Does the Incidence of Group Health Insurance Fall on Individual Workers?

Economic models predict that the cost of health insurance is borne by workers. In this paper we ask two questions. First, is cost shifting individual-specific: does a worker with higher expected medical expenses bear this cost? Second, how do explicit employee contributions affect cost shifting? We estimate wage change regressions that include as explanatory variables changes in health insurance coverage, changes in employee premium contributions, health status, and an interaction between health insurance changes and health status. We find no evidence of a significant wage offset at either the individual or group level and conclude that changes in health insurance status are not exogenous.     

Making the Invisible Visible: Are Health Social Workers Addressing the Social Determinants of Health?

This study explored the ways in which health social workers (HSW) address the social determinants of health (SDH) within their social work practice. Social workers (n?=?54) employed at major hospitals across Toronto had many years of practice in health care (M?=?11 years; SD?=?10.32) and indicated that SDH were a top priority in their daily work; with 98% intentionally intervening with at least one and 91% attending to three or more. Health care services were most often addressed (92%), followed by housing (72%), disability (79%), income (72%), and employment security (70%). Few HSW were tackling racism, Aboriginal status, gender, or social exclusion in their daily practice.     

Do Health Benefits Outweigh the Costs of Mass Recreational Programs? An Economic Analysis of Four Ciclovía Programs

One promising public health intervention for promoting physical activity is the Ciclovía program. The Ciclovía is a regular multisectorial community-based program in which streets are temporarily closed for motorized transport, allowing exclusive access to individuals for recreational activities and physical activity. The objective of this study was to conduct an analysis of the cost-benefit ratios of physical activity of the Ciclovía programs of Bogotá and Medellín in Colombia, Guadalajara in México, and San Francisco in the U.S.A. The data of the four programs were obtained from program directors and local surveys. The annual cost per capita of the programs was: U.S. $6.0 for Bogotá, U.S. $23.4 for Medellín, U.S. $6.5 for Guadalajara, and U.S. $70.5 for San Francisco. The cost-benefit ratio for health benefit from physical activity was 3.23-4.26 for Bogotá, 1.83 for Medellín, 1.02-1.23 for Guadalajara, and 2.32 for San Francisco. For the program of Bogotá, the cost-benefit ratio was more sensitive to the prevalence of physically active bicyclists; for Guadalajara, the cost-benefit ratio was more sensitive to user costs; and for the programs of Medellín and San Francisco, the cost-benefit ratios were more sensitive to operational costs. From a public health perspective for promoting physical activity, these Ciclovía programs are cost beneficial.     

After Graduation,What? An Analysis of the Job Placements of Graduates of Public Health Maternal and Child Health Training Programs

Objectives: In 1995, the Association of Teachers of Maternal and Child Health (ATMCH) decided that information about the employment status of program graduates was essential to attempts to improve MCH curricula. Method: ATMCH requested information from 13 MCH programs in schools of public health funded by the federal Maternal and Child Health Bureau and 12 provided information about their master's degree graduates in the 1990-1994 period, including the year of graduation, degree, Bureau traineeship support, position held, and employing agency. Results: The total number of graduates was 742. Four programs averaged less than 8 graduates per year (small); six, 10–16 (midsize); and two more than 22 (large). More than 90% of graduates received a M.P.H. In the 10 programs that provided data on Bureau support, 46% received traineeship support from the Bureau. Midsize programs had the largest percentage of graduates receiving traineeship support. Overall, 45% of graduates were in administrative positions, 32% were involved in patient care, 20% were in policy-analytic positions, and 3% in other positions. Forty-seven percent of program graduates entered into or continued in community-based agencies, 18% in government agencies, 17% in academic or research agencies, and 18% in other agencies. Program size was significantly associated with both position and the agency in which the graduate was employed. Bureau traineeship support was associated with employing agency. Conclusions: The study suggests the need for changes in MCH curricula, enhanced education opportunities in specialty skill areas, and an ongoing survey of graduates of MCH programs.A Project of the Association of Teachers of Maternal and Child Health.     

Health in All Policies--all talk and little action?

For three decades, Canadian and international researchers have been suggesting that improving population and public health requires attention to a range of determinants and factors and that concerted and coordinated action on the part of non-health ministries and organizations might be necessary to achieve this goal. Suggestions have been made for collaboration and integration by explicitly designing intersectoral actions and interventions and assessing the impact of all policies and programs for their effects on health. While some progress has been made on these goals, it is minor compared to the size of the problem. This article addresses one type of intersectoral action, Health in All Policies (HiAP), and asks questions about why it has not gained a place in governments across Canada. Possible barriers are suggested, such as current structural and political factors that prevent long-range, shared strategies to improve health. Suggestions are made for generating economic and evaluative data on HiAP, developing more sensitive tools for measuring HiAP and adopting explicit "trans-sectoral" approaches to policy-making.     

Effectiveness and Cost-benefit Evaluation of a Comprehensive Workers’ Health Surveillance Program for Sustainable Employability of Meat Processing Workers

Objective To evaluate the effectiveness of a comprehensive workers’ health surveillance (WHS) program on aspects of sustainable employability and cost-benefit. Methods A cluster randomized stepped wedge trial was performed in a Dutch meat processing company from february 2012 until march 2015. In total 305 workers participated in the trial. Outcomes were retrieved during a WHS program, by multiple questionnaires, and from company registries. Primary outcomes were sickness absence, work ability, and productivity. Secondary outcomes were health, vitality, and psychosocial workload. Data were analyzed with linear and logistic multilevel models. Cost-benefit analyses from the employer’s perspective were performed as well. Results Primary outcomes sickness absence (OR?=?1.40), work ability (B?=??0.63) and productivity (OR?=?0.71) were better in the control condition. Secondary outcomes did not or minimally differ between conditions. Of the 12 secondary outcomes, the only outcome that scored better in the experimental condition was meaning of work (B?=?0.18). Controlling for confounders did not or minimally change the results. However, our stepped wedge design did not enable adjustment for confounding in the last two periods of the trial. The WHS program resulted in higher costs for the employer on the short and middle term. Conclusions Primary outcomes did not improve after program implementation and secondary outcomes remained equal after implementation. The program was not cost-beneficial after 1–3 year follow-up. Main limitation that may have contributed to absence of positive effects may be program failure, because interventions were not deployed as intended.     

Displaced Workers and Employer-Provided Health Insurance: Evidence of a Wage/Fringe Benefit Tradeoff?

Job changes that result from plant closings and mass layoffs provide an opportunity to see how workers respond to an employment shock that is arguably exogenous to individual productivity. Comparing compensation packages of displaced workers on their old and new jobs is a potentially promising method to infer a tradeoff between wages and non-wage benefits. Although displaced worker data overcomes many of the pitfalls to estimating wage/fringe tradeoffs by controlling for time-invariant unobserved productivity, time-varying unobservables could still bias estimates. In this analysis, I investigate the compensating wage differential for one particularly valuable benefit, employer-provided health insurance. I find that even after controlling for an extensive set of productivity factors, I obtain results indicating a wrong-signed tradeoff. Those who lose health insurance through the job change also lose wages relative to other displaced workers, while those who gain health insurance also gain in wages. Individuals expected to incur higher health care costs (older workers and workers who are likely to buy family coverage) do not experience steeper wage/health insurance tradeoffs as would be expected if employers were able to pass health care costs on to workers according to individual costs. Although this exercise fails to isolate a wage/fringe tradeoff, the strong correlation between changes in wages and changes in fringe benefits has important implications for public policy towards displaced workers. Further research is needed to understand the true magnitude and distribution of the costs of job displacement taking changes in fringe benefits into account.     

Who's Missing? Predictors of Attrition Following Participation in Culturally Targeted Educational Breast and Cervical Cancer Outreach Programs for Latinas

Rates of breast and cervical cancer screening among Latinas are suboptimal. The Esperanza y Vida program was developed to increase awareness of screening methods among Latinas. Lay health advisor cancer survivors are trained to deliver the program and use a narrative communication approach to promote breast and cervical cancer awareness and screening. This study aimed to identify characteristics of participants, within the larger study, who were lost, due to attrition, for follow-up assistance. Participants (N = 908) completed questionnaires that assessed knowledge, perceptions, and beliefs about breast and cervical cancer and were contacted after the program to assess screening and offer assistance in obtaining screening exams. Latinas who were younger than 40 years of age and who felt that the survivor's story would prompt them to make an appointment for screening were more likely to be lost to follow-up at 2 months. These findings have implications for future breast and cervical cancer outreach programs and interventions.     

Weight During the Postpartum Period: What Can Health Care Workers Do?

To describe the gestational month-to-month weight change, obstetric and lifestyle factors influencing postpartum weight retention (PPWR) and to suggest possible interventions to prevent PPWR. This study was part of a larger research project concerning maternal weight change after childbirth. 343 women were recruited on five maternity wards in the Antwerp region, Belgium. Weight and height were assessed by the researchers during two home visits at 3 and 14 months postpartum and participants completed a questionnaire investigating obstetric and lifestyle factors during the first home visit. The monthly weights in between the home visits were self-reported by the participants. Full data were available for 75 women. One year after childbirth 52.0 % of the women faced postpartum weight retention. The different monthly weight points within the changes differed significantly from each other up to sixth months postpartum. Prepregnancy weight, exceeding the recommendations from the Institute of Medicine (IOM) concerning weight gain during pregnancy, smoking behaviour and exercising during pregnancy significantly influenced the postpartum weight change. The amount of weight gained during pregnancy, breastfeeding, possible postpartum depression and experiencing a shortage of information concerning the weight change after childbirth significantly influenced postpartum weight retention. Weight gain during pregnancy, exceeding IOM-criteria, breastfeeding, depression and lack of information determine PPWR and can be modulated by interventions such as routine weighing or screening of pregnant women. Several of these influencing factors can be preventively influenced by health care workers. Overall, we believe women could benefit from more guidance before, during and after pregnancy. Moreover, we recommend to reintroduce routine weighing of pregnant women as weight gain during pregnancy seems one of the most important factors involved in PPWR.     

Enhancement of Health Department Capacity for Health Care–Associated Infection Prevention Through Recovery Act–Funded Programs

Objectives. We evaluated capacity built and outcomes achieved from September 1, 2009, to December 31, 2011, by 51 health departments (HDs) funded through the American Recovery and Reinvestment Act (ARRA) for health care–associated infection (HAI) program development.Methods. We defined capacity for HAI prevention at HDs by 25 indicators of activity in 6 categories: staffing, partnerships, training, technical assistance, surveillance, and prevention. We assessed state-level infection outcomes by modeling quarterly standardized infection ratios (SIRs) for device- and procedure-associated infections with longitudinal regression models.Results. With ARRA funds, HDs created 188 HAI-related positions and supported 1042 training programs, 53 surveillance data validation projects, and 60 prevention collaboratives. All states demonstrated significant declines in central line–associated bloodstream and surgical site infections. States that implemented ARRA-funded catheter-associated urinary tract infection prevention collaboratives showed significantly greater SIR reductions over time than states that did not (P = .02).Conclusions. ARRA–HAI funding substantially improved HD capacity to reduce HAIs not targeted by other national efforts, suggesting that HDs can play a critical role in addressing emerging or neglected HAIs.Health care–associated infections (HAIs) are an increasingly recognized cause of preventable morbidity and mortality.1,2 Since 2008, the Department of Health and Human Services (DHHS) has committed substantial resources toward prevention of HAIs. This commitment resulted in the DHHS Action Plan to Prevent HAIs, which identified key strategies to achieve and sustain progress in protecting patients from infections.3 Funding to health departments to carry out this plan came from the American Recovery and Reinvestment Act (ARRA) of 2009. The Epidemiology and Laboratory Capacity Program of the Centers for Disease Control and Prevention (CDC) distributed these funds, granting approximately $35.8 million for state-level capacity building for HAI prevention programs (ARRA–HAI) to 51 health departments in 49 states, the District of Columbia, and Puerto Rico.4The DHHS Action Plan emphasized aligning and coordinating HAI stakeholder efforts, promoting standardized metrics for HAI surveillance, and targeting reduction of device-associated, procedure-associated, and multidrug-resistant HAIs. The goal of ARRA–HAI funding was to enhance the role of state and territorial health departments in executing the Action Plan goals through allocation of funds in 3 domains: infrastructure, surveillance, and prevention. The CDC reviewed applications and distributed funds competitively. Health departments applied for a total of $66 230 990 and received $35 800 000 in Epidemiology and Laboratory Capacity funding; all health departments that applied received some funding. The average award was $210 000 for the 17 health departments that received funding only for infrastructure, $630 000 for the 12 health departments that received funding for 2 of the 3 domains, and $1.1 million for the 22 health departments that received funding for all 3 domains. Most health departments with little to no engagement in HAI activities at the time applications were filed (July 2009) received funds only for infrastructure. Conversely, health departments with more active HAI programs applied to enhance existing infrastructure in addition to proposing surveillance and prevention activities (Figure 1).Open in a separate windowFIGURE 1—Distribution of American Recovery and Reinvestment Act funding to 51 state and territorial health departments among infrastructure, surveillance, and prevention funding domains, 2009–2011.The CDC developed a conceptual program model that guided the evaluation and served as the basis for expectations related to health department performance.5 Health departments awarded funding for infrastructure (n = 48) were expected to dedicate staff time to HAI activities, promote strategic partnerships through regular assembly of a multidisciplinary advisory group of HAI stakeholders, and provide training and technical assistance to health care facilities regarding HAIs. Those awarded funding for surveillance (n = 31) were expected to enhance the quality of HAI surveillance through the National Healthcare Safety Network (NHSN) Surveillance System and to work toward active use of NHSN data to inform decision-making and motivate prevention. The 28 health departments awarded funds for prevention collaborative implementation were expected to lead or support multifacility prevention initiatives targeting HAI reductions through systematic implementation of evidence-based practices, data feedback, and culture change strategies.6We assessed capacity built (i.e., breadth of engagement in key HAI activities) and outcomes achieved (i.e., statewide HAI reductions) from September 1, 2009, to December 31, 2011, by the 51 health departments that received ARRA–HAI funding. The purpose of a systematic evaluation was to enhance accountability for federal dollars spent, assist states in monitoring progress, and inform future planning for state HAI programs. We determined health department capacity at baseline and at the end of the ARRA funding period. We aimed to (1) describe capacity enhancements achieved with ARRA–HAI funding, (2) examine the role of baseline capacity and size of funding award in predicting capacity enhancements achieved with ARRA–HAI funding, and (3) assess whether states with health departments that funded infection-specific prevention collaboratives achieved greater HAI reductions during the ARRA funding period than states that did not.