Work, Health, And Insurance: A Shifting Landscape For Employers And Workers Alike

The Impact of Employment Status, Income, and Occupation on the Association Between Workplace Benefits and Health-Related Work Absences

BACKGROUND

Workplace benefits such as paid sick leave and employer-sponsored health insurance influence workers' ability to take time off when ill or injured. We examined whether and to what extent these workplace benefits complement each other in affecting health-related work absences, and whether associations varied by employment status, income, and occupation.

METHODS

This cross-sectional study analyzed pooled data from the 2021 and 2023 National Health Interview Survey (NHIS), a nationally representative survey of US adults. The sample included 31,280 employed adults. Workers were classified into four workplace benefits groups: paid sick leave only, employer-sponsored health insurance only, both benefits, and neither benefit. The primary outcome was health-related work absence in the past 12 months. Interaction terms assessed differences in probability of absence by employment status (full-time vs. part-time), income (< 400% vs. ≥ 400% of the federal poverty level), and occupation type (Management, Professional, Service, Sales, and Production).

RESULTS

Compared to those with neither benefit, the probability of work absence was 7.3 points higher with employer-sponsored health insurance only (p < 0.001), 4.6 points higher with paid sick leave only (p = 0.002), and 12.0 points higher with both benefits (p < 0.001). The association between workplace benefits and health-related work absence varied by employment status, income level, and occupation type (p < 0.001 for all interactions).

CONCLUSIONS

Access to paid sick leave and health insurance increased the likelihood of taking time off due to illness or injury, with differences by employment status, income, and occupation.

Disparities in Rates of Fusions in Lumbar Disc Pathologies

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

To identify disparities in surgical decision making for lumbar disc pathologies based on patient demographics, hospital characteristics, and temporal characteristics of admission.

METHODS

A retrospective analysis of patients admitted for surgical intervention of disc herniation or degeneration was performed to observe the effect of demographic, hospital, and admission-related factors on the decision to perform an isolated decompression or decompression with single level fusion using the National Inpatient Sample.

RESULTS

Of 84 953 patients with lumbar disc pathologies, 69 975 patients were treated electively, and 14 978 patients were treated nonelectively. Hispanic and Asian/Pacific Islander patients were less likely to receive a fusion for elective cases compared with White patients (odds ratio [OR] 0.88, P = .004; OR 0.70, P < .001, respectively). In elective cases, privately insured and self-paying patients were less likely to receive a fusion compared with Medicare patients (OR 0.83, P < .001; OR 0.66, P < .001, respectively), while this effect was limited to self-pay patients in nonelective cases (OR 0.44, P < .001). Urban teaching and nonteaching hospitals were less likely to perform fusions compared with rural hospitals in nonelective cases (OR 0.47, P < .001; OR 0.58, P < .001, respectively). Private for-profit hospitals were associated with higher rates of fusion in both elective and nonelective cases (OR 1.16, P = .003; OR 1.94, P < .001).

CONCLUSION

This study illustrates disparities in the modality of surgical intervention for lumbar disc pathologies in terms of demographics, hospital characteristics, and temporal characteristics of admission. The development of more evidence-based guidelines is warranted to reduce variability seen in treatment regimens for these conditions.

Work Environment Factors and Prevention of Opioid-Related Deaths

Opioid use disorder (OUD) and opioid overdose deaths (OODs) are prevalent among US workers, but work-related factors have not received adequate attention as either risk factors or opportunities for OOD prevention. Higher prevalence of OOD in those with heavy physical jobs, more precarious work, and limited health care benefits suggest work environment and organizational factors may predispose workers to the development of OUD.Organizational policies that reduce ergonomic risk factors, respond effectively to employee health and safety concerns, provide access to nonpharmacologic pain management, and encourage early substance use treatment are important opportunities to improve outcomes. Organizational barriers can limit disclosure of pain and help-seeking behavior, and opioid education is not effectively integrated with workplace safety training and health promotion programs.Policy development at the employer, government, and association levels could improve the workplace response to workers with OUD and reduce occupational risks that may be contributing factors.

Coverage Gaps and Cost-Shifting for Work-Related Injury and Illness: Who Bears the Financial Burden?

The heavy economic burden of work-related injury/illness falls not only on employers and workers' compensation systems, but increasingly on health care systems, health and disability insurance, social safety net programs, and workers and their families. We present a flow diagram illustrating mechanisms responsible for the financial burden of occupational injury/illness borne by social safety net programs and by workers and their families, due to cost-shifting and gaps in workers' compensation coverage. This flow diagram depicts various pathways leading to coverage gaps that may shift the burden of occupational injury/illness-related health care and disability costs ultimately to workers, particularly the most socioeconomically vulnerable. We describe existing research and important research gaps linked to specific pathways in the flow diagram. This flow diagram was developed to facilitate more detailed and comprehensive research into the financial burden imposed by work-related injury/illness, in order to focus policy efforts where improvement is most needed.

Write a Scientific Paper (WASP): Past and anticipated trends in cardiology service requirements at Mater Dei Hospital, Malta

INTRODUCTION

The requirement for medical services fluctuates. This study was carried out in order to attempt to extrapolate the service requirements for various cardiology services at Mater Dei Hospital, Malta over the coming five years, based on service demands from previous years.

METHODS

Past annual data was obtained from hospital records for various services (to 2017). Linear regression was carried out using a bespoke Excel™ spreadsheet in order to extrapolate possible services requirements up to 2022.

RESULTS

All services are expected to increase, with forecasts ranging between 41 and 354%, depending on services being considered.

DISCUSSION

It is easy to "get on with it" and perform the work required at the workplace but this study has shown that it is equally important to anticipate demands lest lack of planning leads to long and important waiting lists for critical diagnostics and treatments. Health care provision requirements are increasing worldwide. Even using conservative estimates and in the absence of the creation of new services, the demands for extant services are likely to continue to grow. Unless medium term plans are made for hardware, software, physical space and staffing, and the funding thereof, waiting lists for investigations in this speciality are bound to rise. This may be mitigated by novel treatments but since these cannot be predicted, it would be safer and wiser to plan ahead lest we are overwhelmed. This paper has also shown how WASP (Write a Scientific Paper) precepts can be applied to elegantly study a problem and write up a paper.

Obesity and Socioeconomic Disparities: Rethinking Causes and Perinatal Care

Obesity affects more than 35% of women aged 20 to 39 years in the United States. This article summarizes recent research that reconceptualizes obesity as adipose disease associated with smoking; socio-economic disparities in employment, education, healthcare access, food quality, and availability; and environmental toxins, ultimately altering microbiomes and epigenetics. Individual prenatal care of women with obesity includes early testing for diabetes, counseling on epigenetic diets, advice supporting weight gain within national guidelines, and vigilance for signs of hypertensive disorders of pregnancy. Intrapartum care includes mechanical cervical ripening measures, patience with prolonged labor, and uterotonic medication readiness in the event of postpartum hemorrhage. Postpartum care includes thrombus risk amelioration through early ambulation, use of compression stockings, and anticoagulation. Delays in lactogenesis II can be offset by measures to support early breastfeeding. Sociopolitical action by nurses at national, state, and community levels to reduce population disparities in racism, education, and employment; reduce pollution from obesogenic chemicals; and improve food quality and distribution policies is likely to have the broadest impact in future obesity reductions and prevention.

Work disability in the United States, 1968-2015: Prevalence, duration, recovery, and trends

The United States workforce is aging. At the same time more people have chronic conditions, for longer periods. Given these trends the importance of work disability, physical or nervous problems that limit a person's type or amount of work, is increasing. No research has examined transitions among multiple levels of work disability, recovery from work disability, or trends. Limited research has focused on work disability among African Americans and Hispanics, or separately for women and men. We examined these areas using data from 30,563 adults in the 1968-2015 Panel Study of Income Dynamics. We estimated annual probabilities of work disability, recovery, and death with multinomial logistic Markov models. Microsimulations accounting for age and education estimated outcomes for African American, Hispanic, and non-Hispanic white women and men. Results from these nationally representative data suggested that the majority of Americans experience work disability during working life. Most spells ended with recovery or reduced severity. Among women, African Americans and Hispanics had less moderate and severe work disability than whites. Among men, African Americans became severely work disabled more often than whites, recovered from severe spells more often and had shorter severe spells, yet had more severe work disability at age 65. Hispanic men were more likely to report at least one spell of severe work disability than whites; they also had substantially more recovery from severe work disability, and a lower percentage of working years with work disability. Among African Americans and Hispanics, men were considerably more likely than women to have severe work disability at age 65. Work disability declined significantly across the study period for all groups. Although work disability has declined over several decades, it remains common. Results suggest that the majority of work disability spells end with recovery, underscoring the importance of rehabilitation and workplace accommodation.

The U.S. Health Care Crisis Continues: A Data Snapshot

Despite implementation of the Affordable Care Act in 2014, the U.S. health care crisis continues. While coverage has been expanded, 28 million people remain uninsured, and tens of millions who have coverage are unable to afford care because of high cost-sharing requirements. Moreover, many with coverage have a sharply restricted choice of physicians and hospitals, and the corporate takeover of medical care in the United States is proceeding rapidly. This article provides a brief précis of recent data on U.S. health policy.