The Sustainability of Hospital Care in The Netherlands from a Labour Market Perspective: A Time Series Analysis of the Baumol Effect between 2000 and 2021

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Line 177: a comma before "workers"

Line 229 : a comma after "In this case"

Line 392 : add "to" before "inspect"

Author Response

Line 177: a comma before "workers"

Line 229 : a comma after "In this case"

Line 392 : add "to" before "inspect"

Dear reviewer, thank you very much for your corrections. The paper has been revised accordingly.

Reviewer 2 Report

Comments and Suggestions for Authors

Dear authors! I like the structure of the research paper. It’s clear presented. By the way I have several suggestions to improve the quality of the research.

First of all in introductory section it’ll be great to emphasize scientific novelty of the research and how these research results can be applicable in the future.

Second, it’ll be great to improve the 2. Theoretical Considerations chapter with modern research results. It’s possible to show research from different countries, to show the actuality of the topic.

Third and one of the main issues data collection is mentioned 2000-2021. The article will be published in 2024. I think it’s very important to show the last two years 2022-2023 for the actuality of the research. If it’s hard to find data, you can show the trend of the graphs.

Author Response

Dear Reviewer,

Thank you very much for reviewing our paper and for your compliments and suggestions.

We have added a few sentences in the introductory to emphasize the novelty of the research (lines 57-62)

We have added a few more recent references to the theoretical considerations section (lines 110-113 and lines 121-123)

Unfortunately, at this moment we are not able to update all the relevant data. We will in the future, because these results are a part of an annual monitor Trends in Public Sector.

 

Reviewer 3 Report

Comments and Suggestions for Authors

 

 

 

Overview
The manuscript presents a detailed exploration of the Baumol effect in the Dutch hospital sector. While the methodology and data analysis are robust, the paper could be enhanced by a deeper theoretical engagement and more nuanced policy discussion.

Expanded literature review:

Please include the following references to provide a more nuanced understanding of the economic dynamics at play:

 

Chletsos, M., & Sintos, A. (2021). The effect of financial fragility on employment. Economic Modelling, 94, 104-120.

Justification: This paper's findings on financial conditions and employment dynamics can provide a comparative economic context for your analysis.

 

Di Guilmi, C., & Fujiwara, Y. (2022). Dual labor market, financial fragility, and deflation in an agent-based model of the Japanese macroeconomy. Journal of Economic Behavior & Organization, 196, 346-371.

Justification: Offers insights into dual labor market dynamics under financial stress, enhancing the depth of your sector-specific analysis.

 

Aikman, D., Haldane, A. G., & Nelson, B. (2015). Curbing the Credit Cycle. The Economic Journal, 125(585), 1072-1109.

Justification: Explores the impact of credit cycles on economic stability and labor markets, relevant to your study’s focus on economic pressures within the hospital sector.

 

Deepen interpretation of research questions:

Introduction section: Please expand the interpretation of your research questions in the introduction section. Offer a more comprehensive discussion of why these questions are critical, situating them within the broader economic challenges facing the healthcare sector globally. This should include theoretical motivations and the anticipated impact of your findings on existing economic models.

 

Enhance argument on policy implications:

Policy discussion: Strengthen the argument concerning the policy implications of your study in the concluding section. Detail how your findings could influence specific healthcare policies, labor market regulations, and economic planning. Discuss potential interventions and their expected impacts, drawing from both your results and comparative studies to propose actionable strategies.

 

 

 

Author Response

 Dear Reviewer,

Thank you very much for reviewing our paper and for your suggestions.

In particular, we like to thank you for the literature suggestions. We included one of the suggestions in our paper. This one could be very well aligned with the scope of the paper. (lines 254-256)

We have expanded the research questions by formulating a number of hypotheses that could directly be related to Baumol’s original ideas. (lines 72-75)

The paper already included a discussion of policy implications and a number of recommendations. It is, of course, possible to extend this to all sorts of other health policy issues. However, we have preferred to stick to the implications and recommendations that are supported by the results of our analysis.

Reviewer 4 Report

Comments and Suggestions for Authors

This study presents an analysis of the Baumol effect in the Dutch hospital industry. While offering valuable insights, the paper would benefit from further refinement to align with the standards of high-quality academic journals. The following revisions are recommended:

1.      Please state the research hypotheses alongside the research questions to provide a clear framework for the analysis.

2.      Please combine the sub-sections within Section 2.

3.      Please enhance Section 3 by incorporating figures to illustrate the structure and key features of the Dutch hospital industry. This will provide readers with a clearer understanding of the context surrounding the study.

4.      Please provide a detailed justification for selecting admissions and third-party revenues as the production variables, acknowledging the limitations and potential biases associated with these measures.

5.      Please clearly explain the statistical procedures employed in the analysis, including the regression model used, estimation methods, and diagnostic tests conducted.

6.      Table 2: Instead of presenting standard errors, please indicate significance levels using asterisks or other appropriate symbols. Please, report the LM autocorrelation test statistic and its critical values, and besides report adjusted R-squared and the F-statistic to enhance the statistical analysis.

7.      Please explore the applicability of Baumol's original model within the complex landscape of the healthcare sector, addressing the unique characteristics of government funding and regulation.

8.      Please relate the empirical findings to specific policy recommendations for the Dutch hospital sector, outlining practical solutions to address rising healthcare costs and labor shortages.

Author Response

Thank you very much for reviewing our paper and for your valuable suggestions.

We added a paragraph in the introductory containing hypotheses (lines 72-75).

We combined the subsections with Section 2.

In the paper we present graphs of the key variables in our analysis. For other interesting developments in hospital care we refer to our interactive database.

We have expanded the research questions by formulating a number of hypotheses that could directly be related to Baumol’s original ideas (lines 72-75).

The paper already included a discussion of policy implications and a number of recommendations. It is, of course, possible to extend this to all sorts of other health policy issues. However, we have preferred to stick to the implications and recommendations that are supported by the results of our analysis.

We added a section explaining our choice  of output variables (lines 337-341).

We added text explaining the statistical procedures. Furthermore we added several statistics to the table Results, asterisks and so forth (lines 293-294 and Table 2)

We already discussed the unique characteristics of the Health system. However, the extent to which this is discussed is a matter of taste. We like to stick to the aspects that are consistent with or supported by our analysis. I think we also made a clear point about the falsification of Baumol's assumption about lagging wages in a stagnant industry. It does certainly not apply to the Dutch hospital industry.