Job postings in the substance use disorder treatment related sector during the first five years of Medicaid expansion
Job postings in the substance use disorder treatment related sector during the first five years of Medicaid expansion
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DOI：
10.1371/journal.pone.0228394
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发表时间：
2020-01-30
期刊：
影响因子：
3.7
通讯作者：
Borner, Katy
中科院分区：
文献类型：
--
作者：
Scrivner, Olga;Nguyen, Thuy;Borner, Katy
背景针对物质使用障碍 (SUD) 存在有效的治疗策略，但在确保 SUD 治疗 (SUDT) 劳动力充足以及提高 SUDT 的负担能力、获取机会和耻辱感方面仍然存在严重障碍。尽管有证据表明，最近根据《平价医疗法案》扩大了医疗补助范围，SUD 药物获取有所增加，但尚不清楚这些政策是否也导致 SUDT 相关劳动力的招聘增加，部分原因是数据可用性较差。我们的研究使用新颖的数据来揭示快速发展且与政策相关的劳动力市场的最新趋势，并有助于了解数据源以跟踪 SUDT 相关劳动力以及最近州医疗保健政策对该行业供应方的影响。方法和数据我们检查 2010-2018 年 SUDT 和相关行为健康部门的招聘尝试，以估计 2014 年及以后州医疗补助扩张对这些结果的因果影响“双重差异”计量经济学模型。我们使用的 Burning Glass Technologies (BGT) 数据几乎涵盖了美国雇主发布的所有职位信息。调查结果在全国范围内，我们发现，相对于其他经济部门或整个医疗保健行业，2010 年至 2018 年该行业的招聘尝试几乎没有增长。然而，这掩盖了 SUDT 职位发布的双峰趋势的异质性，大多数年份有所增加，但 2014 年和 2017 年有所下降，以及不同职业类别之间的重点转移。然而，医疗补助的扩张与在此期间 SUDT 相关行业的总体招聘尝试的任何统计上的显着变化无关，尽管有适度的证据表明初级保健医生的招聘尝试有所增加。 结论 尽管以招聘广告数量衡量的 SUDT 相关行业的招聘尝试并未随着时间的推移而大幅增长，但招聘格局发生了变化。包括报销政策在内的许多国家因素可能会在刺激对 SUDT 相关劳动力的需求方面发挥作用，但我们的研究并未表明最近州医疗补助扩张是统计上可检测到的因素之一。未来的研究需要了解劳动力需求总量信号如何转化为 SUDT 劳动力和可用性的实际增长。
BackgroundEffective treatment strategies exist for substance use disorder (SUD), however severe hurdles remain in ensuring adequacy of the SUD treatment (SUDT) workforce as well as improving SUDT affordability, access and stigma. Although evidence shows recent increases in SUD medication access from expanding Medicaid availability under the Affordable Care Act, it is yet unknown whether these policies also led to a growth in hiring in the SUDT related workforce, partly due to poor data availability. Our study uses novel data to shed light on recent trends in a fast-evolving and policy-relevant labor market, and contributes to understanding data sources to track the SUDT related workforce and the effect of recent state healthcare policies on the supply side of this sector.Methods and dataWe examine hiring attempts in the SUDT and related behavioral health sector over 20102018 to estimate the causal effect of the 2014-and-beyond state Medicaid expansions on these outcomes through "difference-in-difference" econometric models. We use Burning Glass Technologies (BGT) data covering virtually all U.S. job postings by employers.FindingsNationally, we find little growth in the sector's hiring attempts in 2010-2018 relative to the rest of the economy or to health care as a whole. However, this masks heterogeneity in the bimodal trend in SUDT job postings, with some increases in most years but a decrease in 2014 and in 2017, as well as a shift in emphasis between different occupational categories. Medicaid expansion, however, is not associated with any statistically significant change in overall hiring attempts in the SUDT related sector during this time period, although there is moderate evidence of increases among primary care physicians.ConclusionsAlthough hiring attempts in the SUDT related sector as measured by the number of job advertisements have not grown substantially over time, there was a shift in the hiring landscape. Many national factors including reimbursement policy may play a role in incentivizing demand for the SUDT related workforce, but our research does not show that recent state Medicaid expansion was one such statistically detectable factor. Future research is needed to understand how aggregate labor demand signals translate into actual increases in SUDT workforce and availability.