Thailand's Work and Health Transition

Thailand has experienced a rapid economic transition from agriculture to industry and services, and from informal to formal employment. It has much less state regulation and worker representation relative to developed nations, who underwent these transitions more slowly and sequentially, decades earlier. We examine the strengthening of Thai government policy and legislation affecting worker's health, responding to international norms, a new democratic constitution, fear of foreign importer embargos and several fatal workplace disasters. We identify key challenges remaining for Thai policy makers, including legislation enforcement and the measurement of impacts on worker's mental and physical health.     

Adaptation of the older worker to occupational challenges

The occupational adaptation practice model guided the search for and the analysis of the literature on the older worker. The purpose of this literature review was to: identify the occupational challenges that older workers experience, determine ways in which the occupational therapist can promote the occupational adaptation of older workers, and articulate the research and policy changes implied in the model related to health and improved productivity. The analysis of the worker's personal characteristics, work tasks, and environments highlighted the types of occupational challenges that may overwhelm the older worker's adaptive capacity. Straining adaptive capacity of the older worker leads to degradation in levels of mastery. The occupational therapist and others could assist the older worker to achieve relative mastery in response to occupational challenges through ergonomic solutions, training, assistive devices, management policy, and health promotion. Combined efforts of the employer, of the occupational therapist, and of the older work to capitalize on the older worker's years of experience, existing skills, and knowledge facilitates higher job satisfaction, better performance, and an increased sense of well-being in the older worker.     

THE IMPACT OF SKILL ON UNION MEMBERSHIP:

A worker's occupation and industry position in the economy primarily determine gender differences in union membership. However, the data reveal that these economic structural factors are not alone responsible. A specific strategy for rethinking the problem examines bargaining power; skill has been identified as a central factor in worker power. Feminists maintain that gender mediates manual skill's effect on union membership. Logistic regression techniques that test for gender interaction effects support the feminist perspective. Manual skill produces lower rates of union membership for women than men with comparable skills.     

OPTIMAL STRATEGIES FOR WORKERS ON TEMPORARY LAYOFF

In this paper we analyze the worker's behavior when faced with job offers which include possible temporary layoff spells of varying (known) durations. We show that of the three strategies which can be optimal, two involve search in all or part of the layoffs. We also show that the duration of any particular spell plays no role in determining which strategy is optimal to pursue. And finally, we develop an index for evaluating jobs with different wage and layoff probabilities and show that the worker's reservation wage monotonically increases, decreases or remains constant during the course of a layoff.     

AN INCOME-SATIATION MODEL OF EFFICIENCY WAGES

Efficiency wages are wages that exceed a worker's reservation wage. A standard explanation for such wages is "bonding": high wages increase the cost of being discharged for misbehavior and so help ensure worker honesty. A neglected alternative is "satiation": by decreasing the worker's marginal utility of income, the high wage decreases the benefit from misbehavior. Satiation, unlike bonding, applies even in a one-period model, but it relies on the misbehavior having a monetary benefit and on at least part of the punishment being nonmonetary.     

Workers' postural conditions in the charcoal production proccess based on vertical metallic cylynders

Considering the importance of posture to the workers' health in the production of charcoal, this paper presents an ergonomic research based on a biomechanical focus that aims to evaluate the posture adopted by these workers on the production of charcoal in vertical metallic cylinders. Thus, it was verified the incidence of pain and/or musculoskeletal injuries to these workers. Also, it was evaluated the weight carried by them and the positions taken in their daily tasks. Applying the Ergonomic Analysis of Labor, the data collection was done by directly observing the workers, registering images, by interviews, and posture analysis based on the OWAS method. The main results of the research show that there are postures with risks in the four levels of musculoskeletal injuries classified by OWAS, concluding that the method is imperative for ergonomic recommendations for minimization or eradication of suffering injury and worker's postural constraints.     

Strategy-proofness and efficiency in a simple production economy

We consider an economy with two agents, “firm” and “worker.” The firm owns a technology which transforms a single input into a single output and the worker owns a limited amount of input good, for example, leisure. The firm is interested in profit measured in terms of output and the worker's preferences are defined over the input-output space. Manipulability comes not only from a lack of information about the (worker's) preferences but also about the technology. With a possibility for manipulation, can we still obtain efficient allocations? We show that there is no allocation mechanism which is Pareto efficient, strategy-proof, and non-dictatorial. Received: 30 March 1998/Accepted: 06 July 1999     

Disclosure of mental health

As today's workplaces strive toward a climate of inclusiveness for persons with disabilities, much work remains for employers in developing a process to achieve this ideal. While survivors of mental illness are encouraged to disclose related concerns to their employer, such sharing of personal information remains daunting. Similarly, employers attempting to assist the process are often awed by the extent of collaborations involved in integrating employees with mental health issues back to work as well as concern about compliance with human rights legislation. Needed accommodations in terms of approach to the work itself are often simple; however substantiating the need for adjustments is more complex. This case study introduces a model to support the development of shared goals and shared understandings for return to work (RTW) among workers with mental health concerns, employers, co-workers and therapists. The model of occupational competence is used as a basis to guide dialogue, identify challenges and generate solutions that take into consideration a worker's preferences, sensitivities, culture and capacities in relationship to the occupational demands in a given workplace environment. A case study is used to demonstrate the potential utility of the model in assisting stakeholders to strengthen collaborations and partnering to achieve a shared understanding of worker and workplace needs.     

Effect of immunomodulatory therapy and other factors on employment loss time in multiple sclerosis

The factors that influence time missed from work among individuals diagnosed with multiple sclerosis were the focus of this study. Records of individuals who were employed and diagnosed with multiple sclerosis between the years 1999 and 2002 (N=284) were examined for details pertaining to their medical claims. Multivariate regressions, controlling for demographic characteristics, type of immunomodulatory medication, and overall severity of illness, were used in the examination of the total number of days missed from work for any reason and those missed due to absenteeism, short-term disability, or worker's compensation. Results indicate that lost work time is affected by severity of illness, and type of immunomodulatory therapy. Comparing individuals treated with the specific immunomodulator glatiramer acetate, interferon beta-1a (intramuscular), or interferon beta-1b, to those who did not receive multiple sclerosis medications of this type; only glatiramer acetate was associated with significantly fewer days missed from work for short term disability (18.24 fewer days, P<0.03), worker's compensation (29.50 fewer days, P<0.04) or any reason (53.70 fewer days, P< 0.003).     

Trends in health insurance coverage

This Issue Brief presents data on trends in health insurance coverage between 1987-1995. In 1995, 70.7 percent of the nonelderly population had private health insurance coverage, compared with 75.9 percent in 1987. During this period, the percentage of the nonelderly population with employment-based health insurance declined from 69.2 percent to 63.8 percent, while the percentage covered by Medicaid program increased from 8.6 percent to 12.5 percent. The percentage of the nonelderly population without any form of health insurance increased from 14.8 percent in 1987 to 17.4 percent, or 40.3 million individuals, in 1995. The percentage of nonelderly Americans with employment-based coverage fell for both individuals with coverage in their own name and those with coverage as dependents. In 1995, 32.7 percent of the nonelderly population had coverage in their own name, compared with 33.8 percent in 1987. Similarly, 31.1 percent of the nonelderly population had employment-based health insurance as dependents in 1995, compared with 35.4 percent in 1987. One of the most important determinants of health insurance coverage is work status and hours of work. While employment-based health insurance received directly from worker's employer decreased between 1987 and 1995 from 66.2 percent of 63.2 percent among full-time workers, the percentage of part-time workers with employment-based health insurance coverage in their own name increased from 17.2 percent to 20.1 percent. The percentage of workers with dependent coverage fell for both full-time and part-time workers, as did the percentage of nonworkers with dependent coverage. Workers in the manufacturing industry are most likely to have employment-based health insurance; they are also the workers most likely to have experienced a decrease in employment-based coverage between 1987 and 1995. In contrast, workers employed in most of the service sectors, experienced an increase in employment-based health insurance, self-employed workers experienced a decrease, and government workers experienced a slight increase. Cost is one of the primary factors contributing to the decline in employment-based health insurance coverage. While health insurance premium cost increases have slowed during the past three years, many health care analysts are predicting an increase in health insurance premiums during the next few years. Inflationary pressure may come from health care providers, health insurers, consumers, and/or policymakers. If inflationary pressure increases health insurance premiums, we are likely to see a continued decline in employment-based health insurance and a subsequent increase in both Medicaid and uninsured populations.     

Health care reform: managed competition and beyond

Since the election, the health care reform debate has focused on three broad features: implementation of managed competition, changes in the tax treatment of health insurance, and the imposition of budget caps or targets. The basic element of managed competition is the creation of sponsors who act as collective purchasing agents for large groups of individuals. One of the potentially most politically difficult issues in implementing any health care reform proposal is likely to be defining the minimum standard benefit package. It will determine the costs society bears, the income of providers, the health of many individuals, and the attributes of a workable health care reform package. Managed competition is intended to foster competition among health plans on the basis of cost and quality. The measures of quality actually employed in the health care system will determine in large part the incentives faced by insurers, providers, and consumers. The problem of adverse selection is potentially the most important issue in reforming the health insurance market. If individuals can opt not to purchase health benefits, poorer risks will be more likely to purchase health insurance than good risks, and at minimum the price of these benefits will be higher than would otherwise be the case. Managed competition requires that individuals share at least some of the financial consequences of their choices among health plans. As a result, most managed competition proposals change the tax code by limiting the exclusion of employer contributions to health insurance from worker's taxable income. Changing the health insurance market, mandating employer health benefits, and changing the tax code may have significant effects on the health care delivery system, but they are unlikely to reduce health care cost inflation in the near term. One of the proposals for restraining the growth in health care costs is the imposition of a budget on the amount spent on health care services. The combination of the constraints placed on federal governmental action by the budget and the significant political problems involved in reaching a consensus on the important elements of health care reform may limit the ability of the federal government to implement national health care reform in the near term. As a result, individual states may be encouraged by the federal government to continue to experiment with their own health reform programs.     

Proposal for training of workers and researchers as from the participatory return of research results in workers' health

This study streams from a perspective of Workers' Health as a field of intervention where worker's experience on the process of illness is essential to understand and generate changes in the work process, and to contribute to develop knowledge in this area. We intended to collaborate in the training of researchers and nursing workers as a means of contributing to amplify their knowledge related to work and health conditions. As a motto to promote dialogue between researchers and workers, we organized workshops to discuss the results of an epidemiological study on the work-health relationships in nursing. Ten workshops were conducted at two federal public hospitals, in the city of Rio de Janeiro, Brazil. The main aspects discussed during the workshops revealed (i) work nuances for which the questionnaire was not sufficiently sensitive, (ii) some associations between different aspects of the survey, dealt with in the questionnaires, and (iii) recognition that some aspects shown in the epidemiological results were experienced at work. One can appreciate that the proposal presented here contributed to the training of researchers and workers, amplifying their knowledge and contributing to the development of the activity.     

NOTES ON MINCER'S LOG-EARNINGS MODEL

In his famous human capital model, Mincer provides assumptions under which a worker's annual log-earnings are a function of years of schooling and years of experience. The function has the important property, widely invoked in empirical studies, that its derivative with respect to schooling equals the rate of return to the schooling investment. It is shown here that some of Mincer's assumptions are not needed for the property to hold, but that other assumptions carry troublesome hidden implications.     

Medicare on life support: will it survive?

This Issue Brief discusses Medicare reform. The Balanced Budget Act of 1997 reduces spending in the Medicare program by $115 billion between 1998 and 2002. Most of the reduction in spending comes from reducing payments to providers, and most of the savings (36 percent) occur in 2002. By 2007, the Part A trust fund is expected to be insolvent, four years before the baby-boom generation reaches the current Medicare eligibility age of 65. Congress is likely to revisit Medicare reform in the near future. A number of reforms received a significant amount of attention during the Medicare reform debate, but were not included in the final legislation. The Senate-passed legislation would have increased the Medicare eligibility age from 65 to 67, imposed means testing on Medicare Part B, and imposed a Part B home health copayment of $5. While these provisions were not included in the Balanced Budget Act of 1997, they may be the focal point of future Medicare reform. Many changes to the Medicare program are likely to significantly affect employment-based health plans for both active and retired workers. Raising the Medicare eligibility age would undoubtedly affect both workers and retirees. Unless workers are willing to work until age 67, their likelihood of becoming uninsured would increase. In 1995, 15.8 percent of retirees ages 55-64 were uninsured, compared with 11.5 percent of workers in the same age group. Early retirees might also find themselves unable to afford health insurance in the private market. An Employee Benefit Research Institute/Gallup poll indicates a direct link between the availability of retiree health benefits and a worker's decision to retire early. In 1993, 61 percent of workers reported that they would not retire before becoming eligible for Medicare if their employer did not provide retiree health benefits. If workers responded to an increase in the retirement age by working longer, employment-based health plans would probably experience an increase in costs, because older workers are the most costly to cover. Some employers might respond to an increase in the Medicare eligibility age by dropping coverage altogether. The message for future beneficiaries is becoming very clear: expect less from Medicare at later ages and higher premiums. As was true prior to the enactment of Medicare in 1965, workers will increasingly need to include retiree health insurance as an expected expense as they plan and save for retirement.     

FIRM SPECIFIC TRAINING, LAYOFFS, AND UNRELIABLE WORKERS

This paper determines the optimal level of firm specific training and the optimal level of layoffs when some workers are unreliable in that they may receive and accept offers from outside the firm; more specifically, the paper determines the evolution of firm specific training and layoffs as a worker acquires a reputation for reliability with his employer. The paper shows, for example, that layoffs may be higher or lower than the level implied by the condition that a worker's value of leisure equal the value of his contribution to output.     

Risk reduction in musculoskeletal practice assistance professional nursing pilot in semi intensive care unit

The hospitals mostly have a high level of complexity, diversity of services and, consequently, occupational risks. The tasks of mobilization and manual repositioning of patients may require professional of the physical demands due to the weight or excessive patient dependency, attitudes arising from inadequate to lean on a bed or work in a restricted area, sudden weight change that can occur if a patient loses balance or strength to change the position or while moving. These, among many other factors can cause or aggravate musculoskeletal problems in health care workers. These diseases translate into frequent musculoskeletal complaints, high rates of absenteeism, licenses and problems of prolonged labor, creating a vicious cycle that compromises patient safety and performance of institutions. The literature has suggested the administration of courses on handling and transportation of patients as one of the most important strategies to reduce the incidence of problems in the spine between the worker's healths. An exercise program emphasizing global distension and strength, mainly the posterior chain muscles (dorsal region), held twice a week, combined with an approach to ergonomics can reduce musculoskeletal symptoms and absenteeism in nursing.     

The social worker's style

The style of the social work practitioner is a very influential factor for therapeutic effectiveness and is a way of expressing the practitioner's creative artistry. The meanings and functions of style are clarified. The practitioner's general style is analyzed as a combination of personal and professional style elements, responsive to artistic role-task performances in helping clients. A case presentation illustrates a social worker's particular style. Wider cultural influences of a practitioner's style also merit recognition.     

Rethinking work-health models for the new global economy: a qualitative analysis of emerging dimensions of work

Technology change, rising international trade and investment, and increased competition are changing the organization, distribution and nature of work in industrialized countries. To enhance productivity, employers are striving to increase innovation while minimizing costs. This is leading to an intensification of work demands on core employees and the outsourcing or casualization of more marginal tasks, often to contingent workers. The two prevailing models of work and health - demand-control and effort-reward imbalance - may not capture the full range of experiences of workers in today's increasingly flexible and competitive economies. To explore this proposition, we conducted a secondary qualitative analysis of interviews with 120 American workers [6]. Our analysis identifies aspects of work affecting the quality of workers' experiences that are largely overlooked by popular work-health models: the nature of social interactions with customers and clients; workers' belief in, and perception of, the importance of the product of their work. We suggest that the quality of work experiences is partly determined by the objective characteristics of the work environment, but also by the fit of the work environment with the worker's needs, interests, desires and personality, something not adequately captured in current models.     

Organizational construction of intrinsic motivation

Some psychological theorists claim that the worker's level of intrinsic motivation or alienation stems from the meeting between universal drives and personality characteristics and the material attributes of job tasks. Social theorists—focusing on organizational socialization and cultural practices—emphasize the firm's capacity to manipulate the meaning of a task independent of its material qualities. This social construction of a task's meaning may shape the intrinsic rewards a worker associates with it. Little empirical evidence exists that clarifies the conditions under which the psychological or the social model holds, particularly the conditions under which socialization practices within the firm can shape the worker's level of intrinsic motivation associated with specific tasks. We argue that the intrinsic value associated with a task is determined by its centrality to and fit with the organization's normative social and technical structure. Based on a study of eighty-four staff members within a bureaucratic organization we found that workers perceived high levels of intrinsic value for tightly controlled and routine tasks when the firm's rationalized methods of organizing were seen as legitimate. This interaction operated independently of the direct (usually negative) influence of task control on intrinsic value. A contingency model of intrinsic motivation is proposed, taking into account both the material structure of a work task and its fit with the firm's social and technical structure. Here the perceived legitimacy of the organization's structure conditions whether tightly controlled and routine tasks are viewed as alienating or as intrinsically motivating.     

Employee benefits, retirement patterns, and implications for increased work life

This Issue Brief examines why policymakers are concerned about the trend toward early retirement and how it relates to Social Security, Medicare, and employee health and retirement benefits. It reviews the rationale for the effects of economic incentives on early retirement decisions and includes a summary of empirical literature on the retirement process. It presents data on how employee benefits influence workers' expected retirement patterns. Finally, it examines the implications of public policies to reverse early-retirement trends and raise the eligibility age for Social Security and Medicare. An employee Benefit Research Institute/Gallup survey indicates that there is a direct link between a worker's decision to retire early and the availability of retiree health benefits. In 1993, 61 percent of workers reported that they would not retire before becoming eligible for Medicare if their employer did not provide retiree health benefits. Participation in a pension plan can be an important determinant of retirement. Twenty-one percent of pension plan participants planned to stop working before age 65, compared with 12 percent among nonparticipants. Workers whose primary pension plan was a defined benefit plan were more likely to expect to stop working before age 65 (23 percent) than workers whose primary plan was a defined contribution plan (18 percent). Expected income replacement rates effect retirement patterns, indicating that as the expected replacement increases, the probability of expecting to stop working before age 65 increases. Twenty-two percent of workers with an expected income replacement rate below 60 percent expected to stop working before age 65, compared with 29 percent for those in the 60-69 percent replacement range, and 30 percent for those in the 70-79 percent replacement range. Workers expecting to receive retiree health insurance are more likely to expect to stop working before age 65 than workers who do not expect to have retiree health insurance. Twenty-one percent of workers with retiree health insurance expected to stop working before age 65, compared with 12 percent of workers not expecting to receive retiree health insurance. The Social Security Old-Age and Survivors Insurance (OASI) program depends on obtaining sufficient revenue from active workers' payroll taxes to fund the benefits received by retired beneficiaries. Funding the program in the past was in large part effortless because of the relatively large number of workers per retiree. Today, funding the program is a greater challenge because the ratio of workers to retirees has fallen. Policymakers have been able to agree that reform of the program is necessary for its survival; however, the debate over options to reform the program is just beginning, and it is likely to be a long time before a consensus emerges.