The European Journal of Health Economics

, Volume 16, Issue 7, pp 763–780 | Cite as

Hospital staffing and local pay: an investigation into the impact of local variations in the competitiveness of nurses’ pay on the staffing of hospitals in France

  • Jean-Baptiste Combes
  • Eric Delattre
  • Bob Elliott
  • Diane Skåtun
Original Paper


Spatial wage theory suggests that employers in different regions may offer different pay rates to reflect local amenities and cost of living. Higher wages may be required to compensate for a less pleasant environment or a higher cost of living. If wages in a competing sector within an area are less flexible and therefore less competitive this may lead to an inability to employ staff. This paper considers the market for nursing staff in France where there is general regulation of wages and public hospitals compete for staff with the private hospital and non-hospital sectors. We consider two types of nursing staff, registered and assistant nurses and first establish the degree of spatial variation in the competitiveness of pay of nurses in public hospitals. We then consider whether these spatial variations are associated with variation in the employment of nursing staff. We find that despite regulation of pay in the public and private sector, there are substantial local variations in the competitiveness of nurses’ pay. We find evidence that the spatial variations in the competitiveness of pay are associated with relative numbers of assistant nurses but not registered nurses. While we find the influence of the competitiveness of pay is small, it suggests that nonpay conditions may be an important factor in adjusting the labour market as might be expected in such a regulated market.


Wage regulation Local pay Standardised spatial wage differentials Nursing shortage Nursing labour supply 



We are very grateful for the comments of two anonymous referees who greatly improved this article. Our thanks go to the following for their support for this project: to Rennes Métropole for the grant “Allocation Installation Jeunes Chercheurs” and to the University of Aberdeen for financial support; to the Ecole Nationale de la Statistique et de l’Analyse de l’Information, for providing facilities for one of the authors to conduct part of this research; to the Institute National de la Statistique et des Études Économiques for permitting access to and assisting in interpretation of the Déclaration Annuelle des Données Sociales (DADS); to Mehni Benyaala, Martine Delangre, Elodie Kranklader, Alain Esnault for their assistance in accessing and interpreting the DADS and Statistique Annuelle des Etablissements de Santé (SAE); and to Cécile Martin for her comments on this paper at the CES-HESG joint conference in Aix-en-Provence in January 2012. An earlier version of part of this research was presented at Paris, Dauphine and we are grateful to participants for their comments. Although this paper has received very useful comments, we retain responsibility for any remaining errors.

Supplementary material

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Supplementary material 1 (PDF 96 kb)
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Supplementary material 2 (PDF 149 kb)
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Supplementary material 3 (PDF 84 kb)
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Supplementary material 4 (PDF 88 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Jean-Baptiste Combes
    • 1
  • Eric Delattre
    • 2
  • Bob Elliott
    • 3
  • Diane Skåtun
    • 3
  1. 1.Institute for Research and Information in Health EconomicsParisFrance
  2. 2.Université de Cergy-Pontoise and THEMA (UMR CNRS 8184)Cergy-PontoiseFrance
  3. 3.Health Economics Research UnitUniversity of AberdeenAberdeenScotland

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