Is it really worse to have public health insurance than to have no insurance at all? Health insurance and adult health in the United States

Using prospective cohort data from the 1979 National Longitudinal Survey of Youth, this study examines the extent to which health insurance coverage and the source of that coverage affect adult health. While previous research has shown that privately insured nonelderly individuals enjoy better health outcomes than their uninsured counterparts, the same relationship does not hold for those publicly insured through programs such as Medicaid. Because it is unclear whether this finding reflects a true causal relationship or is in fact due to selection bias on socioeconomic status and health, previous estimates of the contribution of health insurance to inequities in health may have been biased. This study attempts to disentangle these competing hypotheses of causation or selection bias by using fixed effects models with sibling clusters to corroborate--or contradict--the results of a conventional OLS regression. By controlling for unobserved factors shared by siblings, such as parental genetic influences, sibling models estimate health insurance effects that are less affected by selection bias. Findings suggest that, among the US. birth cohorts of 1957 to 1961, the negative relationship between public health insurance and health is not causal, but rather due to prior health and socioeconomic status. Conversely, the lack of health insurance coverage has a strong cumulative negative impact on adult health.     

Private health insurance exchanges and defined contribution health plans: is it déjà vu all over again?

This issue brief examines issues related to private health insurance exchanges, possible structures of an exchange, funding, as well as the pros, cons, and uncertainties to employers of adopting them. A summary of recent surveys on employer attitudes are examined, as are some changes that employers have made to other benefits that might serve as historical precedents for a move to some type of defined contribution health benefits approach.     

Activation,medicalisation and inter-organisational cooperation in health insurance – implications for frontline social work in Sweden

This paper focuses on tensions between activation principles and medicalisation in the Swedish sickness insurance and its implications for frontline caseworkers in Social Security Agencies and Public Employment Services. The right to sickness cash benefits has become stricter and more conditioned upon the person’s work ability and employability. The paper describes recent policy changes towards activation and stricter entitlement criteria for sickness benefits policy and explores the consequences of such new activation policies in terms of changed work modes for caseworkers dealing with long-term sick people’s return-to-work process. It is concluded that on the one hand frontline work contains a significant portion of discretion and professional assessment of work abilities, and on the other hand rule-bound administrative work. Furthermore, frontline workers need to apply organisational professionalism as inter-organisational cooperation is required in order to support long-term sick people to return-to-work. Medicalisation of ill-health, manifested in the right to sickness benefits has not been substantially circumscribed by new activation policies in the sickness insurance.     

Poverty and disabled households in the People’s Republic of China: experiences with a new rural health insurance scheme

This article discusses what in international literature has commonly been termed the ‘vicious circle’ of poverty and disability. Our aim is to shed light on recent policies that attempt to break the vicious circle in rural areas in the People’s Republic of China. Drawing on data produced from fieldwork conducted in the Inner Mongolia Autonomous Region, People’s Republic of China, our approach is to explore experiences that households with people with disabilities have had with a newly implemented rural health insurance reform. The introduction of this reform is significant as lack of insurance and high healthcare expenses are currently perceived as crucial to causing poverty in rural China. We show that people with disabilities have been able to access this new insurance. At the same time, as currently practised, the new insurance does not prevent poor households from sinking deeper into poverty when using healthcare services as healthcare expenses increase.     

Will Australian workers' compensation insurance management get better soon?

A study of Australian experience in the state of New South Wales (NSW) suggests that private sector underwriting of workers' compensation insurance risk plus insurer competition on premium price may put downward pressure on benefits for injured workers, inhibit rehabilitation, and cause related cost increases for taxpayers and employers. Insurer underwriting also increases workers' compensation administrative costs and means an unnecessary loss of investment income for government and industry. An emerging and better alternative for the Australian community is for government and industry to underwrite a national workers' compensation scheme and to fix premium and benefit requirements which are competitively administered by insurers. In such a regulatory environment insurer inability to compete on premium price should promote competition to provide effective services to help employers prevent injury, assist rehabilitation and contain cost. National standards are necessary to enable widespread dissemination of comparable, reliable information on the outcome of health, rehabilitation, dispute resolution and return to work services. This is required to assess the competitive performance of service providers in order to ensure effective operation of the market to achieve scheme objectives. Holistic, multi-skilled and objective rehabilitation professionals are needed who can clearly demonstrate the effectiveness of their actions in assisting injury prevention, worker rehabilitation, and safe return to work across a range of industry contexts.     

Can regulation improve long-term care insurance? Lessons from the Medigap experience

This article uses recent experiences from the Medigap market to draw conclusions about the advisability of alternative methods of regulating the market for long-term care insurance. The analysis is based in part on interviews of state insurance regulators, insurance companies, and interest-group representatives. The authors conclude that some regulation of the market is appropriate, but that the structure and extent of regulation found in the Medigap market would likely be inappropriate for the long-term care insurance market at this time.     

Changing work, changing health: can real work-time flexibility promote health behaviors and well-being?

This article investigates a change in the structuring of work time, using a natural experiment to test whether participation in a corporate initiative (Results Only Work Environment; ROWE) predicts corresponding changes in health-related outcomes. Drawing on job strain and stress process models, we theorize greater schedule control and reduced work-family conflict as key mechanisms linking this initiative with health outcomes. Longitudinal survey data from 659 employees at a corporate headquarters shows that ROWE predicts changes in health-related behaviors, including almost an extra hour of sleep on work nights. Increasing employees' schedule control and reducing their work-family conflict are key mechanisms linking the ROWE innovation with changes in employees' health behaviors; they also predict changes in well-being measures, providing indirect links between ROWE and well-being. This study demonstrates that organizational changes in the structuring of time can promote employee wellness, particularly in terms of prevention behaviors.     

Does perceived discrimination affect health? Longitudinal relationships between work discrimination and women's physical and emotional health

This study uses longitudinal data to examine the causal relationships between perceived work discrimination and women's physical and emotional health. Using data on 1,778 employed women in the National Longitudinal Survey of Mature Women, we investigate the structural and individual characteristics that predict later perceptions of discrimination and the effects of those perceptions on subsequent health. We find that perceptions of discrimination are influenced by job attitudes, prior experiences of discrimination, and work contexts, but prior health is not related to later perceptions. However, perceptions of discrimination do impact subsequent health, and these effects remain significant after controlling for prior emotional health, physical health limitations, discrimination, and job characteristics. Overall, the results provide even stronger support for the health impact of workplace discrimination and suggest a need for further longitudinal analyses of causes and consequences of perceived discrimination.     

What encourages community health workers to use mobile technologies for health interventions? Emerging lessons from rural Rwanda

This article explores the determinants of using mobile phone technologies for public health (mHealth) through a quantitative study with community health workers (CHWs) in rural Rwanda. A total of 72 CHWs from two districts in Rwanda who were using the mHealth tool, RapidSMS, were surveyed in June 2014. Using a socio‐technical approach, user, programme and technical characteristics were tested and deemed influential in determining use. Technical characteristics (reminders and alerts) were by far the strongest predicting factors of use. The user characteristic, age, had no influence on utilization, while supports though training and supervision (programme characteristics) revealed mixed findings. These findings illustrate the uniqueness of each context and reiterate the need to consider social and technical factors when implementing mHealth projects.     

High quality private long-term care insurance: can we get there from here?

The private long-term care insurance market has undergone rapid change in the last several years. Although the quality of policies has generally improved, problems remain. Consumer protection issues include the lack of adequate inflation protection features, how activities of daily living are measured, potentially high lapse rates and lack of nonforfeiture values, how home care benefits are defined, and the appropriate loss ratio standards. The concerns of consumer and elderly advocates about the quality of private long-term care insurance have prompted congress to consider the need for federal intervention. While there are numerous approaches that the federal government could take, mandatory standards substantially higher than the current model standards of the National Association of Insurance Commissioners may prove the most effective in improving the quality of policies on a nationwide basis.     

How do health shocks influence retirement decisions?

The financial viability of the nation’s Medicare and Social Security programs has come into question as older adult workers, in particular members of the baby-boomer generation, begin to voluntarily retire. Obviously, any deterioration in the health of older adults will inevitably increase pressure on the Medicare system. However, if older adults respond to changes in their health by reducing their labor supply, than this will also increase demand for the Social Security system. Using data on married and employed couples from the Health and Retirement Study (HRS), this paper determines how the labor supply of each member of a married couple is influenced by changes in the health, assets and medical expenditures of the other member of the couple. Therefore, adding to the extant literature as we determine how the labor supply of an individual responds to health shocks visited on their spouse. We find that the labor supply of both males and females is influenced by their own health shocks and health shocks suffered by their spouses.

Underwriting slavery: insurance and slavery in the Dutch Republic (1718–1778)

This article shows that slavery was more connected to Dutch society and economy than has been previously assumed. It does so by investigating the people involved in Dutch slavery insurance in the period 1718–1734, when the Dutch slave trade was monopolized by the state-chartered West India Company (WIC) and the period 1763–1778, when the private slave trade reached its peak and slavery insurance was more common. This article analyzes a variety of primary sources that have not been studied in this light before. The analysis shows that a large and varied group was involved and that slavery insurance was not a regional institution that only affected the Dutch colonies.     

‘Widening cross-disciplinary research for mental health’: what is missing from the Research Councils UK mental health agenda?

This current issues article is a brief critical examination of the recent Research Councils UK agenda and call for cross-disciplinary research in mental health. Our argument is based on the fact that patient and public involvement (PPI) is the only involvement and influencing strategy for service users and survivors in the agenda. Service user and survivor research as a discipline in itself remains unacknowledged. We conclude that service user and survivor research is distinct and is different to PPI, and should be recognised in any mental health research agenda.     

Does income inequality harm health? New cross-national evidence

The provocative hypothesis that income inequality harms population health has sparked a large body of research, some of which has reported strong associations between income inequality and population health. Cross-national evidence is frequently cited in support of this important hypothesis, but the hypothesis remains controversial, and the cross-national work has been criticized for several methodological shortcomings. This study replicates previous work using a larger sample (692 observations from 115 countries over the 1947-1996 period), a wider range of statistical controls, and fixed-effects models that address heterogeneity bias. The relationship between health and inequality shrinks when controls are included. In fixed-effects models that capture unmeasured heterogeneity, the association between income inequality and health disappears. The null findings hold for two measures of income inequality: the Gini coefficient and the share of income received by the poorest quintile of the population. Analysis of a sample of wealthy countries also fails to support the hypothesis.     

Endangering one’s health to improve performance?

Background: Companies are increasingly applying both goal- and performance-oriented leadership practices. For employees, such indirect control practices make higher self-regulatory demands: They become responsible for their work outcomes and have to bear the consequences of failure just like the self-employed. The current study focuses on the concept of “self-endangering work behaviors” as representing a possible negative effect of indirect control and a possible mediator between work demands and negative outcomes. Method: An online survey was conducted with 607 employees, who reported to work in an indirect control setting. It assessed extension of working hours, intensification of working hours, sickness presenteeism, and faking as possible self-endangering work behaviors together with exhaustion as a subjective well-being measure. The lavaan package was used to test the mediation hypothesis with a structural equation model. Results: Results supported the assumption that self-endangering work behaviors might partly explain the association between work demands and exhaustion. A mediation effect was found for extension of working hours, intensification of working hours, and for faking. However, sickness presenteeism delivered no statistically significant mediation effect in the association between work demands and exhaustion. Discussion: As a mechanism for coping with high work demands, the new concept of self-endangering work behaviors offers one possible explanation for the negative association between high work demands and both subjective well-being and health. The concept needs to be addressed in occupational health prevention initiatives. Such interventions should balance the negative and positive effects of indirect control and take self-endangering work behavior into account.