Gender Related Differences in Surgeon Compensation: Survey Results from the American Society of Colon and Rectal Surgeons

OBJECTIVE

We sought to understand the effect of sex on compensation among colorectal surgeons and to determine which factors contribute to gender-based differences in compensation.

SUMMARY OF BACKGROUND DATA

The sex-based wage gap in the medical profession is among the most pronounced wage gaps in the U.S. Data regarding the wage gap among colorectal surgeons and the underlying reasons for this disparity remain unclear.

METHODS

The Healthcare Economics Committee of the American Society of Colon and Rectal Surgeons conducted a survey to evaluate surgeon demographics, compensation, and practice characteristics. To evaluate the effect of sex on compensation, we performed multivariable linear regression with backward selection. We used a two-sided P -value with a significance threshold <0.05.

RESULTS

The mean difference in normalized total compensation between men and women was $46,250, and when salary was adjusted for FTEs, the difference was $57,000. Women were more likely to perform anorectal surgery, less likely to perform general surgery and less likely to hold positions in leadership. After adjustments, women reported significantly lower compensation (aOR, 0.88; 95% CI, 0.80-0.97). Time spent doing abdominal surgery (aOR, 1.13; 95% CI 1.03-1.23), professor status (aOR, 1.17; 95% CI, 1.03-1.32) and instructor status (aOR, 1.49; 95% 1.28-1.73) were independently associated with compensation.

CONCLUSIONS

We found a 12% adjusted sex wage gap among colorectal surgeons. Gender-based differences in leadership positions and allocation of effort may contribute. Further research will be necessary to clarify sources of wage inequalities. Still, our results should prompt expedient actions to support closing the gap.

Rural job preferences of graduate class medical students in Ethiopia-a discrete choice experiment (DCE)

BACKGROUND

Human resource is one of the health system's building blocks, which ultimately leads to improved health status, equity, and efficiency. However, human resources in the health sector are characterized by high attrition, distributional imbalance, and geographic inequalities in urban and rural settings.

METHODS

An discrete choice experiment (DCE) with 16 choice tasks with two blocks containing five attributes (salary, housing, drug and medical equipment, year of experience before study leave, management support, and workload) were conducted. A latent class and mixed logit model were fitted to estimate the rural job preferences and heterogeneity. Furthermore, the relative importance, willingness to accept and marginal choice probabilities were calculated. Finally, the interaction of preference with age and sex was tested.

RESULTS

A total of 352 (5632 observations) final-year medical students completed the choice tasks. On average, respondents prefer to work with a higher salary with a superior housing allowance In addition, respondents prefer a health facility with a stock of drug and medical equipment which provide education opportunities after one year of service with supportive management with a normal workload. Young medical students prefer lower service years more than older students. Besides age and service year, we do not find an interaction between age/sex and rural job preference attributes. A three-class latent class model best fits the data. The salary was the most important attribute in classes 1 and 3. Contrary to the other classes, respondents in class 2 do not have a significant preference for salary. Respondents were willing to accept an additional 4271 ETB (104.2 USD), 1998 ETB (48.7 USD), 1896 ETB (46.2 USD), 1869 (45.6 USD), and 1175 ETB (28.7 USD) per month for the inadequate drug and medical supply, mandatory two years of service, heavy workload, unsupportive management, and basic housing, respectively.

CONCLUSION

Rural job uptake by medical students was influenced by all the attributes, and there was individual and group-level heterogeneity in preference. Policymakers should account for the job preferences and heterogeneity to incentivize medical graduates to work in rural settings and minimize attrition.

A Causal View of the Role and Potential Limitations of Capitation in Promoting Whole Health System Performance

For several decades, health systems in developed countries have faced rapidly rising healthcare costs without concomitant improvements in health outcomes. Fee for service (FFS) reimbursement mechanisms (RMs), where health systems are paid based on volume, contribute to this trend. In Singapore, the public health service is trying to curb rising healthcare costs by transitioning from a volume-based RM to a capitated payment for a population within a geographical catchment area. To provide insight into the implications of this transition, we developed a causal loop diagram (CLD) to represent a causal hypothesis of the complex relationship between RM and health system performance. The CLD was developed with input from government policymakers, healthcare institution administrators, and healthcare providers. This work highlights that the causal relationships between government, provider organizations, and physicians involve numerous feedback loops that drive the mix of health services. The CLD clarifies that a FFS RM incentivizes high margin services irrespective of their health benefits. While capitation has the potential to mitigate this reinforcing phenomenon, it is not sufficient to promote service value. This suggests the need to establish robust mechanisms to govern common pool resources while minimizing adverse secondary effects.

Cost and cost-effectiveness of abstinence contingent wage supplements

BACKGROUND

Substance use disorders are correlated with unemployment and poverty. However, few interventions aim to improve substance use, unemployment, and, distally, poverty. The Abstinence-Contingent Wage Supplement (ACWS) randomized controlled trial combined a therapeutic workplace with abstinence-contingent wage supplements to address substance use and unemployment. The ACWS study found that abstinence-contingent wage supplements increased the percentage of participants who had negative drug tests, who were employed, and who were above the poverty line during the intervention period. This study presents the cost of ACWS and calculates the cost-effectiveness of ACWS compared with usual care.

METHODS

To calculate the cost and cost-effectiveness of ACWS, we used activity-based costing methods to cost the intervention and calculated the costs from the provider and healthcare sector perspective. We calculated incremental cost-effectiveness ratios and cost-effectiveness acceptability curves for negative drug tests and employment.

RESULTS

ACWS cost $11,310 per participant over the 12-month intervention period. Total intervention and healthcare costs per participant over the intervention period were $20,625 for usual care and $30,686 for ACWS. At the end of the intervention period an additional participant with a negative drug test cost $1437 while an additional participant employed cost $915.

CONCLUSIONS

ACWS increases drug abstinence and employment and may be cost-effective at the end of the 12-month intervention period if decision makers are willing to pay the incremental cost associated with the intervention.

Minimum wages and health: evidence from European countries

This study investigates the effects of minimum wage on health, well-being, and income security in European countries. The empirical strategy consists of exploiting variations in the minimum wage across European countries over time. We show that minimum wage increases improve individuals' self-reported health and income security. Minimum wage increases also improve life satisfaction and happiness. The effects are largest among women, employed individuals, married individuals, and those with less than a secondary education. Our results are robust to several robustness checks and consistent with existing evidence on the relationship between minimum wage and health.

Health occupations salary outcomes: intersections of student race, gender, and first-generation status

Greater diversity in the healthcare workforce has been identified as a critical need in serving an increasingly diverse population. Higher education institutions have been tasked with increasing the number of underrepresented students in the health occupations pipeline to better align with the demographics of the general population and meet the need for a diverse health occupations workforce. This study used the National Science Foundation's National Survey of College Graduates dataset to capture data across time, examining the intersectionality of race, gender, and first-generation status on the salary outcomes of students who earn degrees related to health occupations. Results indicate that the intersecting identities of students who earn a bachelor's degree or higher in the health professions impact salary outcomes. Results of this study have implications for higher education policies that can impact increased diversity in the health occupations workforce pipeline.

Beyond income: material hardship and the health and healthcare of premature children

OBJECTIVES

To estimate national prevalence of household hardships (food insufficiency, financial hardship, and difficulty paying medical bills) among children born term and preterm; and examine associations of household hardships with preterm children's outcomes (health status, emergency room visits, and unmet healthcare needs).

METHODS

We studied 24,026 children aged 0-3 years born term, preterm with moderately low birth weight (1501-2499 grams) and preterm with very low birth weight (VLBW; ≤1500 grams). Using propensity score matching to control for correlates of poverty, we examined associations of hardships and child outcomes.

RESULTS

Compared with term, households with preterm VLBW children had >2-fold higher odds of financial hardship (aOR:2.63; 95% CI: 1.26-5.46) and >5-fold higher odds of difficulty paying bills (aOR:5.60; 95% CI: 2.35-10.35). Matching for sociodemographics, special healthcare needs, income and receipt of public benefits, hardships were independently associated with adverse preterm children's outcomes.

CONCLUSIONS

Addressing household hardships is needed to optimize preterm child outcomes.

Gender Disparities in Physician Assistant Educator Promotion and Compensation: A Mixed Methods Approach

INTRODUCTION

The gender wage gap is well documented in many industries. A disparity in salary between female and male physician assistant (PA) educators has been demonstrated, but disparities in academic rank have not been shown. The purpose of this study was to re-examine gender disparities in compensation to PA educators and to explore whether gender-based disparities exist in promotion to higher academic rank in this field.

METHODS

An explanatory sequential mixed-methods design was used to determine differences in salary and rank by gender. PA Education Association Faculty and Directors Survey data from 2014, 2017, and 2019 were analyzed. A focus group was conducted to explain the findings and understand the barriers to promotion for female faculty.

RESULTS

Female PA faculty members earn $7573 less than their male colleagues when controlling for all other variables. Female faculty members have an increased likelihood (RR 1.150) for being in early career stage versus late career stage. Obtaining a doctoral degree decreased the risk for being in an early career stage (RR 0.567) with men twice as likely to have a doctoral degree as women.

DISCUSSION

Rank and salary disparities exist in PA faculty by gender. Female faculty are less likely to hold doctoral degrees or to be promoted to higher academic ranks, and they earn less than men. Degree level and career track are themes unique to the PA education profession, and further research is needed to understand their impact. With more women entering PA education, pay equity and promotion need to be addressed.

Why They Stay and Why They Leave: Stay Interviews With Registered Nurses to Hear What Matters the Most

Registered nurse retention is declining, with a national turnover rate in 2021 of 27%. After implementing a toolkit, nursing leaders in 1 organization completed 75 stay interviews with nurses in a cardiothoracic telemetry and a cardiothoracic surgical intensive care unit. Nurses reported that unit culture, team/peers, and scheduling were important in decisions to stay in their positions, but respondents considered leaving for salary, growth/development, and traveling opportunities. The stay interview process affords nurse leaders an opportunity to examine why nurses stay or leave and supports the development of targeted retention strategies.

History of Low Hourly Wage and All-Cause Mortality Among Middle-aged Workers

Importance

Earning a low wage is an increasingly recognized public health concern, yet little research exists on the long-term health consequences of sustained low-wage earning.

Objective

To examine the association of sustained low-wage earning and mortality in a sample of workers with hourly wage reported biennially during peak midlife earning years.

Design, Setting, and Participants

This longitudinal study included 4002 US participants, aged 50 years or older, from 2 subcohorts of the Health and Retirement Study (1992-2018) who worked for pay and reported earning hourly wages at 3 or more time points during a 12-year period during their midlife (1992-2004 or 1998-2010). Outcome follow-up occurred from the end of the respective exposure periods until 2018.

Exposures

Low-wage-less than the hourly wage for full-time, full-year work at the federal poverty line-earning history was categorized as never earning a low wage, intermittently earning a low wage, and sustained earning a low wage.

Main Outcomes and Measures

Cox proportional hazards and additive hazards regression models sequentially adjusted for sociodemographics, and economic and health covariates were used to estimate associations between low-wage history and all-cause mortality. We examined interaction with sex or employment stability on multiplicative and additive scales.

Results

Of the 4002 workers (aged 50-57 years at the beginning of exposure period and 61-69 years at the end), 1854 (46.3%) were female; 718 (17.9%) experienced employment instability; 366 (9.1%) had a history of sustained low-wage earning; 1288 (32.2%) had intermittent low-wage earning periods; and 2348 (58.7%) had never earned a low wage. In unadjusted analyses, those who had never earned low wages experienced 199 deaths per 10 000 person-years, those with intermittent low wages, 208 deaths per 10 000 person-years, and those with sustained low wages, 275 deaths per 10 000 person-years. In models adjusted for key sociodemographic variables, sustained low-wage earning was associated with mortality (hazard ratio [HR], 1.35; 95% CI, 1.07-1.71) and excess deaths (66; 95% CI, 6.6-125); these findings were attenuated with additional adjustments for economic and health covariates. Significant excess death and elevated mortality risk were observed for workers with sustained low-wage exposure and employment fluctuations (eg, for sustained low-wage × employment fluctuated, HR, 2.18; 95% CI, 1.35-3.53; for sustained low-wage × stable employment, HR, 1.17; 95% CI, 0.89,-1.54; P for interaction = .003).

Conclusions and Relevance

Sustained low-wage earning may be associated with elevated mortality risk and excess deaths, especially when experienced alongside unstable employment. If causal, our findings suggest that social and economic policies that improve the financial standing of low-wage workers (eg, minimum wage laws) could improve mortality outcomes.

The role amenities play in spatial sorting of migrants and their impact on welfare: Evidence from China

From 2005 to 2015, China's high-skilled labor was increasingly concentrated in cities with high wages and high rents, while a narrowing of the wage gap between high- and low-skilled labor showed an opposite trend to an increase in geographic sorting. In this research, I estimated a spatial equilibrium structural model to identify the causes of this phenomenon and its impact on welfare. Changes in local labor demand essentially led to an increase in skill sorting, and changes in urban amenities further contributed to this trend. An agglomeration of high-skilled labor raised local productivity, increased wages for all workers, reduced the real wage gap, and widened the welfare gap between workers with different skills. In contrast to the welfare effects of changes in the wage gap driven by exogenous productivity changes, changes in urban wages, rents, and amenities increased welfare inequality between high- and low-skilled workers, but this is mainly because the utility of low-skilled workers from urban amenities is constrained by migration costs; if migration costs caused by China's household registration policy were eliminated, changes in urban wages, rents, and amenities would reduce welfare inequality between high- and low-skilled workers to a greater extent than a reduction in the real wage gap between these two groups.

Global evidence of gender equity in academic health research: a scoping review

OBJECTIVES

To chart the global literature on gender equity in academic health research.

DESIGN

Scoping review.

PARTICIPANTS

Quantitative studies were eligible if they examined gender equity within academic institutions including health researchers.

PRIMARY AND SECONDARY OUTCOME MEASURES

Outcomes related to equity across gender and other social identities in academia: (1) faculty workforce: representation of all genders in university/faculty departments, academic rank or position and salary; (2) service: teaching obligations and administrative/non-teaching activities; (3) recruitment and hiring data: number of applicants by gender, interviews and new hires for various rank; (4) promotion: opportunities for promotion and time to progress through academic ranks; (5) academic leadership: type of leadership positions, opportunities for leadership promotion or training, opportunities to supervise/mentor and support for leadership bids; (6) scholarly output or productivity: number/type of publications and presentations, position of authorship, number/value of grants or awards and intellectual property ownership; (7) contextual factors of universities; (8) infrastructure; (9) knowledge and technology translation activities; (10) availability of maternity/paternity/parental/family leave; (11) collaboration activities/opportunities for collaboration; (12) qualitative considerations: perceptions around promotion, finances and support.

RESULTS

Literature search yielded 94 798 citations; 4753 full-text articles were screened, and 562 studies were included. Most studies originated from North America (462/562, 82.2%). Few studies (27/562, 4.8%) reported race and fewer reported sex/gender (which were used interchangeably in most studies) other than male/female (11/562, 2.0%). Only one study provided data on religion. No other PROGRESS-PLUS variables were reported. A total of 2996 outcomes were reported, with most studies examining academic output (371/562, 66.0%).

CONCLUSIONS

Reviewed literature suggest a lack in analytic approaches that consider genders beyond the binary categories of man and woman, additional social identities (race, religion, social capital and disability) and an intersectionality lens examining the interconnection of multiple social identities in understanding discrimination and disadvantage. All of these are necessary to tailor strategies that promote gender equity.

TRIAL REGISTRATION NUMBER

Open Science Framework: https://osf.io/8wk7e/.

A matter of when, not whether: A meta-analysis of modesty bias in East Asian self-ratings of job performance

Much attention has been paid to the question of whether there is a modesty bias in East Asian employees' self-ratings of job performance (i.e., a tendency to self-rate their performance lower than supervisors rate it). However, empirical results are conflicting, with some studies supporting the modesty bias and others not supporting it. We suggest that moderators representing boundary conditions for the modesty bias effect may shed light on these conflicting results. In essence, the question should not be "whether there is a modesty bias," but rather "when is there a modesty bias?" We propose three moderators: purpose of the ratings (administrative, developmental, or research), job performance dimension (task performance, organizational citizenship behavior, or leadership), and country-level in-group collectivism. Based on 40 studies (63 independent samples) with samples from East Asia (mainland China, Japan, South Korea, and Taiwan), we found no evidence of a modesty bias. That is, East Asian employees' self-ratings were, on average, higher than supervisor-ratings of job performance (i.e., a leniency bias). The one exception was when ratings were collected for research purposes; in this case, there was, on average, no mean difference between self- and supervisor-ratings. Thus, East Asian employees' research-purpose self-ratings are more modest, but this does not cross into a "modesty bias." In all, our results do not support a modesty bias as a widespread cultural norm among East Asian employees. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Disease-Related Loss to Government Funding: Longitudinal Analysis of Individual-Level Health and Tax Data for an Entire Country

OBJECTIVES

The objective of this longitudinal analysis was to estimate funding loss in terms of tax revenue to the New Zealand (NZ) government from disease and injury among working age adults.

METHODS

Linked national health and tax data sets of the usually resident population between 2006 and 2016 were used to model 40 disease states simultaneously in a fixed-effects regression analysis to estimate population-level tax loss from disease and injury. To estimate tax revenue loss to the NZ government, we modeled a counterfactual scenario where all disease/injury was cause deleted.

RESULTS

The estimated tax paid by all 25- to 64-year-olds in the eligible NZ population was $15 773 million (m) per annum (US dollar 2021), or $16 446 m for a counterfactual as though no one had any disease disease-related income loss (a 4.3% or $672.9 m increase in tax revenue per annum). The disease that-if it had no impact on income-generated the greatest impact was mental illness, contributing 34.7% ($233.3 m) of all disease-related tax loss, followed by cardiovascular (14.7%, $99.0 m) and endocrine (10.2%, $68.8 m). Tax revenue gains after deleting all disease/injury increased up to 65 years of age, with the largest contributor occurring among 60- to 64-year-olds ($131.7 m). Varied results were also observed among different ethnicities and differing levels of deprivation.

CONCLUSIONS

This study finds considerable variation by disease on worker productivity and therefore tax revenue in this high-income country. These findings strengthen the economic and government case for prevention, particularly the prevention of mental health conditions and cardiovascular disease.

Veterans' Experiences With Accessing Community Emergency Care

INTRODUCTION

Under current regulations, there are three separate authorities for which the Veterans Health Administration (VHA) can pay for emergency medical care received by Veterans in the community. The three VHA authorities have overlapping criteria and eligibility requirements that contribute to a complex and confusing landscape for Veterans when they obtain emergency care in the community. Given the intricacies in how VHA provides coverage for community emergency care and the desire to provide seamless Veteran-centric care, it is imperative to understand Veterans' experiences with navigating coverage for community emergency care. The purpose of this study was to elicit feedback from Veterans about their experiences with and perceptions of community emergency care coverage paid for by VHA.

MATERIALS AND METHODS

Veterans Health Administration data were used to identify geographically diverse Veterans who recently used emergency care. We conducted semi-structured, qualitative interviews with 50 Veterans to understand their VHA coverage and experiences with accessing community emergency care. Interviews were audio recorded and transcribed verbatim. We conducted directed content analysis of interview transcripts.

RESULTS

Veterans emphasized three major concerns with navigating community emergency care: (1) they lack information about benefits and eligibility when they need it most, (2) they require assistance with medical billing to avoid financial hardship and future delays in care, and (3) they desire multimodal communication about VHA policies or updates in emergency coverage.

CONCLUSIONS

Our results highlight the challenges Veterans experience in understanding VHA coverage for community emergency care. Feedback suggests that improving information, support, and communication may help Veterans make timely, informed decisions when experiencing unexpected illness or injury.

The short-term economic consequences of COVID-19: Exposure to disease, remote work and government response

We examine the determinants of the consequences of COVID-19 on employment and wages in the United States. Guided by a pre-analysis plan, we investigate whether the economic consequences of COVID-19 were larger for certain occupations, using four indexes: workers relatively more exposed to disease, workers that work with proximity to coworkers, essential/critical workers and workers who can easily work remotely. We find that individuals that work in proximity to others are more affected while individuals able to work remotely and essential workers are less affected by the pandemic. We also present suggestive evidence that our indexes are likely explanations why certain demographic groups such as younger and minority workers have worse labor market outcomes during the pandemic.

Supporting children's health needs: an analysis of paid leave policies in 193 countries

The COVID-19 pandemic has highlighted the extent to which national laws and policies shape public health and economic security. Paid leave policies enable parents to meet children's health needs while maintaining job and income security. These policies matter immensely to children's health every year. Yet, little is known about the extent to which policies exist to support the full range of childhood health needs. Using a novel dataset constructed from legislative text in 193 countries, this study assesses whether laws in place in 2019 are adequate to support meeting children's everyday, serious, and disability-related health needs. Globally, only half of the countries guaranteed working parents access to any paid leave that could be used to meet children's health needs. Only a third addressed everyday health needs, including leave that matters to reducing infectious disease spread. For serious health needs, even when paid leave was available, it was often too short for complex health conditions. Moreover, although all children require parental presence at medical appointments and for serious illness, fewer countries guaranteed paid leave to care for older children than younger. Addressing these gaps is crucial to supporting child health and working families during times of public health crisis and every year.

An examination of gender difference in advancement and salary for Marriage and Family Therapy faculty members working in public universities

Evidence for inequitable advancement and salary disparity for women in academia is compelling, but only a marginal amount of research has explored this in the field of Marriage and Family Therapy (MFT) specifically. Current research provides preliminary evidence that women remain underrepresented at the Full Professor rank and are paid less than men MFT faculty. This study collected publicly available data for MFT faculty in public universities to explore gender differences in advancement between ranks, salary disparity, and the representation of women and men in the highest and lowest paying niches of MFT academia. Results showed that, despite being 60.15% of MFTs in public universities, women were paid an average of $5596.25 less than men. Men were 1.40 times more likely than women to be promoted to Full Professor on time-within 13 years of their terminal degree. Implications for addressing inequitable advancement and salary disparity for women MFT faculty are discussed.

Advancing Salary Equity in Schools of Medicine in the United States

Equity, in broad terms, is a critical issue and has been identified as an area that needs particular attention in academic medicine. Gender equity, as a subset of overall equity, has equally been shown to be lacking in academic medicine, and most medical schools and academic health systems are involved in substantive journeys to improve all dimensions of equity, diversity, and inclusion. This Invited Commentary calls for including gender-based salary equity as a foundational accomplishment for institutions seeking to achieve overall equity. In addition, the authors provide evidence and recommendations to guide institutions toward best practices in achieving salary equity. They propose 4 areas of consideration: (1) prioritization by leadership; (2) prioritization of resources to ensure success; (3) development of corrective action plans which are "automatic" and based on clear guidelines; and (4) transparency of methodology, data, and results.

Mathematical model estimation of dengue fever transmission risk from Southeast and South Asia into Japan between 2016 and 2018

BACKGROUND

Dengue fever is a viral infection transmitted to humans through the bite of a mosquito infected with the dengue virus. Dengue is one of the most common infectious diseases in the world, and its incidence is rapidly increasing. We estimated the risk of dengue importation from endemic countries to Japan and the transmission risk within Japan using data collected between 2016 and 2018.

METHODS

We conducted simulations that included the number of reported dengue infections and travelers per month in ten countries in Southeast and South Asia.

RESULTS

The estimated importation risks for Japanese returnees and international travelers from each of the ten endemic countries was approximately 1.0 every month from 2016 to 2018. The autochthonous transmission risk in Japan from any target country was 1.0 from June to September yearly. The estimated number of Japanese dengue cases returning to Japan is approximately 25 times higher than that of imported cases reported in Japan.

CONCLUSIONS

The risk of dengue importation into Japan can be sufficiently high. Attention should be paid to autochthonous transmission spread between June and September when mosquitoes are active in Japan. Estimates of seasonal risk variation from each dengue virus-endemic country can be used to inform preventive and control measures for dengue in Japan.

Resource asymmetry reduces generosity and paying forward generosity, among the resource-advantaged and disadvantaged

Decisions to benefit others often entail generalized reciprocity: helping someone who cannot directly return benefits in the future; instead, the beneficiary may "pay it forward" to someone else. While much past work demonstrates that people pay forward generosity, experimental tests of these processes typically assume that people have equal access to same-valued resources that they can use to benefit others. Yet this is rare in daily life, where people commonly experience asymmetries in the resources that they have to help others and to pay forward help received. In an experiment, we find that acts of generalized reciprocity-including initiating generosity and, upon being treated generously, paying it forward-are reduced when there is resource asymmetry between potential benefactors. Results show that the detriments of resource asymmetry occur among both the resource-advantaged and the disadvantaged. Asymmetry in available resources, and inequality more broadly, is thus critical for understanding patterns of generosity.

Affordable Health Insurance Options for Small Business and Low-Wage Workers Remains Elusive: Experience With New Health Reimbursement Arrangements in New Jersey

Low-wage workers and those employed by small businesses are least likely to be offered health insurance coverage and they are over-represented among the uninsured. Two new forms of health reimbursement arrangements (HRAs) that allow employers to help fund individual market coverage for workers have been touted as breakthrough strategies to help fill this gap. Despite several years of experience and low adoption, little is known about employer understanding of or views about these HRA options. Consistent with other evidence, only 11.8% of New Jersey employers we surveyed offer or plan to offer either of the HRA options. Few respondents (18.5%) report familiarity with either option. Even among businesses that offer or plan to offer this form of HRA, under half (47.6%) say that they are familiar with them. Other reasons cited for not offering these options include broker advice and complexity. While more investigation is needed, these findings suggest that new strategies should be explored to fill the gap in health insurance for low-wage and small business employees.

Does Agricultural Credit Input Promote Agricultural Green Total Factor Productivity? Evidence from Spatial Panel Data of 30 Provinces in China

Improving agricultural green total factor productivity is crucial to promoting high-quality agricultural development. This paper selects the panel data of 30 provinces in China from 2009 to 2020 and uses the super-efficiency SBM model with undesirable outputs to measure the agricultural green total factor productivity of all regions in China. On this basis, this paper uses the panel data fixed-effect model and spatial Durbin model to empirically discuss the impact of agricultural credit input on agricultural green total factor productivity and its spatial spillover effect. The main conclusions are as follows: First, from 2009 to 2020, the average values of agricultural green total factor productivity in national, eastern, central, and western regions are 0.8909, 0.9977, 0.9231, and 0.8068, respectively, and the agricultural green total factor productivity needs to be further improved. Second, the agricultural green total factor productivity presents a significant and positive spatial correlation, and the spatial distribution of agricultural green total factor productivity is not random and irregular. Third, agricultural credit input can significantly promote agricultural green total factor productivity in the local region, but it hinders the improvement of agricultural green total factor productivity in the adjacent regions. Fourth, the impact of agricultural credit input on the agricultural green total factor productivity and its spillover effect has a significant regional heterogeneity. This paper believes that paying attention to the spatial spillover effect of agricultural total factor productivity, optimizing the structure and scale of agricultural credit input, and formulating reasonable agricultural credit policies can improve agricultural green total factor productivity.

Correlation between the ratio of physician consultation fees to hourly minimum wage and consultation length: a cross-sectional study of nine countries

OBJECTIVES

Current healthcare reimbursement system is criticised for not adequately compensating physicians' cognitive services. This study was performed to examine primary care physicians' consultation fees in nine countries, relative to the national hourly minimum wage and to examine the correlations of the physician consultation fee with consultation length and other healthcare indices.

DESIGN AND OUTCOME MEASURES

Nine reference countries for which healthcare statistics are publicly available and outpatient consultation is compensated by fee-for-service payment were selected. A representative consultation fee was chosen to calculate the ratio of the consultation fee to the hourly minimum wage. The primary outcome was the correlation between the consultation fee/hourly minimum wage ratio and consultation length. In addition, the consultation fees were compared with fees for haemoglobin A1c tests and brain imaging. Pearson's method was primarily used for correlation analysis.

RESULTS

The mean representative consultation fee/hourly minimum wage ratio was 4.02 (median, 2.7; range, 0.80-10.36). The mean consultation length was 12.9 min (median, 14.7 min; range, 5-21.1 min). A significant correlation (r=0.79) was found between consultation length and the consultation fee/hourly minimum wage ratio. The ratio of consultation fee to hourly minimum wage was moderately negatively correlated with the annual number of physician visits, number of consultations per doctor and length of hospital stay. The brain CT fee/consultation fee ratio was moderately positively correlated with the number of CT units per 1 million population. In Japan and Korea, where the brain CT/consultation fee ratio was highest, the number of CT examinations per population was also highest.

CONCLUSIONS

The relationship of consultation fees to each country's hourly minimum wage varied in nine reference countries; however, it was strongly correlated with consultation length. The imbalance in compensation for cognitive services might drive increased use of imaging tests in some countries.

Student Presenteeism in Digital Times-A Mixed Methods Approach

In young adulthood, important foundations are laid for health later in life. Hence, more attention should be paid to the health measures concerning students. A research field that is relevant to health but hitherto somewhat neglected in the student context is the phenomenon of presenteeism. Presenteeism refers to working despite illness and is associated with negative health and work-related effects. The study attempts to bridge the research gap regarding students and examines the effects of and reasons for this behavior. The consequences of digital learning on presenteeism behavior are moreover considered. A student survey (N = 1036) and qualitative interviews (N = 11) were conducted. The results of the quantitative study show significant negative relationships between presenteeism and health status, well-being, and ability to study. An increased experience of stress and a low level of detachment as characteristics of digital learning also show significant relationships with presenteeism. The qualitative interviews highlighted the aspect of not wanting to miss anything as the most important reason for presenteeism. The results provide useful insights for developing countermeasures to be easily integrated into university life, such as establishing fixed learning partners or the use of additional digital learning material.

Re-aligning Incentives to Address Informal Payments in Tanzania Public Health Facilities: A Discrete Choice Experiment

BACKGROUND

Informal payments for healthcare are typically regressive and limit access to quality healthcare while increasing risk of catastrophic health expenditure, especially in developing countries. Different responses have been proposed, but little is known about how they influence the incentives driving this behaviour. We therefore identified providers' preferences for policy interventions to overcome informal payments in Tanzania.

METHODS

We undertook a discrete choice experiment (DCE) to elicit preferences over various policy options with 432 health providers in 42 public health facilities in Pwani and Dar es Salaam region. DCE attributes were derived from a multi-stage process including a literature review, qualitative interviews with key informants, a workshop with health stakeholders, expert opinions, and a pilot test. Each respondent received 12 unlabelled choice sets describing two hypothetical job-settings that varied across 6-attributes: mode of payment, supervision at facility, opportunity for private practice, awareness and monitoring, measures against informal payments, and incentive payments to encourage noninfraction. Mixed multinomial logit (MMNL) models were used for estimation.

RESULTS

All attributes, apart from supervision at facility, significantly influenced providers' choices (P<.001). Health providers strongly and significantly preferred incentive payments for non-infraction and opportunities for private practice, but significantly disliked disciplinary measures at district level. Preferences varied across the sample, although all groups significantly preferred the opportunity to practice privately and cashless payment. Disciplinary measures at district level were significantly disliked by unit in-charges, those who never engaged in informal payments, and who were not absent from work for official trip. 10% salary top-up were preferred incentive by all, except those who engaged in informal payments and absent from work for official trip.

CONCLUSION

Better working conditions, with improved earnings and career paths, were strongly preferred by all, different respondents groups had distinct preferences according to their characteristics, suggesting the need for adoption of tailored packages of interventions.

The variability and volatility of sleep: An ARCHetypal behavior

Using 1975-2005 Dutch time-diary data covering over 10,000 respondents for 7 consecutive days each, we show that sleep time exhibits non-constant variability, or volatility, characterized by stationary autoregressive conditional heteroscedasticity: The absolute values of deviations from a person's average sleep on one day are positively correlated with those on adjacent days. Sleep is more variable on weekends and among younger people, those without young children, or with less education. Volatility is greater among parents with young children, slightly greater among men, but independent of other demographics. Economic incentives to minimize the dispersion of sleep imply higher-wage workers will exhibit less dispersion, which we observe. Sleep volatility spills over onto volatility in other personal activities, with no reverse causation onto sleep. The results illustrate a novel dimension of inequality among people and could be applied to a wide variety of human behavior and biological processes.

The attractiveness of jobs in the German care sector: results of a factorial survey

The skilled labour shortage in nursing is an issue not unique to Germany. Unattractive characteristics of nursing jobs are one reason for the low supply in nursing personnel. In our study, we analyse the influence of job characteristics on the attractiveness of nursing jobs. We address this issue via factorial survey analysis, an experimental method particularly suited to assessing personal opinions and less prone to social desirability bias than standard interview methods. Around 1300 (current and former) nurses in a distinct region in Germany were asked to rate a set of synthetic job postings, each of which contained information on 9 systematically varied job characteristics. We find that, first, attractiveness of care jobs is most strongly affected by rather "soft" characteristics such as atmosphere within the team and time for patients. "Hard" factors play a considerably smaller role. Second, one hard factor, contract duration, is estimated to be among the most important job factors, however. This is a remarkable finding given that nursing occupations suffer from severe skill shortages. Third, though wage has a statistically significant influence on attractiveness, enormous wage raises would be needed to yield higher attractiveness gains than the top-rated soft factors, or to compensate for less pleasant job characteristics with respect to those factors. Last, even after controlling for other job characteristics, hospital nursing is still rated as more attractive than geriatric nursing.

Postdoctoral employment and future non-academic career prospects

Most recipients of doctorates leave universities some years after graduation, while little is known about their future non-academic career prospects. I report results from a novel microlevel database that links information about doctoral dissertations completed in Germany with doctorate recipients' social security records. The results, based on graduates' individual careers for five broader subject groups, indicate that postdoctoral periods do not result in a wage premium when changing to the non-academic sector.

Paid Leave for Fathers: Policy, Practice, and Reform

Policy Points Government policies that secure paid leave for all parents, regardless of gender, can reduce structural inequalities, while promoting fathers' engagement in parenting. Such policies are likely to be most effective when they secure full, or almost full wage replacement, and when they provide incentives for fathers to take leave. Organizations must also participate in the culture shift, providing workplaces that encourage paternity leave rather than reinforcing the "male breadwinner" stigma.

Intergenerational Interdependence of Labour Market Careers

Labour market disadvantages tend to run in families: children who grow up with parents who experience job losses or receive low wages are themselves at higher risk of experiencing labour market difficulties. However, little is known about the intergenerational transmission for those who manage to escape from precariousness, and how the transmission of labour market disadvantage operates depending on the gender structure of parent-child dyads. The present study uses Swedish register data and longitudinal methods that follow a cohort of people born in 1985 (n = 72,409) and their parents across 26 years. Our findings show that children who experienced parental employment disadvantages had the most severe labour market disadvantages later in life. However, if the employment situations of their parents improved, they were somewhat more likely to follow a more stable, high-wage career path compared to children whose parents experienced more persistent forms of disadvantage, such as long-term unemployment or severe labour market instability. We also show that the mother's labour market disadvantages were an important determinant of the future labour market career of her child, regardless of gender. This finding underscores the need to go beyond the analysis of father-son dyads in intergenerational research.

Sick Leave Due to Stress, What are the Costs for Dutch Employers?

Purpose Stress-related illnesses are prevalent in Western society, causing sick leave and putting a heavy economic burden on employers and society. For Dutch employers it is particularly relevant to have insight into the costs of absenteeism due to stress-related illness, as they are legally obligated to continue payment of wages. Therefore, this study assessed the duration and costs of an episode of sick leave due to stress-related illness for Dutch employers. Methods Data on sick leave due to various stress-related illnesses were obtained from a nationwide occupational health service database. Stress-related illnesses included tension complaints, burn-out, overexertion, and other reactions to stress. The duration per sick leave episode was estimated in working days, after which the average cost per sick leave period was estimated using age- and gender-specific price weights. Results During the study period, 16,676 employees took 17,338 episodes of sick leave due to stress-related illness. On average, one episode of sick leave lasted 101 working days, for which the costs for the employer were on average €19,151 per worker. Women were responsible for most episodes of sick leave and were on average 37 days more absent per episode compared to men. Moreover, of all kinds of stress-related illnesses, burn-out had the longest duration of sick leave with 313 calendar days and 163 working days, resulting in an average cost of €30,770. Conclusions Sick leave due to stress-related illness places a heavy burden on employers and thus society. Further research should be conducted on how to reduce this burden.

Student trainee and paid internship programs have positive results but do little to influence long-term employee diversity in the USDA forest service

Women and Black, Indigenous, and People of Color (BIPOC) employees are underrepresented in science and natural resource management institutions. Student and recent graduate trainee and internship programs have been used to try to address this in United States federal agencies over the last few decades. Our study evaluates how effective such programs are at improving U.S. federal workforce diversity. We used a comprehensive employee dataset from the United States Department of Agriculture (USDA) Forest Service-which has the largest natural resource management workforce in the country-to analyze the demographic characteristics and career paths of paid interns from 1996-2017. We found that a majority of employees who started as interns later converted to permanent employment with the USDA Forest Service. In addition, Black and Hispanic interns were, respectively, 5 and 3 times more likely than White interns to work for the agency in permanent positions after their internships. However, people who started as interns had significantly shorter USDA Forest Service careers than those who started in permanent positions. White women entering directly into permanent positions typically advanced to higher pay grades through promotion faster than White women who entered as interns. Finally, male BIPOC interns involuntarily separated (i.e., were fired) at significantly higher rates than all other employees. Our study suggests that while internship employment programs can be an effective tool for hiring a diverse workforce, they are not sufficient to close the overall workforce diversity gap. In addition, only a small percentage of new hires every year are interns. To achieve a level of representation that mirrors the civilian labor force, our study suggests that internship programs need to focus on long-term employee retention and be of significantly larger scale.

Water savings and urban storm water management: Evaluation of the potentiality of rainwater harvesting systems from the building to the city scale

The main potential benefits of rainwater harvesting, namely water saving and storm water management, are easily evaluable at a building scale when well-known behavioral models are used. However, the evaluation is often more complex at an urban scale, due to a lack of building characteristics and demographic data. In the present paper, we propose a method, which is based on the representative building concept that can be used to quantify the potential benefits of rainwater harvesting at different scales, that is, from the building scale to the district and city scales. Particular attention has been paid to the sizing of the system so that it can be used for different rainwater collection purposes. The method has been applied to the city of Turin (Italy) considering different scenarios: 1) domestic use (e.g., toilet flushing and the washing machine), where buildings are independent of each other, and 2) two public uses (the irrigation of public green areas and street washing), for which we have hypothesized that the rainwater collection takes place at a district scale. The non-potable water saving for domestic use varies across the city from 29% to 62%, according to the characteristics of the buildings, while the reduction of the flow peak conveyed to the sewerage system, during extreme storms, is quite constant (in the 57-67% range). Irrigation and street washing require a lower amount of water, thus about 80% of water can be saved, but the retention efficiency is low, and a slight reduction in the flow peaks can be expected. The aim of the methodology presented in this work is to provide a suitable decision-making tool for policy makers and urban planners to evaluate the capability and efficiency of rainwater harvesting systems for buildings, districts, and cities.

Back to our roots or sowing new seeds: thinking anew on the paradigms of health, harm and disease

Health, harms and disease are intimately linked, and their promotion and distribution are determined by the social, political and physical worlds in which people live. Yet, the popular narrative on health is still dominated by a biological model that focuses on a disease-causing 'pathogen' or 'agent' that leads to pathology which is diagnosable and amenable to intervention at the individual level via measures delivered through the health care and public health systems. This model generally rests on understanding populations as a collection of individuals, with the pattern of disease seen as the sum of a series of risk factors acting on each of them. Too little attention is paid to the ways in which health, harm, disease, causation and risk are conceptualized and used as guiding concepts in research, policy debates and other fora. We often overlook the distribution of health and the regulatory regimes, norms, values and rights that promote or undermine health. By challenging our ways of thinking about health, harms and disease, we can start to appreciate with greater depth the ways in which health can be threatened and what should be seen as harmful, and conversely, opportunities for moving our systems towards promoting and protecting health.