While hospital jobs were lost across the region, employment growth took place in other health care settings such as home care, nursing homes, and physician offices. Outside of Allegheny County, these increases more than made up for hospital downsizing, but even the non-hospital rate of growth has slowed in the past several years. It appears that the region's health sector may be particularly vulnerable to further job dislocation, due to its concentration of health service workers, higher than average per capita health expenditures, and resources dedicated to education and research. If public payment policies and the shift to managed care move toward equalizing health care spending across regions, the Pittsburgh region could find that health care jobs grow very slowly or not at all. Although there is continued health care employment growth in non-hospital settings, these positions differ from traditional hospital jobs in a number of important respects.
Wages are lower, benefits more limited, and use of part-time employment more prevalent.
New primary care physician centers may be in suburban locations that are difficult for displaced urban workers to reach, and home health care positions require a reliable automobile, another potential barrier to re-employment for low wage workers. Hospitals are the major employers in many disadvantaged communities. As employment shifts out of hospitals into less intensive settings, these communities may lose an important source of employment for both skilled and unskilled workers. As a result, the redistribution of health services jobs is likely to have a disproportionate impact on minorities and disadvantaged communities. The data presented in this report raise a number of important policy questions for the region.