Governing physician mobility against China's uneven development : a labor market segmentation perspective

Abstract

Recent years have seen rising concerns over physician mobility in public health and health geography research. The constrained physician mobility presents a significant obstacle in China’s healthcare reform to mitigate healthcare inequalities and New Urbanization Plan to tackle the uneven development through welfare service redistribution. To understand this important yet under-researched topic, this study examines physician mobility from the perspective of labor market segmentation and conceptualizes physician mobility as physicians’ movement between labor market segments embedded in socioeconomic transitions. Three interrelated research questions are examined: (1) Why and how is physician mobility constrained by the organizational and geographical segmentation of China’s physician labor market? (2) How does physician mobility embed in and interact with China’s socioeconomic transitions? (3) How does China’s healthcare reform restructure the physician labor market and what are the impacts on physician mobility? This study employs a mixed-methods approach, mainly a qualitative study based on in-depth interviews with physicians and relevant stakeholders in Sichuan Province, supplemented by spatial regression and qualitative comparative analysis. Findings contribute to the systematic understanding of physician mobility in China. First, physician mobility is a dynamic outcome of the interplay between physicians, hospitals, and cities through the internal labor market (ILM) of healthcare institutions, local labor market (LLM) in geographical settings, and failed external labor market (ELM). Multitasking public hospitals develop their ILM to retain physicians owing to their hospital-specific skills. The neoclassical idea of ELM, in which laborers move fluidly, largely fails due to significant information asymmetries in healthcare. Regional labor demand, supply, and regulation and their dialectics are spatially contextualized, resulting in the formation of city ILMs. The ILM, ELM, and LLM are mutually constitutive and jointly shape constrained physician mobility between hospitals and cities. Second, the constrained physician mobility is mutually constituted with China’s socioeconomic transitions. Hospital ILMs are necessitated and intensified by healthcare delivery marketization, healthcare governance decentralization, and increasing public hospital performance evaluations. The reliance of physicians on the ELM is weakened by the evolution of the physician workforce owing to the increasing long-term medical education, medical college admission expansion, and demographic changes among physicians. City LLMs are reinforced by the welfare regime in China’s pro-large city development, facilitating the “spatial fixity” of physicians in their geographical settings. Interrelated evolutions of ILM, ELM, and LLM presents increasingly complex challenges in physician mobility governance. Third, the labor market segmentation perspective provides a useful lens to understand China’s healthcare reform in restructuring physician labor market. Policy efforts renegotiate stakeholders’ interests mainly through reorganizing or relaxing hospital ILMs and intervening in city LLMs. However, structural forces underlying the constrained physician mobility are inadequately addressed, and the state plays an equivocal and contested role in restructuring the physician labor market. By incorporating labor study theories, this study enriches the “mobility” perspective of healthcare resource allocation and foregrounds healthcare workforce in health geography. It also extends labor geography’s debates of labor agency to professional and welfare workers. Pragmatically, this study provides timely policy recommendations for restructuring physician labor market against China’s uneven development。