Research

Abstract: Healthcare systems worldwide face increasing nursing shortages, but the consequences remain poorly understood. This paper examines how nursing shortages in hospitals affect healthcare provision and patient health, leveraging the 2011 Swiss franc stabilization. Due to wage rigidity in the German healthcare sector, cross-border commuting became more attractive for German registered nurses, causing German hospitals to lose staff based on their proximity to the border. Using rich patient- and hospital-level administrative data in a matched difference-in-differences approach, I find that German border hospitals lost, on average, 12.5% of their nursing staff. In response, hospitals reduced care intensity, leading to a decline in surgeries. While hospitals attempted to prioritize care reductions (triage), even patients with urgent medical needs experienced cutbacks, resulting in a sharp rise in mortality rates and a stagnation in life expectancy. These findings highlight the fragility of healthcare systems to labor market regulations and labor scarcity.

Abstract: We study how the threat of entry affects service quantity and quality of general practitioners (GPs). We leverage Germany’s needs-based primary care planning system, in which the likelihood of new GPs reduces by 20 percentage points when primary care coverage exceeds a cut-off. We compile novel data covering all German primary care regions and up to 30,000 GP-level observations from 2014 to 2019. Reduced threat of entry lowers patient satisfaction for incumbent GPs without nearby competitors but not in areas with competitors. We find no effects on working hours or quality measures at the regional level including hospitalizations and mortality.

Abstract: This study quantifies the relationship between workplace digitalization, characterized by the increasing use of frontier technologies, and workers’ health outcomes using novel and representative German linked employer-employee data. Analyzing changes in individual-level technology use between 2011 and 2019, we find that digitalization induces similar shifts toward more complex and service-oriented tasks for all workers but exacerbates health disparities between cognitive and manual workers. Unlike mature, computer-based technologies, recent frontier technologies significantly degrade manual workers’ subjective health and increase sick leave, while leaving cognitive workers unaffected. Our findings suggest that these negative effects are mitigated in firms that provide training and support to help workers adjust to technological changes.

Abstract: New technologies drive productivity growth, yet the distribution of gains may be unequal. We study how labor market institutions – specifically shop-floor worker representation – mediate the impact of automation. Combining German individual-level administrative records with plant-level data on industrial robot adoption, we find that works councils reduce the separation risk for incumbent workers during automation events. When labor markets are tight and replacement costs are high, incumbent workers become more valuable from the firm’s perspective. Consequently, we document that the moderating effects of works councils diminish. Older workers, who face greater challenges reallocating to new employers, benefit the most from organized labor in terms of wages and employment. Finally, we observe that works councils do not hinder robot adoption; rather, they spur the use of higher-quality robots, encourage more worker training during robot adoption, and foster higher productivity growth thereafter.

Abstract: This paper capitalizes on a nationwide German healthcare reform that limited general practitioners (GPs) in selecting locations to establish their practices. Due to these entry restrictions, a significant number of regions experienced a decline in primary care coverage, depending on pre-reform characteristics and with minimal regional adjustments. By integrating comprehensive datasets at the patient, practice, and regional level within a multi-period difference-in-differences framework, we estimate how reduced access to primary care impacts service provision and population health. Furthermore, precise geo-location data of practices allow us to assess how the effect varies depending on the horizontal and vertical market structure.

Current stage: Data collection completed.