random terms. A distinguished feature of our model is that random terms are correlated over time and jobs (habit persistence). Past options and not only the past optimal choices matter for the current choices. Given observed incentives, we find that nurses are mobile when they are young (less than physicians), but there is also a weak tendency of higher mobility again when they are approaching retirement age. Wage increases have a modest impact on labor supply. The overall elasticity for nurses is close to zero (like for physicians). These low elasticities shadow for stronger responses, shifting labor away from part time jobs in the public and private sector towards full time jobs in the private sector. A change in taxation away from the progressive tax system towards a flat tax of 28% gives Registered Nurses a very modest incentive to shift their job to private hospitals. For physicians the impact is stronger.
{"title":"Wages Anatomy. Labor Supply of Nurses and a Comparison with Physicians","authors":"L. Andreassen, M. D. Di Tommaso, S. Strøm","doi":"10.2139/ssrn.2536261","DOIUrl":"https://doi.org/10.2139/ssrn.2536261","url":null,"abstract":"We estimate a dynamic discrete choice model of Registered Nurses’ labor supply with random terms. A distinguished feature of our model is that random terms are correlated over time and jobs (habit persistence). Past options and not only the past optimal choices matter for the current choices. Given observed incentives, we find that nurses are mobile when they are young (less than physicians), but there is also a weak tendency of higher mobility again when they are approaching retirement age. Wage increases have a modest impact on labor supply. The overall elasticity for nurses is close to zero (like for physicians). These low elasticities shadow for stronger responses, shifting labor away from part time jobs in the public and private sector towards full time jobs in the private sector. A change in taxation away from the progressive tax system towards a flat tax of 28% gives Registered Nurses a very modest incentive to shift their job to private hospitals. For physicians the impact is stronger.","PeriodicalId":104577,"journal":{"name":"HEN: Labor & Workforce (RN","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127336773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amar Gupta, Rajneesh Goyal, K. Joiner, Sanjay Saini
The healthcare industry is being impacted by advances in information technology in four major ways: first, a broad spectrum of tasks that were previously done manually can now be done by computers faster, better, and at lower costs; second, some tasks can be outsourced to other countries using inexpensive communications technology; third, detailed analysis of longitudinal and societal healthcare data can now be analyzed in acceptable periods of time; and fourth, the best medical expertise can be made available to patients without the need to physically transport the patient to the doctor or vice versa. Still, there are many healthcare situations in which face-to-face interaction is the only practical way to render medical assistance. After considering a number of healthcare scenarios in which one or more of the co-authors were involved, this paper concludes that healthcare will increasingly use a portfolio approach comprised of three closely-coordinated components seamlessly interwoven together: healthcare tasks performed by humans on-site; healthcare tasks performed by humans off-site, including tasks performed in other countries; and healthcare tasks performed by computers without direct human involvement. This three-pronged approach will lead to better healthcare services at the most cost-economic rates; further, it will gradually incorporate some of the principles of the 24-Hour Knowledge Factory framework. Organizations that impede or otherwise restrict the use of this multifaceted approach will see higher healthcare costs, and will gradually become less competitive in the global marketplace, as is happening with non-adapting organizations in several other sectors of the economy. Finally, this paper deals with intellectual property and legal aspects related to the proposed three-pronged healthcare services paradigm.
{"title":"Outsourcing in the Healthcare Industry: Information Technology, Intellectual Property, and Allied Aspects","authors":"Amar Gupta, Rajneesh Goyal, K. Joiner, Sanjay Saini","doi":"10.2139/ssrn.1325885","DOIUrl":"https://doi.org/10.2139/ssrn.1325885","url":null,"abstract":"The healthcare industry is being impacted by advances in information technology in four major ways: first, a broad spectrum of tasks that were previously done manually can now be done by computers faster, better, and at lower costs; second, some tasks can be outsourced to other countries using inexpensive communications technology; third, detailed analysis of longitudinal and societal healthcare data can now be analyzed in acceptable periods of time; and fourth, the best medical expertise can be made available to patients without the need to physically transport the patient to the doctor or vice versa. Still, there are many healthcare situations in which face-to-face interaction is the only practical way to render medical assistance. After considering a number of healthcare scenarios in which one or more of the co-authors were involved, this paper concludes that healthcare will increasingly use a portfolio approach comprised of three closely-coordinated components seamlessly interwoven together: healthcare tasks performed by humans on-site; healthcare tasks performed by humans off-site, including tasks performed in other countries; and healthcare tasks performed by computers without direct human involvement. This three-pronged approach will lead to better healthcare services at the most cost-economic rates; further, it will gradually incorporate some of the principles of the 24-Hour Knowledge Factory framework. Organizations that impede or otherwise restrict the use of this multifaceted approach will see higher healthcare costs, and will gradually become less competitive in the global marketplace, as is happening with non-adapting organizations in several other sectors of the economy. Finally, this paper deals with intellectual property and legal aspects related to the proposed three-pronged healthcare services paradigm.","PeriodicalId":104577,"journal":{"name":"HEN: Labor & Workforce (RN","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125117740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：