Category Archives: Health Care

An Overview of the Pension/OPEB Landscape

Source: Alicia H. Munnell and Jean-Pierre Aubry, Center for Retirement Research at Boston College, July 1, 2016

….This paper provides a comprehensive accounting of pension and OPEB liabilities for state and local governments and the fiscal burden that they pose. The analysis includes plans serving more than 800 entities: 50 states, 178 counties, 173 major cities, and 415 school districts related to the sample of cities and counties. The analysis apportions the liabilities of state-administered cost-sharing plans to participating local governments for a more accurate picture of which governmental entity is actually responsible for funding pension and OPEB liabilities. The cost analysis calculates, separately, pension and OPEB costs as a percentage of own-source revenue for states, cities, and counties. It then combines pension and OPEB costs to obtain the overall burden of these programs. Finally, it adds debt service costs to provide a comprehensive picture of government revenue commitments to long-term liabilities….

How to Take the Initiative in Health Care Bargaining

Source: Peter Knowlton, Labor Notes, July 12, 2016

….We know that the universal health care everyone deserves won’t be won in a single shop—but we’re laying the groundwork to set our sights higher in future fights that can bring workers together across a whole chain or geographic area.

BASIC PRINCIPLES
We believe health care is a human right. We make that real with basic principles for what we propose:
– The employer can’t make unilateral changes to the plan design, providers, or amounts that workers pay.
– Any employee administration of health insurance must be done during work hours.
– Members have their choice of medical providers.
– There should be no forms to fill out. Plan documents should be easy to follow.
– Cost increases must not be shifted from the employer to workers.
– Eligibility for health insurance cannot depend on immigration status or employment status (such as job title, work hours, or wage rate).

We may not get all these principles, but they’re solid goals to shoot for. Attaining them eases workers’ financial and emotional stress. Members don’t have to worry so much about their own and their families’ health needs. Aren’t those pretty basic things to ask?

WHAT’S A FAIR SHARE?
In the last few years, we’ve begun to add another principle:
– Employee paycheck deductions should be based on percentage of income, not percentage of premium…..

…..Steps to Mount a Health Care Fight
– Educate and involve members.
– Make comprehensive information requests. Find out exactly what the employer is paying to the health insurance company. If they’re trying to change your insurance, you will need lots of information.
– Ally with groups supporting single payer.
– Publicly blow the whistle on bosses trying to gut coverage.
– Target insurers and the legislature. Have the negotiating committee go visit the insurance company. Demand to meet with the CEO about how the proposed gigantic premium increases will affect your members. Go to the legislature and the governor, too—and let the media know about it. You could get some great publicity.
– Challenge employers to sign on to single payer…..

Nurse Unions and Patient Outcomes

Source: Arindrajit Dube, Ethan Kaplan, and Owen Thompson, ILR Review, Vol. 69 no. 4, August 2016
(subscription required)

From the abstract:
The authors estimate the impact of nurse unions on health care quality using patient-discharge data and the universe of hospital unionization in California between 1996 and 2005. They find that hospitals with a successful union election outperform hospitals with a failed election in 12 of 13 potentially nurse-sensitive patient outcomes. Hospitals were more likely to have a unionization attempt if they were of declining quality, as measured by patient outcomes. When such differential trends are accounted for, unionized hospitals also outperform hospitals without any union election in the same 12 of 13 outcome measures. Consistent with a causal impact, the largest changes occur precisely in the year of unionization. The biggest improvements are found in the incidence of metabolic derangement, pulmonary failure, and central nervous system disorders such as depression and delusion, in which the estimated changes are between 15% and 60% of the mean incidence for those measures.

A Special Issue on Work and Employment Relations in Health Care

Source: ILR Review, Vol. 69 no. 4, August 2016
(subscription required)

From the introduction:
Editorial Essay: Introduction to a Special Issue on Work and Employment Relations in Health Care
Ariel C. Avgar, Adrienne E. Eaton, Rebecca Kolins Givan, and Adam Seth Litwin

…..This special issue of the ILR Review is designed to showcase the central role that work organization and employment relations play in shaping important outcomes such as the quality of care and organizational performance. Each of the articles included in this special issue makes an important contribution to our understanding of the large and rapidly changing health care sector. Specifically, these articles provide novel empirical evidence about the relationship between organizations, institutions, and work practices and a wide array of central outcomes across different levels of analysis. This breadth is especially important because the health care literature has largely neglected employment-related factors in explaining organizational and worker outcomes in this industry. Individually, these articles shed new light on the role that health information technologies play in affecting patient care and productivity (see Hitt and Tambe; Meyerhoefer et al.); the relationship between work practices and organizational reliability (Vogus and Iacobucci); staffing practices, processes, and outcomes (Kramer and Son; Hockenberry and Becker; Kossek et al.); health care unions’ effects on the quality of patient care (Arindrajit, Kaplan, and Thompson); and the relationship between the quality of jobs and the quality of care (Burns, Hyde, and Killet). Below, we position the articles in this special issue against the backdrop of the pressures and challenges facing the industry and the organizations operating within it. We highlight the implications that organizational responses to industry pressures have had for organizations, the patients they care for, and the employees who deliver this care……

Articles include:
Nurse Unions and Patient Outcomes
Arindrajit Dube, Ethan Kaplan, and Owen Thompson
Abstract:
The authors estimate the impact of nurse unions on health care quality using patient-discharge data and the universe of hospital unionization in California between 1996 and 2005. They find that hospitals with a successful union election outperform hospitals with a failed election in 12 of 13 potentially nurse-sensitive patient outcomes. Hospitals were more likely to have a unionization attempt if they were of declining quality, as measured by patient outcomes. When such differential trends are accounted for, unionized hospitals also outperform hospitals without any union election in the same 12 of 13 outcome measures. Consistent with a causal impact, the largest changes occur precisely in the year of unionization. The biggest improvements are found in the incidence of metabolic derangement, pulmonary failure, and central nervous system disorders such as depression and delusion, in which the estimated changes are between 15% and 60% of the mean incidence for those measures.

How Do Hospital Nurse Staffing Strategies Affect Patient Satisfaction?
Jason M. Hockenberry and Edmund R. Becker
Abstract:
In this article, the authors evaluate the role of the nurse staffing mix on hospital patient satisfaction. Using three years (2009 to 2011) of hospital patient satisfaction data linked to data on the productive staffing hours of registered nurses (RNs), licensed vocational nurses, nurse’s aides, and contract nurses for 311 California hospitals, the authors analyze how nurse staffing levels affect 10 dimensions of patient satisfaction. The findings indicate that a higher level of RNs per bed appears to increase overall patient satisfaction. Conversely, hospitals with a higher proportion of nursing hours provided by contract nurses have significantly lower levels of patient satisfaction on scores related to overall patient satisfaction and nurses’ communication with the patient. The results have implications for RN staffing strategies and inform the broader literature on worker-skill mix and employment arrangements.

Who Cares about the Health of Health Care Professionals? An 18-Year Longitudinal Study of Working Time, Health, and Occupational Turnover
Amit Kramer and Jooyeon Son
Abstract
Health care workers are employed in a complex, stressful, and sometimes hazardous work environment. Studies of the health of health care workers tend to focus on estimating the effects of short-term health outcomes on employee attitudes and performance, which are easier to observe than long-term health outcomes. Research has paid only scant attention to work characteristics that are controlled by the employer and its employees, and their relationship to employees’ long-term physical health and organizational outcomes. The authors use data from the National Longitudinal Survey of Youth (NLSY) from 1992 to 2010 to estimate the relationships among working time, long-term physical health, job satisfaction, and turnover among health care employees. Using a between- and within-person design, they estimate how within-person changes in work characteristics affect the within-person growth trajectory of body mass index (BMI) over time and the relationship between working-time changes and physical health, and occupational turnover. The study finds that health care employees who work more hours suffer from a higher level of BMI and are more likely to leave their occupation.

Health Care Information Technology, Work Organization, and Nursing Home Performance
Lorin M. Hitt and Prasanna Tambe

The Consequences of Electronic Health Record Adoption for Physician Productivity and Birth Outcomes
Chad D. Meyerhoefer, Mary E. Deily, Susan A. Sherer, Shin-Yi Chou, Lizhong Peng, Michael Sheinberg, and Donald Levick

Creating Highly Reliable Health Care: How Reliability-Enhancing Work Practices Affect Patient Safety in Hospitals
Timothy J. Vogus and Dawn Iacobucci

Filling the Holes: Work Schedulers As Job Crafters of Employment Practice in Long-Term Health Care
Ellen Ernst Kossek, Matthew M. Piszczek, Kristie L. McAlpine, Leslie B. Hammer, and Lisa Burke

How Financial Cutbacks Affect the Quality of Jobs and Care for the Elderly
Diane J. Burns, Paula J. Hyde, and Anne M. Killett

The Workplace and Health

Source: National Public Radio, the Robert Wood Johnson Foundation, and Harvard T.H. Chan School of Public Health, July 2016

A new poll of working adults in the U.S. by National Public Radio, the Robert Wood Johnson Foundation, and Harvard T.H. Chan School of Public Health was conducted to examine workers’ perceptions of health problems, experiences, issues, and challenges in the workplace. This poll sought to answer seven main questions related to health in the workplace:

1. What relationship do adults see between their workplace and their health?
2. What health benefits are offered to workers to improve their personal health, do workers use these benefits, and what are the reasons why they use or do not use these benefits?
3. What are the experiences of those who are working while they are sick or are caring for sick family members?
4. How does the workplace affect the health of different types of workers, including shift workers, workers in dangerous jobs, disabled workers, and workers in low-paying jobs?
5. How do jobs impact workers’ levels of stress?
6. How do adults rate their workplace in terms of supporting their health?
7. How do paid vacation benefits in the U.S. compare to Europe?

The findings of this survey demonstrate that a significant portion of working adults say that their current job impacts their health. In particular, a considerable share of working adults believe their current job affects their overall health, family life, social life, stress level, weight, eating habits, and sleeping habits. Almost half of all working adults give their workplace only fair or poor ratings in its efforts to reduce their stress. In particular, a majority of workers in low-paying jobs, dangerous jobs, disabled workers, workers in medical and restaurant jobs, and people who work 50 or more hours per week in their main job say their job has a bad impact on their stress level.

Working adults in our sample lived up to America’s reputation for being ‘workaholics,’ as almost two-thirds of them say they often or sometimes work overtime or on the weekends, and about one in five say they work 50 or more hours per week in their main job. Despite most working adults being offered paid vacation days by their workplace, less than half of all workers who receive paid vacation days have used all or most of them in the past year. On the issue of paid vacation, the U.S. also stacks up poorly compared to Europe: while nine in ten full-time working adults in the European Union (EU) have at least four weeks’ of paid vacation, less than four in ten full-time workers in the U.S. say that they are offered this same benefit.

A majority of working adults say they still go to work when they are sick. Half of restaurant workers and more than half of workers in medical jobs say they still go to work always or most of the time when they have a cold or the flu. Many workers have also had experiences in caring for family members who were seriously ill, injured, or disabled while working at their current job.

Overall, a majority of working adults say their workplace provides a healthy work environment, most say their workplace is supportive of them taking steps to improve their personal health, and about half say their workplace offers formal wellness or health improvement programs to help keep themselves healthy.
Related:
Work Can Be A Stressful And Dangerous Place For Many
Source: Joe Neel, NPR, July 11, 2016

Employers’ efforts to reduce stress get low grades in a new poll by NPR, the Robert Wood Johnson Foundation and Harvard’s T.H. Chan School of Public Health.

In particular, among those working adults who say they’ve experienced a great deal of stress at work in the past 12 months, the vast majority, 85 percent, rate the efforts of their workplace to reduce stress as fair or poor.

Overall, 43 percent of working adults told us their job negatively affects their stress levels. Others said their job negatively affects their eating habits (28 percent), sleeping habits (27 percent) and weight (22 percent)….

Poll: More than four in ten working adults think their work impacts their health /Most say their workplace is supportive of actions to improve their health
Source: Harvard T.H. Chan School of Public Health, Press Release, July 11, 2016

A new NPR/Robert Wood Johnson Foundation/Harvard T.H. Chan School of Public Health poll finds that more than four in ten working adults (44%) say their current job has an impact on their overall health, and one in four (28%) say that impact is positive.

However, in the survey of more than 1,600 workers in the U.S., one in six workers (16%) report that their current job has a negative impact on their health. Workers most likely to say their job has a negative impact on their overall health include those with disabilities (35%), those in dangerous jobs (27%), those in low-paying jobs (26%), those working 50+ hours per week (25%), and those working in the retail sector (26%).
Poll: More Than Four in Ten Working Adults Think Their Work Impacts Their Health /Most say their workplace is supportive of actions to improve their health.
Source: Robert Wood Johnson Foundation, Press Release, July 11, 2016

….Key Findings:
Chemicals and contaminants top list of biggest health concerns in the workplace ….
About one in four workers rate their workplace as fair or poor in providing a healthy work environment; about half are offered wellness or health improvement programs ….
A majority of ‘workaholics’ say they work longer hours because it is important to their career; half say they enjoy working longer hours ….
A majority of working adults say they still go to work when they are sick ….
Low-wage workers often face worse conditions than high-wage workers ….

Should Working in Retail Require a Health Warning?
Source: Erin Johansson, Jobs With Justice, July 12, 2016

A recent study has proven what millions of working people have known for years: Work is stressful, and many employers only make things worse.

Moneyball in Medicare

Source: Edward C. Norton, Jun Li, Anup Kumar Das, Lena Chen, National Bureau of Economic Research (NBER), NBER Working Paper No. w22371, June 2016

From the abstract:
US policymakers place a high priority on tying Medicare payments to the value of care delivered. A critical part of this effort is the Hospital Value-based Purchasing Program (HVBP), which rewards or penalizes hospitals based on their quality and episode-based costs of care. Within HVBP, each patient affects hospital performance on a variety of quality and spending measures, and performance translates directly to changes in program points and ultimately dollars. In short, hospital revenue from a patient consists not only of the DRG payment, but also consists of that patient’s marginal future reimbursement. We estimate the magnitude of the marginal future reimbursement for individual patients across each type of quality and performance measure. We describe how those incentives differ across hospitals, including integrated and safety-net hospitals. We find some evidence that hospitals improved their performance over time in the areas where they have the highest marginal incentives to improve care.

Under Affordable Care Act, Growing Use of ‘Community Health Workers’

Source: Michael Ollove, Stateline, July 8, 2016

….Many now recognize that providing good health care has to go beyond the doctor’s office — especially for minorities and low-income people. Limited access to healthy food, environmental perils, crime, insecure housing, insufficient recreational opportunities and the absence of affordable transportation all can have a huge effect on a person’s health. These factors, often called the social determinants of health, are hard for clinicians to address during medical appointments. To contend with them, hospitals, community health clinics, public health agencies and some health plans are increasingly turning to community health workers like Nelson. Thanks in part to federal grants awarded under the Affordable Care Act, the number of community health workers is growing. In 2015, there were 48,000 of them working in the U.S., up from 38,000 three years earlier, a 27 percent increase, according to the U.S. Department of Labor. But many insurers still don’t cover their services, limiting their potential impact…..

Making It Safe to Grow Old: A Financial Simulation Model for Launching MediCaring Communities for Frail Elderly Medicare Beneficiaries

Source: Antonia K. Bernhardt, Joanne Lynn, Gregory Berger, James A. Lee, Kevin Reuter, Joan Davanzo, Anne Montgomery and Allen Dobson, Milbank Quarterly, Early View, July 4, 2016
(subscription required)

From the abstract:
Context:
The Altarum Institute Center for Elder Care and Advanced Illness has developed a reform model, MediCaring Communities, to improve services for frail elderly Medicare beneficiaries through longitudinal care planning, better-coordinated and more desirable medical and social services, and local monitoring and management of a community’s quality and supply of services. This study uses financial simulation to determine whether communities could implement the model within current Medicare and Medicaid spending levels, an important consideration to enable development and broad implementation.

Methods:
The financial simulation for MediCaring Communities uses 4 diverse communities chosen for adequate size, varying health care delivery systems, and ability to implement reforms and generate data rapidly: Akron, Ohio; Milwaukie, Oregon; northeastern Queens, New York; and Williamsburg, Virginia. For each community, leaders contributed baseline population and program effect estimates that reflected projections from reported research to build the model.

Findings:
The simulation projected third-year savings between $269 and $537 per beneficiary per month and cumulative returns on investment between 75% and 165%.

Conclusions:
The MediCaring Communities financial simulation demonstrates that better care at lower cost for frail elderly Medicare beneficiaries is possible within current financing levels. Long-term success of the initiative will require reinvestment of Medicare savings to bolster nonmedical supportive services in the community. Successful implementation will necessitate waiving certain regulations and developing new infrastructure in pilot communities. This financial simulation methodology will help leadership in other communities to project fiscal performance. Since the MediCaring Communities model also achieves the Centers for Medicare and Medicaid Services’ vision for care for frail elders (better care, healthier people, smarter spending) and since these reforms can proceed with limited waivers from Medicare, willing communities should explore implementation and share best practices about how to achieve fundamental service delivery changes that can meet the challenges of a much older population in the 21st century.

Hispanic Children Least Likely to Have Health Insurance: Citizenship, Ethnicity, and Language Barriers to Coverage

Source: Michael J. Staley, Jessica Carson, National Issue Brief #101, Spring 2016

From the summary:
This policy brief examines health insurance coverage of Hispanic children and its relationship to their citizenship status, their parents’1 citizenship status, parents’ insurance coverage, language spoken at home, and their state’s Medicaid expansion policies.

Key Findings:
– Hispanic children are less likely to have health insurance than black or white children, a gap that is explained by differences in citizenship status between Hispanic and non-Hispanic children.
– Noncitizen Hispanic children are nearly three times more likely to be uninsured than Hispanic citizen children living with citizen parents.
– Hispanic children who do not have an insured parent are seven times more likely to be uninsured than Hispanic children with at least one insured parent.
– Children in states that expanded Medicaid are less likely to be uninsured than children in non-expansion states, although low and moderate income children are more likely to be uninsured regardless of state expansion status.