The Political Economy of Health Care: State Policy Climates and the U.S. Healthcare Workforce, 1960-2019

• In Event: 40817 - Health Care and Care Delivery: Medical Organizations, Providers and Patients

Abstract

A burgeoning literature links state policies to healthcare access/use, yet little research has explored whether state policy climates affect the availability of health care itself. This article draws on census microdata and the State Policy & Politics Database to examine the association between state policy liberalism and healthcare workforce availability and diversity from 1960-2019. Analyses reveal two key findings. First, policy liberalism is associated with larger state-level healthcare workforces and nursing workforces, but with smaller physician workforces. Second, the size of the Black physician workforce and most racial/nativity groups of nurses is larger in more liberal policy contexts, whereas such contexts have smaller White physician; foreign-born nursing; and Black/foreign-born medical assistant/health aide workforces. Bringing a political economy perspective to understanding the (mal)distribution of the healthcare workforce emphasizes a “two-tiered” U.S. healthcare system, stratified in both its availability and diversity. This stratification may reflect and reify existing inequities in population health.

Author

• Rebecca Anna Schut, Case Western Reserve University