Health Manpower: Profile, Stock and Requirements

of Medicare.onthe numberof non-physicianmedicalworkershiredmaynot bo as directas the spe=ificationindicates.

Supply of doctors is a bit lower in public hospitals, although-notby any significant amount. The fazt that a hospital is private or government has no effect on the number of physicians entering or shifting to the hospital servicesmarket.It may be thatthe existence of tertiaryproviders has significant supply effects, but appaxeutly,the presenceof prlmary-type providers(whoso doctors are poorly compensatedrelativeto specialistsin tertiaryhospitals)is having a confounding effect on the results.The supply of nursesis a differentmatter.Public hospitalshave a highly significantimpact on the stock of nurses,andthis is probablydue to the higher compensation levels fornurses ingovemment-txm facilities.

Public hospitals likewise positively relate withthesupply ofmedical technologists, whichiscontrary tothea priori prediction ofno-impact.

Thecausal mechanism isunclear inthis case, unless compensation levels arealsohigher forlaboratory-based technicians inpublic hospitals.

The supply ofpharmacists wasnotincluded inthis aspect oftheregression. ....

Turningnow toanother type ofinstitutional setting, secondary providers areseento slightly influence thesupply ofhospital doctors while primary providers haveasio-,ificant impact on thesupply ofhospital-based nurses andmedical technologists.

Thisissomewhat surprising, since arguably, itisthepresence ofadvanced, urbanbasedtertiary hospitals whichshould lure morepeoplo into joining hospital staff.

Thegrowth oftertiary facilities hasbeenquite stagnant, however, anditisthelarger numberOfsecondary hospitals whichhasprobably bccua '_secoyld "best" havenforanincreasing numberofdoctors.

Although thegrowth ofprimary providers has beenmorerapid, theydonothavethecapacity toabsorb a large numbcrofdoctors.

Again, the results arepuzzling forthesupplyof nurses and medicaltechnologists.

Either there are measurement errors orpresumably there arebehavioral factors opcrating within theprimary hospital setting (e.g., altruism, theneedtoservice thepoor)that induce nursing ormedical technology.

Thesefactors needtobe further investigated.

Finally, the urban location of a provideraffects the hospital'ssupply of doctors and medical technologists, which confirms the a priori expectationthat a host of "modernizing" factors(e.g., educationalopportunities,comfortablelifestyles) arepowerfulinducementsformany to change work settings in medicineand medicaltechnology.Location,however,does not have supply effects as far as nurses and pharmacistsarc concerned. There is a need to further investigate thelocational preferences ofthese health manpowercategories.

If indeed Medicare has been, at least arguably, a driving force in the growthof health care providers, itisapparent thatitisaswelltheimpetus forthegrowth ofhospital-based health manpower.

The demandformorehealth workers isderived fromthedemandfacing health care providers.

Theregression results showthat Medicare elements, suchashospital charges, volume ofclaims andinstitutional setting, arefactors that canstrongly influence thesupply ofhealth workers.

Further limitations: The results should beinterpreted asrelating onlytotheincreased supply ofhealth _m__npower tohospitals.

Theaggregate supply effects arelong-term incharacter andcannot be adequately captureA inaleast squares estimation using cross-section data.

Infact,