Health insurance coverage and self-employment

Self-Employed Canadians' Experiences with Cancer and Work: A Qualitative Study

Self-employed individuals with cancer face unique challenges that have not been fully explored in previous research. For example, while some studies conducted in Europe have suggested that self-employed workers with cancer experience more adverse health and work-related outcomes compared to salaried workers, the specific manners in which cancer affects the health, work, and businesses of self-employed individuals remain inadequately understood. This lack of understanding represents a crucial gap in the literature, as self-employed individuals make up a significant portion of the workforce in many countries, including Canada. To address this gap, a qualitative interpretive description study was undertaken to explore the experiences of 23 self-employed Canadians diagnosed with cancer from six provinces, with the aim of generating insights into the unique challenges faced by this population. The interviews were conducted in the language chosen by the participants from the two official languages of Canada, namely English and French. Using reflexive thematic analysis, four major themes and twelve subthemes were generated from the participants' shared accounts that reflected the impact of cancer on self-employed Canadians' physical, cognitive, and psychological function, affecting their work ability and their ability to maintain their business and financial well-being. Participants in the study also shared strategies they used to continue working and maintain their business during their cancer experience. This study sheds light on the impact of cancer on self-employed individuals and provides insight into the experiences of self-employed individuals with cancer that can inform the development of interventions to support this population.

Self-employment and health inequality of migrant workers

Background

Self-employment is one of the most common forms of employment for migrant workers in China. However, migrant workers’ lifestyle and behavior, as well as health disparities among them, would be impacted by self-employment. This research aims to explore the mechanism and group differences of the effect of self-employment on health inequality among Chinese migrant workers.

Materials and methods

To explore the effect of self-employment on health inequalities among migrant workers, this research uses the data from the 2018 China Migrant Workers Dynamic Monitoring Survey, and the RIF-I-OLS decomposition method.

Results

We find that self-employment will reduce the health inequality of Chinese migrant workers significantly, especially among migrant workers with low education, low income, and low social integration. A further examination reveals that self-employment can directly promote the self-rated health of migrant workers. Additionally, it indirectly alleviates the health inequality among migrant workers by mediating effect of expanding access to public welfare, such as by establishing health records and strengthening health education.

Conclusion

The government should permit and encourage migrant workers to engage in self-employment. It is necessary to provide public services such as health education, health records, and health rights for migrant workers, and focus on the employment of migrant workers in city, especially those with low income and low education. we believe that measures should be taken to enhance migrant workers’ sense of belonging in urban China Only on this basis can health inequality among migrant workers be truly reduced.

Compensation, Benefits, and Total Rewards: A Bird's-Eye (Re)View

Research on compensation and employee benefits has enjoyed a long and rich history. Energized by a new generation of scholars, changes in the broader workplace context, and developments in adjacent areas of inquiry, many classic theoretical tensions and research questions have begun to evolve in novel directions, and exciting new areas of research are developing. In addition, there have been numerous calls for more academic research on both compensation and benefits and for greater alignment of that research with the needs and interests of practice, including the tendency of many practitioners (and employees) to view pay and benefits holistically as a package. In this review we highlight selected recent research on key components of core total rewards—compensation plus retirement, health, and work-life benefits. Extrapolating from our review, we identify evolving themes and trends and advance several recommendations for future research and suggestions for practice.

Health insurance coverage and self-employment

BACKGROUND

Self-employed workers are 10% of the US labor force, with growth projected over the next decade. Whether existing policy mechanisms are sufficient to ensure health insurance coverage for self-employed workers, who do not have access to employer-sponsored coverage, is unclear.

OBJECTIVE

To determine whether self-employment is associated with lack of health insurance coverage.

DATA SOURCES

Secondary analysis of Medical Expenditure Panel Survey (MEPS) data collected 2014-2017.

STUDY DESIGN

Participants were working age (18-64 years), employed, civilian noninstitutionalized US adults with two years of Medical Expenditure Panel Survey (MEPS) participation in 2014-2017. We compared those who were employees vs those who were self-employed. Key outcomes were self-report of health insurance coverage, and of delaying needed medical care.

DATA EXTRACTION METHODS

Longitudinal design among individuals who were employees during study year 1, comparing health insurance coverage among those who did vs did not transition to self-employment in year 2.

PRINCIPAL FINDINGS

16 335 individuals, representing 121 473 345 working-age adults, met inclusion criteria; of these, 147, representing 1 097 582 individuals, transitioned to self-employment. In unadjusted analyses, 25.7% of those who became self-employed were uninsured in year 2, vs 8.1% of those who remained employees (P < .0001). In adjusted models, self-employment was associated with greater risk of being uninsured (26.1% vs 8.0%, risk difference 18.0%, 95% confidence interval [CI] 9.2% to 26.9%, P = .0001). A time-by-employment type product term suggests that 10.0 percentage points (95%CI 0.3 to 19.7 percentage points, P = .04) of the risk difference may be attributable to the change to self-employment. Self-employment was also associated with delaying needed medical care (12.0% vs 3.1%, risk difference: 8.9%, 95% CI 3.1% to 14.6%, P = .003).

CONCLUSIONS

One in four self-employed workers lack health insurance coverage. Given the rise in self-employment, it is imperative to identify ways to improve health care insurance access for self-employed working-age US adults.