Category Archives: Health Care

The Interconnected Relationships of Health Insurance, Health, and Labor Market Outcomes

Source: Matthew S. Rutledge, Center for Retirement Research at Boston College, WP#2016-2, July 2016

From the abstract:
The Affordable Care Act (ACA) has greatly increased the proportion of non-elderly Americans with health insurance. One justification for the ACA is that improving individuals’ access to health insurance would improve their health outcomes, mostly by increasing the probability that they have a regular source of care. Another is that increasing the availability of health insurance outside of employment reduces the “job lock” that ties poorly matched workers to their jobs only because they want to maintain coverage. This study reviews the literature on the relationships between health insurance and health, between health and work, and between health insurance and labor market outcomes directly. The review uses evidence from recent policy expansions in Oregon and Massachusetts, and among Social Security disability beneficiaries and Medicare enrollees, to evaluate the extent to which expansions have the expected effects on labor market outcomes, indirectly and directly.

This paper found that:
• Health insurance generally improves health. The gains in mental health are the most consistent across studies, though most studies also find notable improves in physical health measures, including mortality.
• Greater health generally allows for increased labor supply, though the strength of this relationship depends crucially on whether the health measure is objective or subjective, the group under consideration, and the study’s strategy for accounting for the endogeneity of the relationship.
• Expanded access to health insurance increases transitions into self-employment and allows older workers to retire earlier, but the effect on labor force participation, employment, and job mobility is less clear.

The policy implications of this paper are:
• Coverage expansions, including the ACA, are likely to result in a healthier and more productive pool of potential workers, and this effect is likely to increase labor supply.
• But not many studies have examined the full chain of relationships directly, by following recipients of expanded coverage to see if their improved health causally increased labor supply, so further work is needed in evaluating coverage expansions.

The Impact of Massachusetts Health Insurance Reform on Labor Mobility

Source: Norma B. Coe, Wenliang Hou, Alicia H. Munnell, Patrick J. Purcell, Matthew S. Rutledge, Center for Retirement Research at Boston College, 2016
(Full paper not available at the link, contact the authors for info)

From the abstract:
This paper examines the impact of the Massachusetts Health Insurance reform of 2016 on job mobility and employment exit using administrative data from the Social Security Administration. The Massachusetts reform mandated that every resident have insurance coverage, and facilitated this initiative by requiring employers to offer coverage, as well as expanding Medicaid and creating health insurance exchanges with subsidized premiums. These elements provided the basis for the Patient Protection and Affordable Care Act (ACA), passed nationwide in 2010, so the experience of workers in Massachusetts provides evidence on how the ACA may affect labor market efficiency. Of particular interest is the extent to which Massachusetts’ reform reduced “job lock” – the phenomenon where workers stay with employers to maintain their health insurance coverage, rather than move to a more productive match at another employer (especially a small firm unlikely to offer coverage) or exit employment entirely. The project measures differential effects by age, gender, and firm size, and tries to disentangle the effects of the employer mandate and the individual mandate by identifying individuals who cross state lines between home and work.

Trend analysis and regression estimates indicate that Massachusetts residents were actually less likely to move to new employers after the reform, relative to workers in neighboring states that did not make structural changes to their health insurance market.

Estimates of whether Massachusetts workers moved from large firms, which likely offered insurance, to small firms is statistically insignificant.

Employment transitions were largely unaffected by the Massachusetts reform, though some select groups saw increases in employment exits that may be consistent with the easing of job lock.

What if More States Expanded Medicaid in 2017? Changes in Eligibility, Enrollment, and the Uninsured

Source: Matthew Buettgens and Genevieve M. Kenney, Robert Wood Johnson Foundation & Urban Institute, Quick Strike Series, July 2016

From the summary:
If the 19 states that have not expanded Medicaid did so in 2017, up to 5 million fewer people would be uninsured with the largest drops coming in Texas, Georgia and Florida.

Key Findings:
Groups that could see the largest uninsurance drops, if the states expand Medicaid:
– Adults without kids (3.6 million)
– White, non-Hispanics (2.4 million)
– People with only a high school education (2.2 million)
– Full-time workers (1.3 million)
– Hispanics (1.2 million) and Black, non-Hispanics (1.2. million)

19% fewer medical errors after team training

Source: Amy McCaig, Futurity, July 15, 2016

Team training for health care employees can reduce patient mortality by 15 percent, a new study has found. The approach can also reduce medical errors by 19 percent. Team training aims to improve team-based knowledge, skills, attitudes, and problem-solving interactions. It focuses on developing coordination, cooperation, communication, leadership, and other team-based skills. Team members train in specific roles while performing specific tasks and interact or coordinate to achieve a common goal or outcome…..

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.