Title:American Health Economy Illustrated
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Last week, I pointed out that for almost 50 years, unemployment rates among males working in hospitals or other parts of the health services industry have been lower than for their counterparts in the rest of the economy. The pattern for women, however, is far different. For nearly a half century, women working in health services outside of hospitals have routinely experienced higher unemployment than their counterparts in the rest of the civilian workforce—typically by two to three percentage points (figure 16.3b). Recall that non-hospital health settings include nursing homes in addition to physician offices or other ambulatory locations.
Many decades ago, women working in hospitals also experienced higher unemployment rates than in the rest of the economy. Prior to the introduction of Medicare and Medicaid in 1966 (both programs were enacted on July 30, 1965, but Medicaid did not begin until January 1, 1966 and Medicare began on July 1, 1966), the unemployment rate among female hospital workers was double that of female workers in the civilian workforce and even slightly exceeded the unemployment rate for women in the rest of the health services industry. Subsequently, however, unemployment rates fell well below those for women in other health services jobs and since 1994, female hospital workers have been in the same position as their male counterparts, enjoying an unemployment rate well below that of workers in the rest of the economy.
The unemployment rates shown are for experienced workers only, not for new workers or those reported as being “not in labor force” because of school, an inability to find work, or other reasons. Unlike men, the disparity in unemployment rates between female health industry workers and those in the general economy does not follow this same pattern when we use the conventionally-reported unemployment figures for comparison. For example, in 2009, the overall female unemployment rate was 8.1 percent, compared to only 2.2 percent among hospital workers and 5.5 percent among those working in the non-hospital health services sector. In 2010, overall female unemployment had risen slightly to 8.6 percent, whereas unemployment among female hospital workers had grown to 2.9 percent and female unemployment elsewhere in the health services industry had climbed to 6.4 percent. Thus, in both years, female health workers outside of hospitals had lower unemployment rates than females in the general workforce, whereas this is not true when we examine rates for experienced workers. In contrast, for female hospital workers, recent unemployment rates have been lower than for female civilian workers regardless of whether we use all workers or experienced workers as the basis for comparison.
Why the difference between men and women? One possible reason is that females tend to be concentrated more in health support occupations such as home health care and nursing, whereas men are more concentrated in health care practitioner or technical occupations requiring a higher level of education. In general, the hospital jobs filled by women (e.g., RNs) require more education than the much larger number of jobs held by women outside of hospitals requiring less skilled labor (e.g., home health aides). Thus, just as more educated workers throughout the labor market have experienced lower levels of unemployment than those with less education, female hospital workers likewise experience lower unemployment than their generally less educated, less skilled counterparts elsewhere in the health industry.
The most recent figures show that females in the hospital industry continue to have a margin of advantage over workers in the general economy, and like males, the size of this margin has shrunk somewhat. By July 2011, overall female unemployment had risen its 2010 annual average of 8.6 percent to 9.4 percent (not seasonally adjusted), and hospital worker unemployment among females also had risen somewhat to 3.4 percent (compared to an annual average of 2.9 percent). In that same month, female unemployment among non-hospital health services workers was lower than its 2010 annual average of 6.4 percent, at 5.6 percent. In short, female health workers outside of hospitals have experienced shrinking unemployment even as women in general have faced rising unemployment.
There is no more reason to believe that this margin of advantage in unemployment for female workers in the health care industry will disappear anytime soon than there is for males. That said, if in the unlikely event massive Medicare payment cuts are imposed on physician practices and/or hospitals, women would be much more vulnerable to unemployment effects than men. More than three-quarters of workers in physician practices and hospitals are women and, as noted earlier, they tend to fill positions requiring less skill. But I’ll repeat my earlier contention regarding male health sector workers: for the foreseeable future, the overall number of people employed in health care seems destined to rise faster than number of civilian workers overall. That prospect bodes well for female and male health workers alike.
Christopher J. Conover is a research scholar at Duke University’s Center for Health Policy and Inequalities Research and an adjunct scholar at AEI. The charts shown are from his new book American Health Economy Illustrated, to be released in January 2012 by AEI Press. See PowerPoint version of Figure 16.3b and Excel spreadsheet on unemployment by industry and sex for data, sources, and methods.