Author
Abstract
This paper examines wage setting mechanisms for health workers in hospitals across eight different OECD countries. It describes similarities and differences and how fixed or fluid these approaches have been in recent years through health system reforms, labour market dynamics and economic pressures. Based on a review of grey literature and expert interviews with officials from the covered countries, it finds that prior to the economic downturn, several countries had signalled a shift to more local and flexible wage setting in the hospital sector but this ambition does not seem to have been realised in full for public sector hospitals in most OECD countries. Fiscal pressures have led to some “recentralisation” of wage setting, particularly in France, Portugal and the United Kingdom. While the extent of centralisation has been a question of considerable debate, the countries covered in this paper suggest that the benefits of centralised and/ or co-ordinated wage setting generally appear to have been given more attention by policy makers. The current research base on the effectiveness of different wage setting approaches is limited. Policy-making would benefit from developing a better understanding of the impact of wage setting on improved hospital performance and quality. Ce document analyse les mécanismes de détermination des salaires des agents hospitaliers dans huit pays de l’OCDE. Il décrit les similitudes et les différences entre ces mécanismes et évalue la capacité d’adaptation dont ils ont fait preuve ces dernières années face aux réformes des systèmes de santé, à la dynamique du marché du travail et aux pressions économiques. Il ressort d’un examen de la documentation parallèle et d’entretiens menés avec des experts des pays concernés que si, avant la crise économique, plusieurs pays de l’OCDE avaient annoncé que la détermination des salaires dans le secteur hospitalier allait être plus locale et flexible, la plupart d’entre eux semblent ne pas avoir complètement atteint ces objectifs dans les hôpitaux du secteur public. Les difficultés budgétaires ont en effet contraint à une « recentralisation », notamment en France, au Portugal et au Royaume-Uni. L’intérêt de la centralisation fait l’objet d’un large débat, mais dans les pays couverts dans ce document, il semblerait que les décideurs mettent généralement en avant les avantages de la centralisation et/ou de l’harmonisation de la détermination des salaires. La base de recherches sur l’efficacité des différentes approches est actuellement limitée et le processus décisionnel gagnerait à meilleur compréhension des effets de la détermination des salaires sur l’amélioration de la performance et de la qualité des hôpitaux.
Suggested Citation
James Buchan & Ankit Kumar & Michael Schoenstein, 2014.
"Wage-setting in the Hospital Sector,"
OECD Health Working Papers
77, OECD Publishing.
Handle:
RePEc:oec:elsaad:77-en
DOI: 10.1787/5jxx56b8hqhl-en
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JEL classification:
- I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
- J45 - Labor and Demographic Economics - - Particular Labor Markets - - - Public Sector Labor Markets
- J50 - Labor and Demographic Economics - - Labor-Management Relations, Trade Unions, and Collective Bargaining - - - General
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