Journal article
The Effect of Nursing Home Closure on Local Employment in the United States
Health services research, Vol.58(3), pp.744-752
06/2023
DOI: 10.1111/1475-6773.14125
PMCID: PMC10154163
PMID: 36573262
Abstract
To estimate the effect of nursing home closure on local employment, overall, and by rurality.
We obtain 2008 to 2018 county-level data from the Quarterly Workforce Indicators, Medicare Provider of Services, Area Health Resource, and Urban Influence Codes files. From 2008 to 2018, 878 counties experienced at least one nursing home closure, and 2,055 counties did not experience a closure.
Using a difference-in-difference study design, we compare the changes of total employment, health sector employment and non-health sector employment over time between counties with and without a nursing home closure. We utilize the variation in the year and quarter of nursing home closures to estimate subsequent employment changes as well as employment trends before closure. We also account for contemporaneous events including nursing home entries and hospital entries and closures, and evaluate heterogeneity by rurality.
We include data on nursing home closure from the Medicare Provider of Service file. Quarterly county-level employee counts were obtained from the Quarterly Workforce Indicators provided by the Census Bureau. County-level demographic data were obtained from the Area Health Resource Files. We use Urban Influence Codes from the Economic Research Service, Department of Agriculture, to classify metropolitan, micropolitan, and rural (noncore) counties.
Health sector employment decreased by about 3.2-4.1% (p<0.01) in counties with a nursing home closure. The reduction was largest in rural counties (approximately 7.2-9.4%, p<0.01). The reduction in health sector employment persisted over time, particularly in rural counties. Overall, there was no discernable effect on non-health sector employment.
Nursing home closure is associated with a persistent decline in health sector employment, particularly in rural counties, suggesting a reduction in the healthcare workforce and in the ability to sustain healthcare services supply, particularly in rural areas. This article is protected by copyright. All rights reserved.
Details
- Title: Subtitle
- The Effect of Nursing Home Closure on Local Employment in the United States
- Creators
- Lili Xu - Department of Health Management and Policy, College of Public Health, The University of Iowa, Iowa City, Iowa, USAHari Sharma - University of IowaGeorge L Wehby - National Bureau of Economic Research
- Resource Type
- Journal article
- Publication Details
- Health services research, Vol.58(3), pp.744-752
- DOI
- 10.1111/1475-6773.14125
- PMID
- 36573262
- PMCID
- PMC10154163
- NLM abbreviation
- Health Serv Res
- ISSN
- 0017-9124
- eISSN
- 1475-6773
- Language
- English
- Electronic publication date
- 12/26/2022
- Date published
- 06/2023
- Academic Unit
- Preventive and Community Dentistry; Health Management and Policy; Economics; Public Policy Center (Archive)
- Record Identifier
- 9984354113302771
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