The Effects of Job Insecurity on Health Care Utilization: Findings from a Panel of U.S. Workers

Mental health and employment outcomes in working-age US adults, 2010-2019

BACKGROUND

Individuals with severe mental illness experience greater unemployment and barriers to workforce re-entry. However, less is known about additional indicators of employment stability for individuals across mental illness severity.

AIMS

This study aims to examine associations between mental illness severity, use and adequacy of mental health treatment, and indicators of employment stability.

METHODS

In this repeated cross-sectional study, 2010-2019 data from the U.S. National Survey of Drug Use and Health were used to construct multivariate logistic regression models predicting the odds of part-time employment, past-year work interruption, number of past-year employers, and past-month health-related work absence by mental illness severity and adequacy of mental health treatment.

RESULTS

Compared to individuals with no mental illness, those with any and severe mental illness had significantly higher odds of part-time employment (adjusted odds ratios [AORs] = 1.51 and 2.16, 95% confidence intervals [CIs] 1.4-1.6 and 2.0-2.3), multiple past-year employers (AORs = 1.78 and 2.34, CIs 1.7-1.9 and 2.1-2.6), past-year work interruption (AORs = 1.69 and 2.20, CIs 1.6-1.8 and 2.1-2.4), and >7 days of past-month work absence (AORs = 2.51 and 3.82, CIs 2.3-2.8 and 3.3-4.5). Among respondents with mental illness, perceived inadequacy of mental treatment predicted higher odds of all adverse employment outcomes.

CONCLUSIONS

Compared to those with no mental illness, individuals with mental illness of any severity have higher odds of employment instability. Policy and programmatic support aimed at addressing the needs of individuals with mental illness, including access to adequate mental health treatment, are needed to facilitate continued, competitive employment.

Perceived job insecurity and task performance: what aspect of performance is related to which facet of job insecurity

Employee task performance is considered to be of crucial importance for organizational survival and growth, at the same time, the struggle for organizational survival and growth most especially in the current economic climate gives rise to perceptions of job insecurity among employees thereby making the perception of job insecurity a relevant topic. This study examined the effect of perceived job insecurity on task performance. In addition, the effect of both quantitative and qualitative facets of job insecurity on the different components of task performance, was investigated. By making use of the multi-stage sampling technique, a total of 342 employees with age range of 23 to 46 years were proportionately selected from the cluster that represents each bank. Furthermore, the close ended and structured questionnaire was utilized in a descriptive cross-sectional research design to elicit responses from these employees. Based on the regression analysis conducted, it was revealed that while perceived job insecurity as a uni-dimensional construct exercise a significant and negative effect on task performance, both quantitative and qualitative job insecurity also have a significant and negative effect on this performance with the later, found to exercise a stronger negative impact. Furthermore, results also indicate that while quantitative job insecurity is more negatively related with the job quality component of performance, both job quantity and job time limit are more negatively related with qualitative job insecurity. To conclude, recommendations were made on the need for organizations to focus intervention on antecedents of job insecurity which have been classified as macro level, micro level and personality factors with the view of reducing the incidence of perceived job insecurity. It was also recommended that managers should endeavor to concentrate more resources on those employees who suffer from qualitative job insecurity whenever there is a need to make use of these interventions, while also being in cognizant of the fact that a different level of intervention is required for employees with different level of job quality, job quantity and job time limit.

Impact of Insurance Type on Self-Reported Symptom Severity at the Preoperative Visit for Carpal Tunnel Release

PURPOSE

Prior studies evaluated the impact of insurance type on access to hand care. However, there is limited literature quantifying whether patient symptoms are worse at the time of intervention. Our primary null hypothesis was that insurance type would not be associated with Patient-Reported Outcomes Measure Information System (PROMIS) Upper-Extremity (UE), Physical Function (PF), Pain Interference (PI), and Depression scores at the preoperative visit before carpal tunnel release (CTR).

METHODS

Between December 2016 and November 2018, patients with known carpal tunnel syndrome presenting to a tertiary academic hand clinic for the preoperative visit within 3 months of CTR, completed PROMIS UE, PF, PI, and Depression computer adaptive tests. Patient characteristics were recorded, including insurance type as commercial, Medicare, Medicaid, or workers' compensation. Multivariable linear regression was used to determine which variables were associated with PROMIS scores at the preoperative visit before CTR.

RESULTS

A total of 301 patients were included in the analysis. All PROMIS domains were significantly different by insurance type; Medicaid patients had the worst preoperative score for all domains in bivariate analysis. In multivariable linear regression modeling, commercial insurance was associated with better preoperative PROMIS UE, PF, PI, and Depression scores.

CONCLUSIONS

Commercial insurance is associated with significantly better preoperative PROMIS PF, PI, and Depression scores compared with other insurance types (ie, Medicaid, Medicare, and Workers' compensation). This may be the result of a number of factors, including differences in access to hand care or life circumstances that allow for only certain individuals to seek hand care early on in the disease process. However, further research is warranted to determine more definitively why this association exists.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic II.

Layoffs and the mental health and safety of remaining workers: a difference-in-differences analysis of the US aluminium industry

BACKGROUND

Relatively few studies have examined the effects of layoffs on remaining workers, although the effects of layoffs and downsizing events may extend beyond those employees who lose their jobs.

METHODS

We examined the effects of layoffs on mental healthcare utilisation and injury risk among workers at 30 US plants between 2003 and 2013. We defined layoffs as reductions in the hourly workforce of 20% or more at each plant. Using a difference-in-differences approach, we compared the change in outcomes during layoffs versus the same 3-month period 1 year previously, accounting for secular trends with control plants.

RESULTS

Our study population included 15 502 workers and 7 layoff events between 2003 and 2013. Layoffs were associated with only minor decreases in injuries (-0.006, 95% CI -0.013 to 0.001). The probability of outpatient visits related to mental health increased by 1% during layoffs (0.010, 95% CI 0.003 to 0.017), and the probability of mental health-related prescriptions increased by 1.4% (0.014, 95% CI -0.0006 to 0.027). Among women, the increase in outpatient visits was more pronounced (0.017, 95% CI 0.003 to 0.031). Increased prescription utilisation appeared attributable primarily to opioid use (0.016, 95% CI 0.005 to 0.027).

CONCLUSION

Our results indicate an association between layoffs and remaining workers' mental health and safety, although changes mental healthcare utilisation may reflect both changes in underlying mental health and changes in care-seeking. Future research on concordance of service utilisation and underlying health may yield valuable insight into the experiences employed workers in the wake of layoffs.

The short-term effects of the earned income tax credit on health care expenditures among US adults

OBJECTIVE

To test the hypothesis that the earned income tax credit (EITC)-the largest US poverty alleviation program-affects short-term health care expenditures among US adults.

DATA SOURCES

Adult participants in the 1997-2012 waves of the US Medical Expenditure Panel Survey (MEPS) (N = 1 282 080).

STUDY DESIGN

We conducted difference-in-differences analyses, comparing health care expenditures among EITC-eligible adults in February (immediately following EITC refund receipt) with expenditures during other months, using non-EITC-eligible individuals to difference out seasonal variation in health care expenditures. Outcomes included total out-of-pocket expenditures as well as spending on specific categories such as outpatient visits and inpatient hospitalizations. We conducted subgroup analyses to examine heterogeneity by insurance status.

PRINCIPAL FINDINGS

EITC refund receipt was not associated with short-term changes in total expenditures, nor any expenditure subcategories. Results were similar by insurance status and robust to numerous alternative specifications.

CONCLUSIONS

EITC refunds are not associated with short-term changes in health care expenditures among US adults. This may be because the refund is spent on other expenses, because of income smoothing, or because of similar refund-related variation in health care expenditures among noneligible adults. Future studies should examine whether other types of income supplementation affect health care expenditures, particularly among individuals in poverty.

County-Level Unemployment Rates and Service Intensity in Primary Care Physician Offices for Medicare Patients

The macroeconomic environment has been shown to affect health-care service utilization. We examined the relationship between unemployment rate and service intensity among a nationally representative sample of primary care office visits from Medicare patients by merging data from the 2006-2012 National Ambulatory Medical Care Survey with unemployment data from the Bureau of Labor Statistics. Multispecialty practices demonstrated increases in the number of electrocardiogram tests prescribed and the number of return appointments scheduled. In contrast, single-specialty practices did not respond on those margins and instead increased the likelihood of administering diagnostic and screening examinations. We found no significant relationship between unemployment rates and the number of laboratory and imaging services, magnetic resonance imaging use, referrals, or medication prescribing. These results were robust to controlling for extensive visit characteristics and county-, year-, and month-fixed effects. Our results suggest that physicians responded to the Great Recession by changing their practice behavior.

Quantitative Job Insecurity and Well-Being: Testing the Mediating Role of Hindrance and Challenge Appraisals

The aim of this study is to determine the extent to which cognitive appraisals of job insecurity may mediate the link between job insecurity and well-being among employees. According to cognitive appraisal theory, the two cognitive appraisals of job insecurity, hindrance vs. challenge appraisals, were integrated into a conceptual model and examined as the mediators of job insecurity-wellbeing association. Well-being related outcomes were job satisfaction and emotional exhaustion. Hypotheses were tested using a total sample of 306 hospital staff¹. Respondents from diverse departments of this hospital were recruited and completed scales on quantitative job insecurity, hindrance vs. challenge appraisals of job insecurity, job satisfaction, and emotional exhaustion. Results indicated that hindrance appraisals of job insecurity mediated the association between job insecurity and emotional exhaustion. Challenge appraisals did not mediate the job insecurity-well-being association. In all, only one out of four mediation paths was found significant. As a result, employees hindered by job insecurity are more likely to be emotionally exhausted.

Do cognitive appraisals moderate the link between qualitative job insecurity and psychological-behavioral well-being?

Purpose

The purpose of this paper is to detect the association between qualitative job insecurity and well-being related outcomes and to determine the extent to which cognitive appraisals of job insecurity moderate this association. According to appraisal theory, it is anticipated a hindrance appraisal of job insecurity to amplify and a challenge appraisal of job insecurity to buffer this association.

Design/methodology/approach

To test the hypotheses, 250 healthcare employees from different departments of an Iranian large public hospital were recruited. Participants responded to scales on qualitative job insecurity, cognitive appraisals, job satisfaction, emotional exhaustion, absenteeism and presenteeism.

Findings

Results showed that qualitative job insecurity negatively influenced both psychological and behavioral well-being; however, this influence was greater for psychological well-being than for behavioral well-being. Besides, the moderation tests showed that only the hindrance appraisals of job insecurity amplified the link between job insecurity and psychological outcomes.

Research limitations/implications

This study sampled employees from a public hospital and did not include employees from private hospitals. This may limit the generalizability of the findings. Also, due to using a cross-sectional research design we encourage future studies to replicate the same findings using other different research designs.

Practical implications

The findings aid occupational health psychologists to design particular interventions for protecting those aspects of employee’s well-being that are more vulnerable when qualitative job insecurity is chronically perceived.

Originality/value

Together, these findings suggest that the hindrance appraisals of qualitative job insecurity are more likely to moderate the link between job insecurity and well-being outcomes.

The EU referendum and mental health in the short term: a natural experiment using antidepressant prescriptions in England

Background

Previous research has highlighted the impact of economic conditions and uncertainty on physical and mental health. The unexpected result of the Brexit referendum in 2016 triggered high levels of economic uncertainty.

Objective

To examine whether prescriptions for antidepressants increased after the referendum result, benchmarking them against other drug classes.

Methods

We used GP practice prescribing data to compile the number of defined daily doses per capita every month in each of the 326 voting areas in England over the period 2011–2016. We used a difference-in-differences (DID) approach to identify the effects of Brexit on antidepressant prescriptions, compared with trends in a control group (antigout and iron preparations) that were unlikely to be associated with uncertainty and depression.

Results

Antidepressant prescribing continued to increase after the referendum but at a slower pace. Therapeutic classes used as controls showed a decrease. The DID approach shows that there was a relative increase of 13.4% in antidepressants compared with other therapeutic classes (DID coeff: 0.134; 95% CI 0.093 to 0.174).

Conclusion

Our results are open to different interpretations and should be treated with caution. This relative increase in antidepressant prescribing after the referendum may be attributed to increased uncertainty for certain parts of the population, but does not rule out an improvement in mood for others. Alternatively, some other factor—for example, distraction, might have contributed to a decrease in the control therapeutic classes. A possible policy implication is that programmes for the promotion of mental health may need to be intensified during periods of uncertainty.

Psychosocial Workplace Factors and Healthcare Utilization: A Study of Two Employers

Background: While a large literature links psychosocial workplace factors with health and health behaviors, there is very little work connecting psychosocial workplace factors to healthcare utilization.

Methods: Survey data were collected from two different employers using computer-assisted telephone interviewing as a part of the Work-Family Health Network (2008-2013): one in the information technology (IT) service industry and one that is responsible for a network of long-term care (LTC) facilities. Participants were surveyed four times at six month intervals. Responses in each wave were used to predict utilization in the following wave. Four utilization measures were outcomes: having at least one emergency room (ER)/Urgent care, having at least one other healthcare visit, number of ER/urgent care visits, and number of other healthcare visits. Population-averaged models using all four waves controlled for health and other factors associated with utilization.

Results: Having above median job demands was positively related to the odds of at least one healthcare visit, odds ratio [OR] 1.37 (P<.01), and the number of healthcare visits, incidence rate ratio (IRR) 1.36 (P<.05), in the LTC sample. Work-to-family conflict was positively associated with the odds of at least one ER/urgent care visit in the LTC sample, OR 1.15 (P<.05), at least one healthcare visit in the IT sample, OR 1.35 (P<.01), and with more visits in the IT sample, IRR 1.35 (P<.01). Greater schedule control was associated with reductions in the number of ER/urgent care visits, IRR 0.71 (P<.05), in the IT sample.

Conclusion: Controlling for other factors, some psychosocial workplace factors were associated with future healthcare utilization. Additional research is needed.

Colorectal cancer screening at US community health centers: Examination of sociodemographic disparities and association with patient-provider communication

BACKGROUND

Colorectal cancer (CRC) screening rates are low among underserved populations. High-quality patient-physician communication potentially influences patients' willingness to undergo CRC screening. Community health centers (HCs) provide comprehensive primary health care to underserved populations. This study's objectives were to ascertain national CRC screening rates and to explore the relations between sociodemographic characteristics and patient-provider communication on the receipt of CRC screening among HC patients.

METHODS

Using 2014 Health Center Patient Survey data, bivariate and multivariate analyses examined the association of sociodemographic variables (sex, race/ethnicity, age, geography, preferred language, household income, insurance, and employment status) and patient-provider communication with the receipt of CRC screening.

RESULTS

Patients between the ages of 65 and 75 years (adjusted odds ratio [aOR], 2.49; 95% confidence interval [CI], 1.33-4.64) and patients not in the labor force (aOR, 2.32; 95% CI, 1.37-3.94) had higher odds of receiving CRC screening, whereas patients who were uninsured (aOR, 0.33; 95% CI, 0.18-0.61) and patients who were non-English-speaking (aOR, 0.42; 95% CI, 0.18-0.99) had lower odds. Patient-provider communication was not associated with the receipt of CRC screening.

CONCLUSIONS

The CRC screening rate for HC patients was 57.9%, whereas the rate was 65.1% according to the 2012 Behavioral Risk Factor Surveillance System and 58.2% according to the 2013 National Health Interview Survey. The high ratings of patient-provider communication, regardless of the screening status, suggest strides toward a patient-centered medical home practice transformation that will assist in a positive patient experience. Addressing the lack of insurance, making culturally and linguistically appropriate patient education materials available, and training clinicians and care teams in cultural competency are critical for increasing future CRC screening rates. Cancer 2017;123:4185-4192. © 2017 American Cancer Society.

Health & access to care among working-age lower income adults in the Great Recession: Disparities across race and ethnicity and geospatial factors

In the United States (US) and elsewhere, residents of low resource areas face health-related disparities, and may experience different outcomes throughout times of severe economic flux. We aimed to identify individual (e.g. sociodemographic) and environmental (e.g. region, rurality) factors associated with self-reported health and forgone medical care due to the cost of treatment in the US across the Great Recession (2008-2009). We analyzed nationally representative data (2004-2010) using the Behavioral Risk Factor Surveillance System in the US. Individual and geospatial factors (rurality, census region) were used to identify differences in self-reported health and forgone medical care due to the cost. Adjusted-analyses taking into account individual and geospatial factors among those with incomes <$50,000 identified multiple differences across time, sex, education, disability, rurality and Census Region for health. Similar analyses for forgone medical care found that those in the Recovery and the Recession were more likely to report forgone care than before the Recession. Having insurance and/or being employed (versus unemployed) was a protective factor in terms of reporting fair/poor health and having to forgo health care due to cost. Policies affecting improvements in health and access for vulnerable populations (e.g., low-income minority adults) are critical. Monitoring trends related to Social Determinants of Health, including the relationship between health and place (e.g. Census region, rurality), is necessary in efforts targeted towards ameliorating disparities.