The gender wage gap in the public and private sectors in Bangladesh

The gender wage gap is well studied in developed countries; however, recently it has generated much interest in developing countries. This thesis addresses three issues regarding the gender wage gap in Bangladesh. Firstly, it explores the wage determinants for formal public and private sector employees in Bangladesh and examines the gender pay gap. This is the first time different decomposition methods have been used to compare the sources of the gender wage gap as well as any potential discrimination effect in the formal sector of the Bangladeshi labour market. These decomposition methods are: the original Oaxaca (1973) and Blinder (1973) decomposition methods, the Neumark (1988), Cotton (1988), and Reimers (1983) methods, and the extended Oaxaca method including both the employment selection and the double selection correction in the wage equation. In addition to mentioned methods, to quantify the gender wage gap in monetary terms, a recently developed ‘simulated change’ approach by Olsen and Walby (2004) is also applied for the first time to the Bangladeshi data. By using the Labour Force Survey 2005-06, BBS (LFS 2005-06) data results show formal sector female employees earn about 32.1 per cent less than their male counterparts. Without considering the selection correction, a large range of human capital, demographic and labour market related variables are explained less than half of the total gender wage gap (21 to 46 per cent of the total wage gap) and the major part of the wage gap is unexplained (54 to 79 per cent of the total wage gap). This could partly be attributed to discrimination. Using the double selection correction method, the decomposition results changed where a small part of the wage gap was explained by the measured characteristics (only nine per cent of the total wage gap) and a major part is attributed to the discrimination and selection effect. The selection effect also reveals that exclusion of the double selection correction might lead to an overestimation of the gender wage gap in the formal sector of Bangladesh. In addition, results based on the Olsen and Walby (2004) simulation method show that, if the other characteristics of male and female employees were similar, ‘being female’ is sufficient, to generate significantly lower wages than males in the formal sector. If females in the workplace are treated as males, without considering any other endowment increases, females could increase their earnings by 4095.3 Taka1 per year. Results also indicate that not only endowment differences in human capital and work experience related variables were important, but discrimination appears to play a significant role in the total wage gap throughout the formal sector of the Bangladeshi labour market. Secondly, the study investigates whether public sector employees enjoyed a wage premium or not, compared to the private sector and whether the gender wage gap is greater in the public sector. In addition, the research considered whether there was an impact from the inclusion of the different selection correction terms in the wage equation. In Bangladesh, public sector employees have, on average, a 60 per cent wage premium over the private sector. Using both the original Oaxaca and the extended Oaxaca methods, where selection effect is partly captured by both explained and unexplained components, and using the public sector wage structure as the basis of the non-discriminatory wage structure, these methods revealed a considerably larger portion of explained (72 - 93 per cent of the total wage gap) and a smaller portion of unexplained part of the wage gap. However, if the selection correction is considered as another component of the decomposition outcome then the major portion of the total public and private sectors wage gap is justified (explained) by the effect of the selection correction and unexplained factors. Furthermore, a large part of the wage premium exists in favour of public sector female employees compared to males and the gender wage gap is lower in the public sector than the private sector. Finally, this study compares the gender wage gap of five different occupations. The gender wage gap is associated with labour market rigidities where one of the important factors is occupational segregation where females are disproportionately distributed in occupations resulting in lower earnings. The largest gender wage gap was found in agriculture, forestry, fisheries, production and transport labour jobs (56.4 per cent) and the lowest in the professional, technical administrative and managerial jobs (22.1 per cent). Substantial differences are found in the size of the endowment gap across occupations and larger variations occurred in the adjusted wage gap which varied from 21.4 per cent in sales and service occupations, to 100 per cent in professional and technical jobs (the highest). This too can be partly explained by discrimination. A reduction in the gender wage gap is expected not only to increase national income, but also to reduce poverty and lead to better outcomes for future generations. National policy should aim to reduce the gender wage gap and achieve gender wage equality in the formal sector; for example through a targeted program to remove the gender differences in education and to reduce the skill difference, with a better child care policy to encourage labour force retention and increased labour market experience for female employees, with anti-discriminatory policies and the enforcement of existing antidiscrimination policies, and a more equal distribution of males and females across occupations.

‘Failure to maintain’: care rationing and the clinical and financial burden of nurse sensitive hospital-acquired complications in complex older patients

Background: The ageing population, with concomitant increase in chronic conditions, is increasing the presence of older people with complex needs in hospital. People with dementia are one of these complex populations and are particularly vulnerable to complications in hospital. Registered nurses can offer simultaneous assessment and intervention to prevent or mitigate hospital-acquired complications through their skilled brokerage between patient needs and hospital functions. A range of patient outcome measures that are sensitive to nursing care has been tested in nursing work environments across the world. However, none of these measures have focused on hospitalised older patients. Method: This thesis explores nursing-sensitive complications for older patients with and without dementia using an internationally recognised, risk-adjusted patient outcome approach. Specifically explored are: the differences between rates of complications; the costs of complications; and cost comparisons of patient complexity. A retrospective cohort study of an Australian state’s 2006–07 public hospital discharge data was utilised to identify patient episodes for people over age 50 (N=222,440) where dementia was identified as a primary or secondary diagnosis (N=44,422). Extra costs for patient episodes were estimated based on length of stay (LOS) above the average for each patient’s Diagnosis Related Group (DRG) (N=157,178) and were modelled using linear regression analysis to establish the strongest patient complexity predictors of cost. Results: Hospitalised patients with a primary or secondary diagnosis of dementia had higher rates of complications than did their same-age peers. The highest rates and relative risk for people with dementia were found in four key complications: urinary tract infections; pressure injuries; pneumonia, and delirium. While 21.9% of dementia patients (9,751/44,488, p<0.0001) suffered a complication, only 8.8% of non-dementia patients did so (33,501/381,788, p<0.0001), giving dementia patients a 2.5 relative risk of acquiring a complication (p<0.0001). These four key complications in patients over 50 both with and without dementia were associated with an eightfold increase in length of stay (813%, or 3.6 days/0.4 days) and double the increased estimated mean episode cost (199%, or A$16,403/ A$8,240). These four complications were associated with 24.7% of the estimated cost of additional days spent in hospital in 2006–07 in NSW (A$226million/A$914million). Dementia patients accounted for 22.0% of these costs (A$49million/A$226million) even though they were only 10.4% of the population (44,488/426,276 episodes). Hospital-acquired complications, particularly for people with a comorbidity of dementia, cost more than other kinds of inpatient complexity but admission severity was a better predictor of excess cost. Discussion: Four key complications occur more often in older patients with dementia and the high rate of these complications makes them expensive. These complications are potentially preventable. However, the care that can prevent them (such as mobility, hydration, nutrition and communication) is known to be rationed or left unfinished by nurses. Older hospitalised people who have complex needs, such as those with dementia, are more likely to experience care rationing as their care tends to take longer, be less predictable and less curative in nature. This thesis offers the theoretical proposition that evidence-based nursing practices are rationed for complex older patients and that this rationed care contributes to functional and cognitive decline during hospitalisation. This, in turn, contributes to the high rates of complications observed. Thus four key complications can be seen as a ‘Failure to Maintain’ complex older people in hospital. ‘Failure to Maintain’ is the inadequate delivery of essential functional and cognitive care for a complex older person in hospital resulting in a complication, and is recommended as a useful indicator for hospital quality. Conclusions: When examining extra length of stay in hospital, complications and comorbid dementia are costly. Complications are potentially preventable, and dementia care in hospitals can be improved. Hospitals and governments looking to decrease costs can engage in risk-reduction strategies for common nurse sensitive complications such as healthy nursing work environments that minimise nurses’ rationing of functional and cognitive care. The conceptualisation of complex older patients as ‘business as usual’ rather than a ‘burden’ is likely necessary for sustainable health care services of the future. The use of the ‘Failure to Maintain’ indicators at institution and state levels may aid in embedding this approach for complex older patients into health organisations. Ongoing investigation is warranted into the relationships between the largest health services expense (hospitals), the largest hospital population (complex older patients), and the largest hospital expense (nurses). The ‘Failure to Maintain’ quality indicator makes a useful and substantive contribution to further clinical, administrative and research developments.