PubMed Search: Medical Expenditure Panel Survey
Crossed with keywords: Job, Work, Employment, Occupation, and Vocation
Conducted on: Tuesday, January 5, 2009
1. BMC Health Serv Res. 2008 May 9;8:101.
Body mass index and employment-based health insurance.
Fong RL, Franks P.
Department of Family & Community Medicine, University of California, Davis,
Sacramento, CA 95817, USA. rlfong@ucdavis.edu
BACKGROUND: Obese workers incur greater health care costs than normal weight
workers. Possibly viewed by employers as an increased financial risk, they may be
at a disadvantage in procuring employment that provides health insurance. This
study aims to evaluate the association between body mass index [BMI, weight in
kilograms divided by the square of height in meters] of employees and their
likelihood of holding jobs that include employment-based health insurance [EBHI].
METHODS: We used the 2004 Household Components of the nationally representative
Medical Expenditure Panel Survey. We utilized logistic regression models with
provision of EBHI as the dependent variable in this descriptive analysis. The key
independent variable was BMI, with adjustments for the domains of demographics,
social-economic status, workplace/job characteristics, and health
behavior/status. BMI was classified as normal weight (18.5-24.9), overweight
(25.0-29.9), or obese (> or = 30.0). There were 11,833 eligible respondents in
the analysis. RESULTS: Among employed adults, obese workers [adjusted probability
(AP) = 0.62, (0.60, 0.65)] (P = 0.005) were more likely to be employed in jobs
with EBHI than their normal weight counterparts [AP = 0.57, (0.55, 0.60)].
Overweight workers were also more likely to hold jobs with EBHI than normal
weight workers, but the difference did not reach statistical significance [AP =
0.61 (0.58, 0.63)] (P = 0.052). There were no interaction effects between BMI and
gender or age. CONCLUSION: In this nationally representative sample, we detected
an association between workers' increasing BMI and their likelihood of being
employed in positions that include EBHI. These findings suggest that obese
workers are more likely to have EBHI than other workers.
PMCID: PMC2387152
PMID: 18471293 [PubMed - indexed for MEDLINE]
2. J Occup Environ Med. 2008 May;50(5):527-34.
The association of diabetes with job absenteeism costs among obese and morbidly
obese workers.
Cawley J, Rizzo JA, Haas K.
Department of Policy Analysis and Management, Cornell University, Ithaca, New
York 14853, USA. JHC38@cornell.edu
Comment in:
J Occup Environ Med. 2008 Oct;50(10):1094; author reply 1094-5.
OBJECTIVE: To determine the extent to which absenteeism costs associated with
obesity and morbid obesity are traceable to diabetes, and whether obesity and
morbid obesity remain predictors of absenteeism costs after controlling for
diabetes. METHODS: Data from the Medical Expenditure Panel Survey for 2000-2004
are examined. Outcomes are probability of missing work in the previous year and
number of workdays missed. Predictors include diabetes, obesity and morbid
obesity, age, education, occupation category, and race. Models are estimated by
gender. RESULTS: Probability of missing work in the past year, number of days
missed, and absenteeism costs rise significantly with diabetes among the obese
and morbidly obese, with costs higher for the morbidly obese, after controlling
for diabetes. CONCLUSIONS: Diabetes is strongly predictive of absenteeism among
obese and morbidly obese workers. Employer efforts to reduce absenteeism should
include consideration of anti-obesity interventions and diabetes prevention.
PMID: 18469621 [PubMed - indexed for MEDLINE]
3. Health Aff (Millwood). 2003 May-Jun;22(3):203-13.
Health insurance for workers who lose jobs: implications for various subsidy
schemes.
Kapur K, Marquis MS.
RAND, Santa Monica, California, USA.
A number of proposals have been made to help laid-off workers purchase health
insurance. We use data from the 1996 Medical Expenditure Panel Survey to profile
the insurance status of workers who left a job. Our descriptive analysis suggests
that it might be difficult to design policies that target those who would
otherwise be uninsured and that large subsidies might be needed to help laid-off
workers.
PMID: 12757286 [PubMed - indexed for MEDLINE]
4. Health Aff (Millwood). 2003 Mar-Apr;22(2):139-53.
Pathways to access: health insurance, the health care delivery system, and
racial/ethnic disparities, 1996-1999.
Zuvekas SH, Taliaferro GS.
Center for Cost and Financing Studies, Agency for Healthcare Research and
Quality, Rockville, Maryland, USA.
We examine the roles that insurance coverage, the delivery system, and external
factors play in explaining persistent disparities in access among racial and
ethnic groups of all ages. Using data from the 1996-1999 Medical Expenditure
Panel Surveys and regression-based decomposition methods, we find that our
measures of health care system capacity explain little and that while insurance
clearly matters, external factors are equally important. Employment, job
characteristics, and marital status are key determinants of disparities in access
to insurance but are difficult for health policy to affect directly. Much of
existing disparities remains unexplained, presenting a challenge to developing
policies to eliminate them.
PMID: 12674417 [PubMed - indexed for MEDLINE]
1. Psychiatr Serv. 2009 Oct;60(10):1323-8.
County-level estimates of mental health professional shortage in the United
States.
Thomas KC, Ellis AR, Konrad TR, Holzer CE, Morrissey JP.
Cecil G Sheps Center for Health Services Research, University of North Carolina
at Chapel Hill, Chapel Hill, NC 27599, USA.
Comment in:
Psychiatr Serv. 2010 Jan;61(1):95; author reply 95-6.
OBJECTIVE: This study examined shortages of mental health professionals at the
county level across the United States. A goal was to motivate discussion of the
data improvements and practice standards required to develop an adequate mental
health professional workforce. METHODS: Shortage of mental health professionals
was conceptualized as the percentage of need for mental health visits that is
unmet within a county. County-level need was measured by estimating the
prevalence of serious mental illness, then combining separate estimates of
provider time needed by individuals with and without serious mental illness
derived from National Comorbidity Survey Replication, U.S. Census, and Medical
Panel Expenditure Survey data. County-level supply data were compiled from
professional associations, state licensure boards, and national certification
boards. Shortage was measured for prescribers, nonprescribers, and a combination
of both groups in the nation's 3,140 counties. Ordinary least-squares regression
identified county characteristics associated with shortage. RESULTS: Nearly one
in five counties (18%) in the nation had unmet need for nonprescribers. Nearly
every county (96%) had unmet need for prescribers and therefore some level of
unmet need overall. Rural counties and those with low per capita income had
higher levels of unmet need. CONCLUSIONS: These findings identified widespread
prescriber shortage and poor distribution of nonprescribers. A caveat is that
these estimates of need were extrapolated from current provider treatment
patterns rather than from a normative standard of how much care should be
provided and by whom. Better data would improve these estimates, but future work
needs to move beyond simply describing shortages to resolving them.
PMID: 19797371 [PubMed - in process]
2. Diabetes Care. 2009 Dec;32(12):2187-92. Epub 2009 Sep 3.
Health care and productivity costs associated with diabetic patients with
macrovascular comorbid conditions.
Fu AZ, Qiu Y, Radican L, Wells BJ.
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio,
USA. fuz@ccf.org
OBJECTIVE: To examine and quantify from the societal perspective the impact of
macrovascular comorbid conditions (MVCCs) on health care and productivity costs
in diabetic patients in the U.S. RESEARCH DESIGN AND METHODS: With use of the
pooled Medical Expenditure Panel Survey (MEPS) 2004 and 2006 data, a nationally
representative adult sample (aged >or=18 years) was included in the study. Health
care cost was measured by the annual health care expenditure. Productivity cost
was calculated from the lost productivity from missed work days and additional
bed days due to illness/injury based on the 2006 average national hourly wage.
Both 2004 and 2006 cost data were adjusted to 2006 dollars. Given the heavily
right-skewed distribution of the cost data, the generalized linear model with
log-link function and gamma variance was used to identify the relationship
between MVCCs and costs after controlling for age, sex, race, ethnicity,
education, income, employment status, smoking status, health insurance, diabetes
severity, and comorbidities. Negative binomial models were applied to analyze the
outcomes of missed work days and bed days. All statistics were adjusted using the
proper sampling weight from MEPS. RESULTS: Compared with diabetic patients
without MVCCs (n = 3,320), those with MVCCs (n = 913) had statistically
significant higher annual health care costs (5,120 USD, P < 0.001), more missed
work days (13.03 days, P < 0.001), and more bed days (7.60 days, P = 0.025) per
patient after controlling for differences in sociodemographics, smoking, diabetes
severity, and comorbidities. The marginal lost productivity cost was 2,388 USD
annually per patient. CONCLUSIONS: From the U.S. societal perspective, MVCCs in
diabetic patients are associated with increased health care and lost productivity
costs.
PMCID: PMC2782975 [Available on 2010/12/1]
PMID: 19729528 [PubMed - in process]
3. Spine (Phila Pa 1976). 2009 Sep 1;34(19):2077-84.
Trends in health care expenditures, utilization, and health status among US
adults with spine problems, 1997-2006.
Martin BI, Turner JA, Mirza SK, Lee MJ, Comstock BA, Deyo RA.
Departments of Health Services, University of Washington, Seattle, USA.
bim@u.washington.edu
STUDY DESIGN: Analysis of nationally representative survey data for spine-related
health care expenditures, utilization and self-reported health status. OBJECTIVE:
To study trends from 1997 to 2006 in per-user expenditures for spine-related
inpatient, outpatient, pharmacy, and emergency services; and to compare these
trends to changes in health status. SUMMARY OF BACKGROUND DATA: Although prior
work has shown overall spine-related expenditures accounted for $86 billion in
2005, increasing 65% since 1997, the study did not report per-user expenditures.
Understanding population-level per-user expenditure for specific services
relative to changes in the health status may help assess the value of these
services. METHODS: We analyzed data from the Medical Expenditure Panel Survey, a
multistage survey sample designed to produce unbiased national estimates of
health care utilization and expenditure. Spine-related hospitalizations,
outpatient visits, prescription medications and emergency department visits were
identified using ICD-9-CM diagnosis codes. Regression analyses controlling for
age, sex, comorbidity, and time (years) were used to examine trends from 1997 to
2006 in inflation-adjusted per-user expenditures, and utilization, and
self-reported health status. RESULTS: An average of 1774 respondents with spine
problems was surveyed per year; the proportion suggested an increase in the
number of people who sought treatment for spine problems in the United States
from 14.8 million in 1997 to 21.9 million in 2006. From 1997 to 2006, the mean
adjusted per-user expenditures were the largest component of increasing total
costs for inpatient hospitalizations, prescription medications, andemergency
department visits, increasing 37% (from $13,040 in 1997 to $17,909 in 2006), 139%
(from $166 to $397), and 84% (from $81 to $149), respectively. A 49% increase in
the number of patients seeking spine-related care (from 12.2 million in 1997 to
18.2 million in 2006) was the largest contributing factor to increased outpatient
expenditures. Population measures of mental health and work, social, and physical
limitations worsened over time among people with spine problems. CONCLUSION:
Expenditure increases for spine-related inpatient, prescription, and emergency
services were primarily the result of increasing per-user expenditures, while
those related to outpatient visits were primarily due to an increase in the
number of users of ambulatory services.
PMID: 19675510 [PubMed - indexed for MEDLINE]
4. Med Care. 2009 Jul;47(7 Suppl 1):S104-8.
Econometric modeling of health care costs and expenditures: a survey of
analytical issues and related policy considerations.
Mullahy J.
Department of Population Health Sciences, University of Wisconsin-Madison,
Madison, Wisconsin 52726, USA. jmullahy@wisc.edu
BACKGROUND: Econometric modeling of healthcare costs and expenditures has become
an important component of decision-making across a wide array of real-world
settings. OBJECTIVES: The objective of this article is to provide a brief summary
of important conceptual and analytical issues involved in econometric healthcare
cost modeling. To this end, the article explores: outcome measures typically
analyzed in such work; the decision maker's perspective in econometric cost
modeling exercises; specific analytical issues in econometric model
specification; statistical goodness-of-fit testing; empirical implications of
"upper tail" (or "high cost") phenomena; and issues relating to the reporting of
findings. DATA: Some of the concepts explored here are illustrated in light of
samples drawn from the 2005 Medical Expenditure Panel Survey and the 2005
Nationwide Inpatient Sample. RESULTS AND CONCLUSIONS: Analysts of healthcare cost
data have at their disposal an increasingly sophisticated tool kit for analyzing
such data that can in principle and in fact yield increasingly interesting
insights into data structures. Yet for such analyses to usefully inform policy
decisions, the manner in which such studies are designed, undertaken, and
reported must accommodate considerations relevant to the decision-making
community. The article concludes with some preliminary thoughts on how such
bridges might be constructed.
PMID: 19536020 [PubMed - indexed for MEDLINE]
5. Acad Pediatr. 2009 Jul-Aug;9(4):263-9. Epub 2009 May 31.
The impact of childhood activity limitations on parental health, mental health,
and workdays lost in the United States.
Witt WP, Gottlieb CA, Hampton J, Litzelman K.
Department of Population Health Sciences, School of Medicine and Public Health,
University of Wisconsin-Madison, 610 North Walnut Street, Office 503, Madison,
Wisconsin 53726, USA. wwitt@wisc.edu
OBJECTIVE: The aim of this study was to determine if and to what extent the onset
and persistence of childhood activity limitations (ongoing, resolved, or newly
reported) resulted in subsequent adverse health, mental health, and work
attendance outcomes among parents in the United States. METHODS: A study was
conducted using 10 panels (1996-2005) of the Medical Expenditure Panel Survey
(MEPS), a household survey of a nationally representative sample of the civilian
noninstitutionalized population in the United States. Participants in this study
were 18 827 parents and their children aged 0 to 17 years. RESULTS: During the
2-year study period, 15.6% of parents reported caring for a child aged 0 to 17
years with a limitation. Parents of children with any activity limitation were
significantly more likely to experience subsequent poor health and mental health.
Parents of children with ongoing or newly reported limitations had an increased
number of lost workdays as compared with parents of children without limitations.
Moreover, caring for multiple children with activity limitations was predictive
of adverse parental mental health outcomes. Parents of children with ongoing
activity limitations had significantly increased odds of poor mental health
compared with parents of children with resolved limitations. CONCLUSIONS: Caring
for a child with activity limitations affects the health, mental health, and work
attendance of parents. These findings indicate that child health can importantly
influence the health and work behavior of the family and that health care
providers should consider a family-centered approach to care.
PMCID: PMC2743933 [Available on 2010/7/1]
PMID: 19487173 [PubMed - indexed for MEDLINE]
6. Qual Life Res. 2009 Aug;18(6):727-35. Epub 2009 May 8.
Reliability and validity of the SF-12v2 in the medical expenditure panel survey.
Cheak-Zamora NC, Wyrwich KW, McBride TD.
School of Public Health, Saint Louis University, St. Louis, MO 63104, USA.
cheaknc@slu.edu
OBJECTIVE: Evaluate the reliability and validity of the Medical Outcomes Study
Short-Form version 2 (SF-12v2) in the 2003-2004 Medical Expenditure Panel Survey
(MEPS). RESEARCH DESIGN: Data were collected in the self-administered mail-out
questionnaire and face-to-face interviews of the MEPS (n = 20,661). Internal
consistency and test-retest reliability and construct, discriminate, predictive
and concurrent validity were tested. The EQ-5D, perceived health and mental
health questions were used to test construct and discriminate validity.
Self-reported work, physical and cognitive limits tested predictive validity and
number of chronic conditions assessed concurrent validity. RESULTS: Both Mental
Component Summary Scores (MCS) and Physical Component Summary Scores (PCS) were
shown to have high internal consistency reliability (alpha > .80). PCS showed
high test-retest reliability (ICC = .78) while MCS demonstrated moderate
reliability (ICC = .60). PCS had high convergent validity for EQ-5D items (except
self-care) and physical health status (r > .56). MCS demonstrated moderate
convergent validity on EQ-5D and mental health items (r > .38). PCS distinguish
between groups with different physical and work limitations. Similarly, MCS
distinguished between groups with and without cognitive limitations. The MCS and
PCS showed perfect dose response when variations in scores were examined by
participant's chronic condition status. CONCLUSIONS: Both component scores showed
adequate reliability and validity with the 2003-2004 MEPS and should be suitable
for use in a variety of proposes within this database.
PMID: 19424821 [PubMed - indexed for MEDLINE]
7. Obesity (Silver Spring). 2008 Sep;16(9):2155-62.
The effect of obesity and cardiometabolic risk factors on expenditures and
productivity in the United States.
Sullivan PW, Ghushchyan V, Ben-Joseph RH.
Department of Clinical Pharmacy, University of Colorado at Denver, Colorado, USA.
patrick.sullivan@uchsc.edu
OBJECTIVE: To examine the effect of obesity and cardiometabolic risk factors on
medical expenditures and missed work days. METHODS AND PROCEDURES: The 2000 and
2002 Medical Expenditure Panel Survey (MEPS), a nationally representative survey
of the US population, was used to estimate the marginal effect of obesity (BMI >
or = 30) on annual per-person medical expenditures and missed work days for
patients with diabetes, dyslipidemia, or hypertension using multivariate
regression methods controlling for age, sex, race, ethnicity, education, income,
insurance, and smoking status. Maximum Likelihood Heckman Selection with Smearing
retransformation was used to assess medical expenditures, and Negative Binomial
regression was used for missed work days. RESULTS: Normal weight individuals with
diabetes, dyslipidemia, or hypertension had significantly greater medical
expenditures than those without the respective condition ($6,006 (5,124-6,887),
$4,760 (4,102-5,417), $3,911 (3,345-4,476)) and obesity significantly exacerbated
this effect ($7,986 (7,397-8,574), $7,636 (7,072-8,200), $6,197 (5,745-6,649);
$2007; all P < 0.05). In addition, diabetes, dyslipidemia, and hypertension
resulted in greater missed work days (3.1 (0.94-6.21), 3.2 (0.42-7.91), 1.4
(0.0-3.52)) (all P < 0.05 except hypertension), which resulted in greater lost
productivity ($433, $451, $199) and obesity significantly exacerbated the
deleterious effect on work days (8.7 (4.44-15.2), 5.5 (2.18-10.5), 4.5
(2.92-6.34)) and lost productivity ($1,217, $763, $622) (all P < 0.05). In
addition, medical expenditures increased for increasing weight category and
increasing number of risk factors. DISCUSSION: Obesity significantly exacerbates
the deleterious effect of diabetes, dyslipidemia, and hypertension on medical
expenditures and productivity loss in the United States. Obesity is preventable
and public health efforts need to be undertaken to prevent its alarming increase
in order to reduce the incidence and effect of cardiometabolic risk factors.
PMID: 19186336 [PubMed - indexed for MEDLINE]
8. J Cancer Surviv. 2009 Mar;3(1):43-58. Epub 2008 Dec 10.
Preventive health services and lifestyle practices in cancer survivors: a
population health investigation.
Findley PA, Sambamoorthi U.
School of Social Work, Rutgers University, New Brunswick, NJ 08901, USA.
pfindley@rci.rutgers.edu
INTRODUCTION: Long term health in cancer survivors require both preventive health
services and certain health behavior practices in order to prevent the major
chronic diseases that can occur for any adult in the general population. Despite
this we currently do not know the pattern of clinical preventive services and
health behaviors of cancer survivors in the US population. The present study
examines the patterns of preventive health activities in two domains: clinical
preventive services and healthy lifestyle practices in a heterogeneous population
of cancer survivors. METHODS: Longitudinal analyses of Medical Expenditure Panel
Survey (MEPS) data, a nationally representative health survey, for the calendar
years 2000 through 2004 were conducted. Cancer survivors were defined as
individuals diagnosed with cancer in the baseline year and alive in the
subsequent year. To address both provider based and behavioral health activities,
two categories of care were included: clinical preventive services consisting of
influenza immunization, routine physical examination, and a dental check up
within the last year using the follow-up year data and healthy lifestyle
practices including engaging in moderate/vigorous exercise three times per week,
maintaining a body mass index (BMI) within normal range, and not currently
smoking. Chi-square tests and Poisson regressions were performed to identify
factors that were associated with these preventive health activities. RESULTS:
Unadjusted rates of preventive health activities were as follows: 78% had a
routine physical check up, 66% visited the dentist at least annually, and 54%
received an influenza immunization. Across healthy lifestyle practices, 80% did
not smoke, 52% engaged in regular exercise, and 37% maintained their BMI within
normal range. Only 31% received all three clinical preventive services and only
16.5% engaged in all three healthy lifestyle practices. Across both domains of
preventive health activities, age, marital status, and education were positively
associated with the number of services. Presence of diabetes and poorer mental
health were associated with greater number of clinical preventive services and
lower number of healthy lifestyle practices. Cancer survivors with fair/poor
perception of their mental health had lower number of clinical preventive
services and those with fair/poor perception of physical health engaged in lower
number of healthy lifestyle practices. Demographic and health status factors
impacted the two domains differentially. DISCUSSION/CONCLUSIONS: The rates and
predictors of preventive care varied by type of service/domain suggesting that
individualization is needed in creating a comprehensive preventive service and
lifestyle activity plan that accounts for the survivor's specific total care
needs, including all comorbidities. However, it was also found that cancer
survivors are less likely to engage in all types of preventive activities; a
one-size-fit-all approach is not recommended for preventive health education and
planning for this population. IMPLICATIONS FOR CANCER SURVIVORS: Our study
findings suggest the need to address the overall long term healthcare of cancer
survivors by prioritizing and developing individualized preventive plans to
optimize care that emphasize education, self care perceptions, and incorporate
other comorbidities.
PMID: 19067178 [PubMed - indexed for MEDLINE]
9. Women Health. 2008;47(4):1-17.
Disparities in preventive care by body mass index categories among women.
Banerjea R, Findley PA, Sambamoorthi U.
School of Social Work, Rutgers University, 536 George Street, New Brunswick, NJ
08901, USA. ranjanabanerjea@gmail.com
OBJECTIVE: The present analyses examined the relationship of body mass index
(BMI) categories to receiving age-appropriate preventive services among women.
METHOD: Data from the Medical Expenditure Panel Survey (2003, N = 10,954) were
analyzed using multiple logistic regressions. Outcomes were: age-appropriate
Pap-test, mammography, colorectal, cholesterol and blood pressure screening, and
influenza immunization. RESULTS: Overall, 3% of participants were underweight,
and 26.3% were obese. Obese women were less likely to receive Pap-tests (p <
.01), and underweight women less likely to receive mammography (p < .001). Dental
care was less likely across all BMI groups outside the normal weight range.
CONCLUSIONS: The association between BMI categories and preventive services use
varied by type of preventive care.
PMID: 18843937 [PubMed - indexed for MEDLINE]
10. Obesity (Silver Spring). 2008 Jun 26. [Epub ahead of print]
The Effect of Obesity and Cardiometabolic Risk Factors on Expenditures and
Productivity in the United States.
Sullivan PW, Ghushchyan V, H Ben-Joseph R.
1Department of Clinical Pharmacy, University of Colorado at Denver and Health
Sciences Center, Pharmaceutical Outcomes Research Program, Denver, Colorado, USA.
Objective:To examine the effect of obesity and cardiometabolic risk factors on
medical expenditures and missed work days.Methods and Procedures:The 2000 and
2002 Medical Expenditure Panel Survey (MEPS), a nationally representative survey
of the US population, was used to estimate the marginal effect of obesity (BMI
>/= 30) on annual per-person medical expenditures and missed work days for
patients with diabetes, dyslipidemia, or hypertension using multivariate
regression methods controlling for age, sex, race, ethnicity, education, income,
insurance, and smoking status. Maximum Likelihood Heckman Selection with Smearing
retransformation was used to assess medical expenditures, and Negative Binomial
regression was used for missed work days.Results:Normal weight individuals with
diabetes, dyslipidemia, or hypertension had significantly greater medical
expenditures than those without the respective condition ($6,006 (5,124-6,887),
$4,760 (4,102-5,417), $3,911 (3,345-4,476)) and obesity significantly exacerbated
this effect ($7,986 (7,397-8,574), $7,636 (7,072-8,200), $6,197 (5,745-6,649);
$2007; all P < 0.05). In addition, diabetes, dyslipidemia, and hypertension
resulted in greater missed work days (3.1 (0.94-6.21), 3.2 (0.42-7.91), 1.4
(0.0-3.52)) (all P < 0.05 except hypertension), which resulted in greater lost
productivity ($433, $451, $199) and obesity significantly exacerbated the
deleterious effect on work days (8.7 (4.44-15.2), 5.5 (2.18-10.5), 4.5
(2.92-6.34)) and lost productivity ($1,217, $763, $622) (all P < 0.05). In
addition, medical expenditures increased for increasing weight category and
increasing number of risk factors.Discussion:Obesity significantly exacerbates
the deleterious effect of diabetes, dyslipidemia, and hypertension on medical
expenditures and productivity loss in the United States. Obesity is preventable
and public health efforts need to be undertaken to prevent its alarming increase
in order to reduce the incidence and effect of cardiometabolic risk
factors.Obesity (2008) doi:10.1038/oby.2008.325.
PMID: 18719635 [PubMed - as supplied by publisher]
11. Pediatrics. 2008 Aug;122(2):e480-486.
Access to and use of paid sick leave among low-income families with children.
Clemans-Cope L, Perry CD, Kenney GM, Pelletier JE, Pantell MS.
The Urban Institute, 2100 M St NW, Washington, DC 20037, USA.
lclemans@ui.urban.org
OBJECTIVE: The ability of employed parents to meet the health needs of their
children may depend on their access to sick leave, especially for low-income
workers, who may be afforded less flexibility in their work schedules to
accommodate these needs yet also more likely to have children in poor health. Our
goal was to provide rates of access to paid sick leave and paid vacation leave
among low-income families with children and to assess whether access to these
benefits is associated with parents' leave taking to care for themselves or
others. METHODS: We used a sample of low-income families (<200% of the federal
poverty level) with children aged 0 to 17 years in the 2003 and 2004 Medical
Expenditure Panel Survey to examine bivariate relationships between access to and
use of paid leave and characteristics of children, families, and parents'
employer. RESULTS: Access to paid leave was lower among children in low-income
families than among those in families with higher income. Within low-income
families, children without >or=1 full-time worker in the household were
especially likely to lack access to this benefit, as were children whose parents
work for small employers. Among children whose parents had access to paid sick
leave, parents were more likely to take time away from work to care for
themselves or others. This relationship is even more pronounced among families
with the highest need, such as children in fair or poor health and children with
all parents in full-time employment. CONCLUSIONS: Legislation mandating paid sick
leave could dramatically increase access to this benefit among low-income
families. It would likely diminish gaps in parents' leave taking to care for
others between families with and without the benefit. However, until the
health-related consequences are better understood, the full impact of such
legislation remains unknown.
PMID: 18676534 [PubMed - indexed for MEDLINE]
12. J Occup Environ Med. 2008 May;50(5):527-34.
The association of diabetes with job absenteeism costs among obese and morbidly
obese workers.
Cawley J, Rizzo JA, Haas K.
Department of Policy Analysis and Management, Cornell University, Ithaca, New
York 14853, USA. JHC38@cornell.edu
Comment in:
J Occup Environ Med. 2008 Oct;50(10):1094; author reply 1094-5.
OBJECTIVE: To determine the extent to which absenteeism costs associated with
obesity and morbid obesity are traceable to diabetes, and whether obesity and
morbid obesity remain predictors of absenteeism costs after controlling for
diabetes. METHODS: Data from the Medical Expenditure Panel Survey for 2000-2004
are examined. Outcomes are probability of missing work in the previous year and
number of workdays missed. Predictors include diabetes, obesity and morbid
obesity, age, education, occupation category, and race. Models are estimated by
gender. RESULTS: Probability of missing work in the past year, number of days
missed, and absenteeism costs rise significantly with diabetes among the obese
and morbidly obese, with costs higher for the morbidly obese, after controlling
for diabetes. CONCLUSIONS: Diabetes is strongly predictive of absenteeism among
obese and morbidly obese workers. Employer efforts to reduce absenteeism should
include consideration of anti-obesity interventions and diabetes prevention.
PMID: 18469621 [PubMed - indexed for MEDLINE]
13. JAMA. 2008 Feb 13;299(6):656-64.
Expenditures and health status among adults with back and neck problems.
Martin BI, Deyo RA, Mirza SK, Turner JA, Comstock BA, Hollingworth W, Sullivan
SD.
Department of Orthopaedics and Sports Medicine, University of Washington,
Seattle, WA 98104, USA. bim@u.washington.edu
Erratum in:
JAMA. 2008 Jun 11;299(22):2630.
Comment in:
JAMA. 2008 Jun 11;299(22):2627; author reply 2627-8.
CONTEXT: Back and neck problems are among the symptoms most commonly encountered
in clinical practice. However, few studies have examined national trends in
expenditures for back and neck problems or related these trends to health status
measures. OBJECTIVES: To estimate inpatient, outpatient, emergency department,
and pharmacy expenditures related to back and neck problems in the United States
from 1997 through 2005 and to examine associated trends in health status. DESIGN
AND SETTING: Age- and sex-adjusted analysis of the nationally representative
Medical Expenditure Panel Survey (MEPS) from 1997 to 2005 using complex survey
regression methods. The MEPS is a household survey of medical expenditures
weighted to represent national estimates. Respondents were US adults (> 17 years)
who self-reported back and neck problems (referred to as "spine problems" based
on MEPS descriptions and International Classification of Diseases, Ninth
Revision, Clinical Modification definitions). MAIN OUTCOME MEASURES:
Spine-related expenditures for health services (inflation-adjusted); annual
surveys of self-reported health status. RESULTS: National estimates were based on
annual samples of survey respondents with and without self-reported spine
problems from 1997 through 2005. A total of 23 045 respondents were sampled in
1997, including 3139 who reported spine problems. In 2005, the sample included 22
258 respondents, including 3187 who reported spine problems. In 1997, the mean
age- and sex-adjusted medical costs for respondents with spine problems was $4695
(95% confidence interval [CI], $4181-$5209), compared with $2731 (95% CI,
$2557-$2904) among those without spine problems (inflation-adjusted to 2005
dollars). In 2005, the mean age- and sex- adjusted medical expenditure among
respondents with spine problems was $6096 (95% CI, $5670-$6522), compared with
$3516 (95% CI, $3266-$3765) among those without spine problems. Total estimated
expenditures among respondents with spine problems increased 65% (adjusted for
inflation) from 1997 to 2005, more rapidly than overall health expenditures. The
estimated proportion of persons with back or neck problems who self-reported
physical functioning limitations increased from 20.7% (95% CI, 19.9%-21.4%) to
24.7% (95% CI, 23.7%-25.6%) from 1997 to 2005. Age- and sex-adjusted
self-reported measures of mental health, physical functioning, work or school
limitations, and social limitations among adults with spine problems were worse
in 2005 than in 1997. CONCLUSIONS: In this survey population, self-reported back
and neck problems accounted for a large proportion of health care expenditures.
These spine-related expenditures have increased substantially from 1997 to 2005,
without evidence of corresponding improvement in self-assessed health status.
PMID: 18270354 [PubMed - indexed for MEDLINE]
14. J Occup Environ Med. 2007 Dec;49(12):1367-75.
Medical costs and sources of payment for work-related injuries among Hispanic
construction workers.
Dong X, Ringen K, Men Y, Fujimoto A.
CPWR - The Center for Construction Research and Training, Silver Spring, MD
20910, USA. SDong@cpwr.com
OBJECTIVE: To assess medical costs of occupational injuries and sources of
payment among Hispanic and non-Hispanic construction workers. METHODS: More than
7000 construction workers, including 1833 Hispanic workers were examined using
the Medical Expenditure Panel Survey, 1996 to 2002. Univariate and multivariate
analyses were conducted using SUDAAN. RESULTS: Annually, work-related injuries in
construction cost $1.36 billion (2002 dollars), with 46% paid by workers'
compensation. Compared with non-Hispanic workers, Hispanic workers were 53% more
likely to have medical conditions resulting from work-related injuries, but 48%
less likely to receive payment for medical costs from workers' compensation (P <
0.05). CONCLUSIONS: This study suggests an urgent need to reform the current
workers' compensation system to reduce the burden shifted to injured workers and
society. Such reforms should include easier access and more assistance for
Hispanic and other immigrant workers.
PMID: 18231083 [PubMed - indexed for MEDLINE]
15. J Occup Environ Med. 2007 Dec;49(12):1317-24.
Occupation-specific absenteeism costs associated with obesity and morbid obesity.
Cawley J, Rizzo JA, Haas K.
Department of Policy Analysis and Management, Cornell University, Ithaca, NY
14853, USA. JHC38@cornell.edu
OBJECTIVE: To document the absenteeism costs associated with obesity and morbid
obesity by occupation. METHODS: Data from the Medical Expenditure Panel Survey
for 2000-2004 are examined. The outcomes are probability of missing any work in
the previous year and number of days of work missed in the previous year.
Predictors include clinical weight classification, age, education, and race.
Models are estimated separately by gender and occupation category. RESULTS: The
probability of missing work in the past year, number of days missed, and costs of
absenteeism rise with clinical weight classification for both women and men, and
vary across occupation. Absenteeism costs associated with obesity total $4.3
billion annually in the United States. CONCLUSION: Substantial absenteeism costs
are associated with obesity and morbid obesity. Employers should explore
workplace interventions and health insurance expansions to reduce these costs.
PMID: 18231079 [PubMed - indexed for MEDLINE]
16. Value Health. 2007 Nov-Dec;10(6):443-50.
Productivity costs associated with cardiometabolic risk factor clusters in the
United States.
Sullivan PW, Ghushchyan V, Wyatt HR, Wu EQ, Hill JO.
University of Colorado at Denver and Health Sciences Center, Pharmaceutical
Outcomes Research Program, School of Pharmacy, 4200 East Ninth Avenue, C238,
Denver, CO 80262, USA. patrick.sullivan@uchsc.edu
OBJECTIVE: Cardiometabolic risk factors such as overweight/obesity,
hyperlipidemia, diabetes, and hypertension are prone to cluster together in the
same individual and result in an elevated risk of cardiovascular disease and
mortality. The purpose of this study was to examine and quantify the impact of
cardiometabolic risk factor clusters independent of heart disease on productivity
in a nationally representative sample of US adults. METHODS: The current study
estimated the impact of cardiometabolic risk factor clusters on missed work days
and bed days, controlling for sociodemographic characteristics, comorbidity, and
smoking status in a nationally representative, pooled 2000 and 2002 Medical
Expenditure Panel Survey sample. Cardiometabolic risk factor clusters included
BMI >or= 25 and two of the following three: diabetes, hyperlipidemia, and/or
hypertension. All estimates were expressedin $US 2005. Sensitivity analyses were
conducted to examine the impact of varying assumptions on the results. RESULTS:
After controlling for differences in sociodemographics, smoking and comorbidity,
individuals with cardiometabolic risk factor clusters missed 179% more work days
and spent 147% more days in bed (in addition to lost work days) than those
without. Lost work days and bed days resulted in $17.3 billion annually in lost
productivity attributable to cardiometabolic risk factor clusters in the United
States. Sensitivity analyses resulted in a range of annual lost productivity
costs from $3.2 to $23.1 billion. CONCLUSIONS: Common cardiometabolic risk factor
clusters have a significant deleterious impact on the US economy, resulting in
$17.3 billion in lost productivity.
PMID: 17970926 [PubMed - indexed for MEDLINE]
17. Med Care. 2007 Jul;45(7):602-9.
Global self-rated mental health: associations with other mental health measures
and with role functioning.
Fleishman JA, Zuvekas SH.
Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and
Quality, 540 Gaither Road, Rockville, MD 20850, USA. jfleishm@ahrq.gov
BACKGROUND: A large body of research shows that global self-rated health is
related to important outcome variables. Increasingly, studies also obtain a
single global self-rating of mental health, but understanding of what this item
measures is limited. OBJECTIVE: To clarify interpretation of self-reported mental
health, we examine its associations with other validated measures of mental
health and role functioning. RESEARCH DESIGN: We conducted cross-sectional
analyses of nationally representative data from the Medical Expenditure Panel
Survey. MEASURES: In-person household interviews obtained data on global
self-reported mental health and any limitations in work, school, or housekeeping
activities. Adult respondents (N = 11,109) completed the SF-12 health status
survey, the K6 scale of nonspecific psychologic distress, and the Patient Health
Questionnaire (PHQ-2) depression screener in a self-administered questionnaire.
We used the SF-12 Mental Component Summary and the mental health subscale.
Analyses examined associations among mental health measures and regressed
activity limitations, and the SF-12 physical and emotional role functioning
scales on mental health measures, controlling for demographics and selected
chronic conditions. RESULTS: The 4 multi-item mental health measures were
strongly correlated with each other (r > 0.69), but correlated less strongly with
the self-reported mental health item (r approximately 0.4). In an exploratory
factor analysis, self-reported mental health loaded on both mental and physical
health factors. In multivariate analyses, each mental health variable was
significantly associated with activity limitations and with role functioning, but
the association of self-reported mental health with emotional role functioning
was relatively weak. CONCLUSIONS: Although global self-rated mental health is
related to symptoms of psychologic distress, it cannot be considered to be a
substitute for them.
PMID: 17571008 [PubMed - indexed for MEDLINE]
18. AJR Am J Roentgenol. 2006 Nov;187(5):1160-5.
How could the radiologist shortage have eased?
Sunshine JH, Meghea C.
Research Department, American College of Radiology, 1891 Preston White Dr.,
Reston, VA 20191, USA. jsunshine@acr.org
OBJECTIVE: In 2000, a severe shortage of diagnostic radiologists existed in the
United States. We seek to explain how the shortage eased greatly by 2003, despite
the fact that the total imaging workload usually grows much faster than the
number of radiologists in practice, which would be expected to intensify the
shortage. MATERIALS AND METHODS: We measured the contribution of eight possible
explanations, predominantly using simple quantitative analyses. We analyzed
published data, data on the volume of imaging from Medicare and from the Medical
Expenditure Panel Survey, data on residents and fellows from the American College
of Radiology's (ACR) membership department, data on residents from the American
Board of Radiology, data from the ACR's 1995 and 2003 Surveys of Radiologists,
and data from interviews about nighthawk services. RESULTS: From these data
sources, we determined the following. Total imaging and imaging by radiologists
continued to grow rapidly--by > 20% from 2000 to 2003 (measured in relative value
units), which was somewhat faster than in the years preceding 2000 when the
shortage was building. Foreign imagers took on a negligible portion of the
workload. No reductions in retirement occurred among radiologists during
2000-2003, a 10-20% decrease in the annual number of residency graduates
occurred, and no increase in residents going directly into the workforce rather
than taking a fellowship was noted. Radiologists' average annual work hours were
relatively constant, increasing by perhaps 2%. Work done per hour--that is,
productivity--increased sharply (by approximately 15%) during this period.
CONCLUSION: Increased productivity is the predominant explanation of how the
radiologist shortage eased. The contribution of other factors was, in comparison,
small or even in the opposite direction.
PMID: 17056900 [PubMed - indexed for MEDLINE]
19. Ment Retard. 2006 Aug;44(4):249-59.
Women with cognitive limitations living in the community: evidence of
disability-based disparities in health care.
Parish SL, Saville AW.
School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill,
NC 27599-3550, USA. parish@email.unc.edu
Using data from the Medical Expenditure Panel Survey for 2000 and 2002, we
compared potential and realized use of health care for a national sample of
working-age women with cognitive disabilities. Despite having similar likelihoods
of potential access to health care as compared to nondisabled women, they had
markedly worse rates of receiving cervical cancer and breast cancer screenings,
similar rates of routine check-ups, and yet had better rates of receipt of
influenza shots. They were also less likely to be satisfied with their medical
care than were nondisabled women. Policy recommendations are suggested to address
the disability-based disparities in reproductive health care for women with
cognitive limitations.
PMID: 16834462 [PubMed - indexed for MEDLINE]
20. Headache. 2006 Apr;46(4):563-76.
Workplace absenteeism and aspects of access to health care for individuals with
migraine headache.
Lofland JH, Frick KD.
Health Policy, Thomas Jefferson University, Philadelphia, PA, USA.
OBJECTIVES: (1) To examine the relationship between access to care and the number
of missed workdays, and (2) to determine how this relationship is confounded by
the presence of having health insurance and health care use among migraineurs.
DESIGN/METHODS: This retrospective, pooled, cross-sectional study used 1996 to
1999 Medical Expenditure Panel Survey data. Employed migraineurs who were between
18 and 65 years of age were included. Individuals reporting a neoplastic or an
acute pain condition were excluded. An access to care index was developed using
Rasch Partial Credit Analysis. A 2-part model was used to estimate the annual
number of missed workdays. RESULTS: Of the 703 migraineurs, 538 (77%) reported
missing work time. Of those who missed work, the mean (SE) annual number of
missed workdays was 4.4 (.39). A higher level of access to care (P= .025) and
presence of depression (P= .033) were significantly associated with missing a
greater number of workdays. We created a proxy for migraine severity based on
migraine-related prophylactic medication use and hospitalization(s). Severe
migraines were significantly (OR = 2.01, SE = .51, P= .006) associated with an
increased likelihood to miss workdays. When health insurance was included in the
model, a higher level of access to care was significantly associated with the
increased likelihood to miss workdays (OR = 1.04, SE = .021, P= .05). From the
original model, the odds ratio (1.035 to 1.040) and the SE (.020 to .021)
increased slightly. When health care use was included in the model and health
insurance was removed, (1) emergency department visits were significantly (P=
.006) associated with missing a greater number of workdays, and (2) access to
care was significantly associated with missing a greater number of workdays (P=
.028). When having health insurance and health care use were simultaneously
included in the model, a higher level of access to care was significantly
associated with greater likelihood to miss work (OR = 1.040, SE = .0212, P= .05)
and missing a greater number of workdays (P= .005). However, a change of 1
standard deviation in the score would be associated with a 12% change in the odds
to miss work and only 8 percentage points change in the number of missed
workdays. CONCLUSIONS: Contrary to expectations, a higher level of access to care
is significantly associated with an increased likelihood to miss work and with
missing a greater number of workdays. Depression, migraine severity, and health
care use are important explanatory variables. Having health insurance may be a
confounder between access to care and workplace absenteeism.
PMID: 16643549 [PubMed - indexed for MEDLINE]
21. Med Decis Making. 2006 Jan-Feb;26(1):18-29.
Estimating the association between SF-12 responses and EQ-5D utility values by
response mapping.
Gray AM, Rivero-Arias O, Clarke PM.
Health Economics Research Centre, Department of Public Health, University of
Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
alastair.gray@dphpc.ox.ac.uk
BACKGROUND: Reliably mapping from generic or disease-specific health status
measures into health state utilities would assist health economists. Existing
studies mainly use ordinary least squares (OLS) regression equations to predict
utility values for particular health states. The authors examine an alternative
approach to map between 2 generic health status instruments, the SF-12 and the
EQ-5D. METHODS: Multinomial logit regression is used to estimate the probability
that a respondent will select a particular level of response to questions in the
EQ-5D, using individual question responses and summary scores from the SF-12 as
predictors. Monte Carlo simulation methods are used to generate predicted EQ-5D
responses, and utility scores (tariffs) are then attached. Results are compared
with an alternative approach based on direct mapping to utility scores using OLS.
DATA: The authors estimate equations using 12,967 adult survey responses-from the
2000 US Medical Expenditure Panel Survey. They report mean squared error (MSE)
and mean absolute error (MAE) of their predicted utilities within this sample,
and out-of-sample using 13,304 adults from the 1996 Health Survey for England.
RESULTS: The authors obtain an in-sample and out-of-sample MSE of 0.03, compared
with 0.02 for the OLS approach. Their MAE of 0.11 is similar to OLS results. The
authors' method predicts group mean utility scores and differentiates between
groups with or without known existing illness. CONCLUSIONS: The authors' approach
has higher MSE than the direct OLS approach but gives more descriptive data on
domains of health effects. Further out of sample prediction work will help test
the validity of these methods.
PMID: 16495197 [PubMed - indexed for MEDLINE]
22. Am J Manag Care. 2005 Oct;11(10):641-6.
A cost-benefit simulation model of coverage for bariatric surgery among full-time
employees.
Finkelstein EA, Brown DS.
RTI International, PO Box 12194, 3040 Cornwallis Road, Research Triangle Park, NC
27709-2194, USA. finkelse@rti.org
OBJECTIVE: To use a simulation model to estimate the costs and benefits of
bariatric surgery among full-time employees. STUDY DESIGN: Multivariate
regression analysis of nationally representative survey data sets to estimate the
costs of obesity and a simulation model of the number of years until breakeven
under alternate assumptions about the costs and benefits of bariatric surgery.
METHODS: We used a 2-part model to estimate medical costs of obesity based on the
2000-2001 Medical Expenditure Panel Survey. We estimated work loss with a
negative binomial regression based on the 2002 National Health Interview Survey.
Using these results, we simulated the expected number of years required for a
bariatric surgery procedure to become cost saving. RESULTS: Nine percent of the
full-time US workforce, or 29% of the obese workforce, is eligible for bariatric
surgery. Obese workers eligible for bariatric surgery have 5.1 (P < .01)
additional days of work loss and USD 2230 (in 2004 dollars) (P < .01) higher
annual medical costs than persons of normal weight. CONCLUSION: Although the cost
implications of bariatric surgery among full-time employees depend on many
factors, the simulations reveal that 5 or more years of follow-up are most likely
required for these operations to become cost saving unless the employee bears a
significant fraction of the total costs of the surgery.
PMID: 16232005 [PubMed - indexed for MEDLINE]
23. J Gerontol A Biol Sci Med Sci. 2005 Sep;60(9):1184-9.
Obesity and mortality in elderly nursing home residents.
Grabowski DC, Campbell CM, Ellis JE.
Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue,
Boston, Massachusetts 02115, USA. grabowski@med.harvard.edu
BACKGROUND: The increasing prevalence of obese Americans over the last several
decades has been well documented. A number of studies have analyzed the
relationship of obesity and mortality in community-dwelling elderly persons, but
little work has analyzed this issue within the institutionalized elderly
population. METHODS: In an analysis of the 1996 Medical Expenditures Panel Study,
we used logistic regression methods to examine the excess mortality associated
with obesity, as defined by body mass index (BMI), over calendar year 1996 for
existing and new nursing home residents. RESULTS: Across the total sample of
existing and new residents, there was not a statistically significant difference
in mortality for "obese" (BMI > 28 kg/m2) nursing home residents (odds ratio [OR]
0.89; 95% confidence interval [CI], 0.67-1.17) compared to the "normal" group,
but obesity was associated with significantly less mortality among existing
residents (OR 0.75; 95% CI, 0.57-0.98). For "thin" (BMI < 19 kg/m2) nursing home
residents, there was significantly higher mortality among both current residents
(OR 1.40; 95% CI, 1.11-1.77) and new admissions (OR 1.63; 95% CI, 1.17-2.28). For
"very obese" (BMI > 35 kg/m2) individuals, there was a significantly higher
mortality among new admissions (OR 1.75; 95% CI, 1.10-2.80), but not existing
residents (OR 0.67; 95% CI, 0.38-1.15). These effects persisted for "very obese"
individuals (BMI > 40 kg/m2). CONCLUSIONS: Very obese nursing home residents
experience higher mortality early in their stay, but this association diminishes
over time with some evidence suggesting that a higher BMI may be protective among
long-stay residents.
PMID: 16183961 [PubMed - indexed for MEDLINE]
24. J Am Dent Assoc. 2005 Feb;136(2):221-8.
An analysis of preventive dental visits by provider type, 1996.
Goodman HS, Manski MC, Williams JN, Manski RJ.
Department of Health Promotion and Policy, Dental School, University of Maryland,
Baltimore 21201, USA. hsg001@dental.umaryland.edu
BACKGROUND: Understanding preventive dental visit utilization patterns
facilitates planning of the dental health services delivery system. The authors
examine these patterns by analyzing the receipt of preventive dental services in
the United States by type of dental provider. METHODS: The authors analyzed data
from the 1996 Medical Expenditure Panel Survey (MEPS) for the U.S.
community-based population. They developed national estimates for the population
with preventive dental visits by provider type, including the population with a
preventive dental visit and mean number of preventive dental visits per person
for socioeconomic and demographic categories. RESULTS: Respondents who are white,
are older, are female, have dental insurance, are from higher income and
education backgrounds, and reside in small metropolitan areas were more likely (P
< .05) to receive preventive care from a dental hygienist than from a dentist.
CONCLUSION: MEPS data showed that people's socioeconomic background and other
demographic factors were associated with having a preventive dental visit with a
dentist or dental hygienist. These factors also influence the per-person number
of preventive visits by type of dental practitioner. These elements must be
considered when planning for future dental work force needs. PRACTICE
IMPLICATIONS: Estimating future dental work force needs through this analysis
assists dentists in meeting patient demand and maximizing the productive output
of all services rendered in their practices, including preventive services.
PMID: 15782529 [PubMed - indexed for MEDLINE]
25. J Child Adolesc Psychopharmacol. 2005 Feb;15(1):88-96.
Race/ethnicity and insurance status as factors associated with ADHD treatment
patterns.
Stevens J, Harman JS, Kelleher KJ.
Ohio State University Department of Pediatrics, Division of Psychology, Columbus,
OH 43205, USA. stevensj@chi.osu.edu
Using data from the 1997-2000 Medical Expenditure Panel Survey (MEPS),
disparities in different stages of attention-deficit/hyperactivity disorder
(ADHD) health care were investigated, from initial detection to follow-up
physician visits and psychotherapy appointments. Differences in ADHD diagnoses,
stimulant usage, and health-care visits were examined by age, race/ethnicity,
region, and type of insurance. Major significant findings were: (1) children
without insurance had lower levels of care in all stages relative to children
with insurance, (2) Hispanic-American and African-American children were less
likely to be diagnosed with ADHD by parent report than were white American
children, and (3) African-American youths with ADHD were less likely to initiate
stimulant medication relative to white American children. Implications for
expanding childhood health insurance coverage, and for future work on minority
mental health care in regard to ADHD, are discussed.
PMID: 15741790 [PubMed - indexed for MEDLINE]
26. Prev Chronic Dis. 2005 Jan;2(1):A11. Epub 2004 Dec 15.
Direct and indirect costs of asthma in school-age children.
Wang LY, Zhong Y, Wheeler L.
Surveillance and Evaluation Research Branch, Division of Adolescent and School
Health, National Center for Chronic Disease Prevention and Health Promotion,
Centers for Disease Control and Prevention, Chamblee, GA 30341, USA. lgw0@cdc.gov
INTRODUCTION: Asthma is one of the most common chronic diseases of childhood and
is the most common cause of school absenteeism due to chronic conditions. The
objective of this study is to estimate direct and indirect costs of asthma in
school-age children. METHODS: Using data from the 1996 Medical Expenditure Panel
Survey, we estimated direct medical costs and school absence days among
school-age children who had treatment for asthma during 1996. We estimated
indirect costs as costs of lost productivity arising from parents' loss of time
from work and lifetime earnings lost due to premature death of children from
asthma. All costs were calculated in 2003 dollars. RESULTS: In 1996, an estimated
2.52 million children aged five to 17 years received treatment for asthma. Direct
medical expenditure was 1009.8 million dollars (401 dollars per child with
asthma), including payments for prescribed medicine, hospital inpatient stay,
hospital outpatient care, emergency room visits, and office-based visits.
Children with treated asthma had a total of 14.5 million school absence days;
asthma accounts for 6.3 million school absence days (2.48 days per child with
asthma). Parents' loss of productivity from asthma-related school absence days
was 719.1 million dollars (285 dollars per child with asthma). A total of 211
school-age children died of asthma during 1996, accounting for 264.7 dollars
million lifetime earnings lost (105 dollars per child with asthma). Total
economic impact of asthma in school-age children was 1993.6 million dollars (791
dollars per child with asthma). CONCLUSION: The economic impact of asthma on
school-age children, families, and society is immense, and more public health
efforts to better control asthma in children are needed.
PMCID: PMC1323314
PMID: 15670464 [PubMed - indexed for MEDLINE]
27. Med Care. 2004 May;42(5):456-64.
The admission of blacks to high-deficiency nursing homes.
Grabowski DC.
Department of Health Care Organization and Policy, School of Public Health,
University of Alabama at Birmingham, Birmingham, Alabama, USA. grabowsk@uab.edu
BACKGROUND: Although the presence of racial and ethnic disparities in nursing
home care has been established, there is no work to date examining the
relationship between race and government-cited nursing home deficiencies.
Deficiencies are evaluations of poor quality made by state surveyors under the
federal nursing home certification regulations. OBJECTIVE: The objective of this
study was to examine whether blacks and other minority elders are
disproportionately admitted to high-deficiency nursing homes. RESEARCH DESIGN:
This observational study used a merged file containing individual-level data from
the Nursing Home Component of the 1996 Medical Expenditures Panel Study (MEPS)
and facility-level quality information from the Online Survey, Certification, and
Reporting System. SUBJECTS: The subjects were a 1996 nationally representative
sample of 2690 nursing home admissions from the MEPS. MEASURES: The key variables
of interest were the race and ethnicity of newly admitted nursing home residents
and the facility's count of government-assigned deficiency citations. RESULTS:
Controlling for individual, facility, and market characteristics, blacks were
disproportionately admitted to nursing homes with a higher number of
deficiencies. In a model that controlled for resident and home characteristics,
blacks were admitted to nursing homes that exceeded the mean state deficiency
level by 1.32. CONCLUSIONS: Policymakers might wish to consider initiatives that
provide better quality information to black nursing home consumers, and, to the
extent that black consumers lack choice, provide greater resources and better
oversight of facilities that care for predominantly black residents.
PMID: 15083106 [PubMed - indexed for MEDLINE]
28. J Occup Rehabil. 2004 Mar;14(1):1-11.
Employment and disability: evidence from the 1996 medical expenditures panel
survey.
Findley PA, Sambamoorthi U.
Program for Disability Research, Rutgers University, New Brunswick, New Jersey
08901, USA. pfindley@rci.rutgers.edu
The relationship between employment and disability has gained national attention,
as the ability to maintain employment is inconsistent among those with
limitations. This cross-sectional study of employment among individuals (N =
1691, age 21-62 years) with self-reported limitations in the 1996 Medical
Expenditures Panel Survey seeks to identify predictors of employment despite
physical and/or cognitive limitations. Two predictive models of employment
including 10 variables are explored; 1 included insurance (chi2 = 3856.85, p < or
= 0.00) and the other removed the insurance variable (chi2 = 280.21, p < or =
0.00). Individuals with limitations who are employed are more likely to have a
college-level education, have better physical and mental health perceptions and
have private insurance. This analysis demonstrates that people do work despite
reported activity, functional or sensory limitations and that socioeconomic
factors are crucial in why someone is able to attain employment.
PMCID: PMC1805460
PMID: 15055500 [PubMed - indexed for MEDLINE]
29. Med Care. 2003 Jul;41(7 Suppl):III75-III86.
Demographic variation in SF-12 scores: true differences or differential item
functioning?
Fleishman JA, Lawrence WF.
Center for Cost and Financing Studies, Agency for Healthcare Research and
Quality, Rockville, Maryland 20852, USA. jfleishm@ahrq.gov
BACKGROUND: Demographic differences have been reported in summary measures of
physical and mental health based on the SF-12 instrument. OBJECTIVES: This study
examines the extent to which differential item functioning (DIF) contributes to
observed subgroup differences in health status. DIF refers to situations in which
the psychometric properties of items are not invariant across different groups.
The presence of DIF confounds interpretation of subgroup differences. SUBJECTS: A
national sample of 11,626 adult respondents in the 2000 Medical Expenditure Panel
Survey who completed a self-administered questionnaire. MEASURES: In addition to
the SF-12, we collected data on demographic characteristics (age, gender,
education, and race/ethnicity) and whether the person had ever been diagnosed
with six chronic medical conditions. RESULTS: Multiple-indicator multiple-cause
latent variable models showed significant differences in physical health by
gender, age, and education. Adjusting for DIF reduced but did not eliminate age
and education differences. However, for mental health, adjusting for DIF resulted
in Black-White differences becoming nonsignificant, and the effect for the oldest
age group switched from positive to negative. Race/ethnicity was not associated
with physical health status. CONCLUSIONS: Age group comparisons of mental health
may be particularly affected by DIF. Differences in education, as well as age and
gender, need to be controlled when making group comparisons. Additional work is
needed to understand factors that give rise to demographic differences in
reported health status.
PMID: 12865729 [PubMed - indexed for MEDLINE]
30. Value Health. 2003 Mar-Apr;6(2):107-15.
Economic costs of influenza-related work absenteeism.
Akazawa M, Sindelar JL, Paltiel AD.
Yale School of Medicine, New Haven, CT 06520, USA.
BACKGROUND: Influenza vaccinations are currently advocated only for individuals
over age 50. However, vaccination of all working-age people may be warranted
based on reduced absenteeism from work. OBJECTIVE: This study aims to quantify
the association between lost workdays and influenza, controlling for other
factors. A secondary aim of the study is to assess the net benefit of expanded
vaccination in a workplace setting. RESEARCH DESIGN: Multivariate regression
analyses of the 1996 Medical Expenditure Panel Survey Household Component are
used to estimate the number of workdays missed because of influenza-like illness
(ILI) when controlling for other health, demographic, and employment factors.
Mean productivity costs are measured in terms of absences from work and valued in
dollar terms. The net benefit of influenza vaccination is estimated using a
simple decision analysis. SUBJECTS AND MEASURES: Health, demographic, and
employment data for employed individuals between the ages of 22 and 64 years are
analyzed. RESULTS: The average number of workdays missed due to ILI was 1.30
days, and the average work loss was valued at 137 US dollars per person. The
vaccine strategy was not preferred in the baseline analysis; however, this result
was sensitive to assumptions regarding the incidence of influenza, the cost of
delivering the vaccine, and the productivity impact of worker absenteeism.
Moreover, nonproductivity benefits of vaccination were omitted. CONCLUSIONS: The
economic attractiveness of expanded investment in influenza vaccination hinges on
employer- and population-specific assumptions. Our analysis provides a simple
framework within which competing considerations of disease epidemiology, worker
productivity, and economic cost may be weighed.
PMID: 12641861 [PubMed - indexed for MEDLINE]
31. Health Aff (Millwood). 2001 Sep-Oct;20(5):241-51.
Are the benefits of newer drugs worth their cost? Evidence from the 1996 MEPS.
Lichtenberg FR.
Columbia University, New York City, USA.
Comment in:
Health Aff (Millwood). 2007 May-Jun;26(3):880-6.
Health Aff (Millwood). 2001 Nov-Dec;20(6):306-7.
This study analyzes data on prescribed medicines from the 1996 Medical
Expenditure Panel Survey (MEPS) to examine the association between the use of
newer medicines and morbidity, mortality, and health spending. We find that
people consuming newer drugs were significantly less likely to die by the end of
the survey and were significantly less likely to experience work-loss days than
were people consuming older drugs. Our most notable finding, however, is that use
of newer drugs tends to lower all types of nondrug medical spending, resulting in
a substantial net reduction in the total cost of treating a given condition.
PMID: 11558710 [PubMed - indexed for MEDLINE]
32. Dev Health Econ Public Policy. 1998;6:35-49.
The demand for health: an empirical test of the Grossman model using panel data.
Nocera S, Zweifel P.
University of Zurich, Switzerland.
Grossman derives the demand for health from an optimal control model in which
health capital is both a consumption and an investment good. In his approach, the
individual chooses his level of health and therefore his life span. Initially an
individual is endowed with a certain amount of health capital, which depreciates
over time but can be replenished by investments like medical care, diet,
exercise, etc. Therefore, the level of health is not treated as exogenous but
depends on the amount of resources the individual allocates to the production of
health. The production of health capital also depends on variables which modify
the efficiency of the production process, therefore changing the shadow price of
health capital. For example, more highly educated people are expected to be more
efficient producers of health who thus face a lower price of health capital, an
effect that should increase their quantity of health demanded. While the Grossman
model provides a suitable theoretical framework for explaining the demand for
health and the demand for medical services, it has not been too successful
empirically. However, empirical tests up to this date have been exclusively based
on cross section data, thus failing to take the dynamic nature of the Grossman
model into account. By way of contrast, the present paper contains individual
time series information not only on the utilization of medical services but also
on income, wealth, work, and life style. The data come from two surveys carried
out in 1981 and 1993 among members of a Swiss sick fund, with the linkage between
the two waves provided by insurance records. In all, this comparatively rich data
set holds the promise of permitting the Grossman model to be adequately tested
for the first time.
PMID: 10662408 [PubMed - indexed for MEDLINE]
33. Telemed J. 1998 Winter;4(4):293-304.
A cost-effectiveness analysis of shipboard telemedicine.
Stoloff PH, Garcia FE, Thomason JE, Shia DS.
Center for Naval Analyses, Alexandria, Virginia 22302-8268, USA.
BACKGROUND: The U.S. Navy is considering the installation of telemedicine
equipment on more than 300 ships. Besides improving the quality of care, benefits
would arise from avoiding medical evacuations (MEDEVACs) and returning patients
to work more quickly. Because telemedicine has not yet been fully implemented by
the Navy, we relied on projections of anticipated savings and costs, rather than
actual expenditures, to determine cost-effectiveness. OBJECTIVES: To determine
the demand for telemedicine and the cost-effectiveness of various technologies
(telephone and fax, e-mail and Internet, video teleconferencing (VTC),
teleradiology, and diagnostic instruments), as well as their bandwidth
requirements. METHODS: A panel of Navy medical experts with telemedicine
experience reviewed a representative sample of patient visits collected over a
1-year period and estimated the man-day savings and quality-of-care enhancements
that might have occurred had telemedicine technologies been available. The
savings from potentially avoiding MEDEVACs was estimated from a survey of ships'
medical staff. These sample estimates were then projected to the medical workload
of the entire fleet. Off-the-shelf telemedicine equipment prices were combined
with installation, maintenance, training, and communication costs to obtain the
lifecycle costs of the technology. RESULTS AND CONCLUSIONS: If telemedicine were
available to the fleet, ship medical staffs would initiate nearly 19, 000
consults in a year-7% of all patient visits. Telemedicine would enhance quality
of care in two-thirds of these consults. Seventeen percent of the MEDEVACs would
be preventable with telemedicine (representing 155,000 travel miles), with a
savings of $4400 per MEDEVAC. If the ship's communication capabilities were
available, e-mail and Internet and telephone and fax would be cost-effective on
all ships (including small ships and submarines). Video teleconferencing would be
cost-effective on large ships (aircraft carriers and amphibious) only.
Teleradiology would be cost-effective on carriers only. Telemedicine's bandwidth
requirement is small-1% of a month's time. However, if the ships' medical
departments need to resort to a commercial satellite, E-mail and Internet would
be the only telemedicine modality generating enough monetary benefits to offset
the costs.
PMID: 10220469 [PubMed - indexed for MEDLINE]
34. Am J Ther. 1997 Jul-Aug;4(7-8):259-73.
Calcium and bone health in children: a review.
Stallings VA.
Division of Gastroenterology and Nutrition, The Children's Hospital of
Philadelphia, University of Pennsylvania School of Medicine, Philadelphia 19104,
USA.
The recent national survey shows that dietary calcium intake is variable in
children and adolescents, with about half consuming less than the intake
recommended by the Recommended Dietary Allowances or the National Institutes of
Health Consensus Panel on Optimal Calcium Intake. Osteoporosis is a major disease
in adults, resulting in 1.5 million fractures and over $10 billion in medical
expenditures annually. Osteoporosis is of growing interest in the research,
public health, and health consumer-lay communities and to the many primary care
and specialty physicians and other health care professionals who work directly
with patients with osteoporosis. Treatment of osteoporosis to prevent fracture is
improving with newly introduced medications and approaches, but it is not as
effective as needed. Effective prevention strategies are critical to decreasing
the morbidity and mortality of the disease. Peak bone mass, obtained during
childhood and adolescent growth, is one of the major determinants for the risk of
developing osteoporosis and fracture. Genetic potential, gender, ethnic origins,
nutritional factors such as calcium and vitamin D intake, growth patterns, and
physical activity influence the accretion of bone mineral during childhood and
determine the peak bone mass. Randomized, placebo-controlled intervention trials
conducted in healthy children who are consuming amounts of dietary calcium in
accordance with the US recommendations show that bone mass can be increased by
calcium supplementation. Retrospective studies in adults suggest that childhood
calcium intake is associated with risk of later osteoporosis and fracture. In
addition, common childhood clinical conditions, such as low calcium intake
related to lactose intolerance or the use of glucocorticoid medications for
chronic illness, are risk factors for the development of osteoporosis in
childhood, not just in adulthood. An approach for physicians and other pediatric
care providers for screening children for low dietary calcium intake, low bone
density, and other osteoporosis risk factors using dual-energy X-ray
absorptiometry and the use of calcium supplementation in clinical care are
presented.
PMID: 10423619 [PubMed - indexed for MEDLINE]
35. Pediatrics. 1996 Aug;98(2 Pt 1):226-30.
Parental availability for the care of sick children.
Heymann SJ, Earle A, Egleston B.
Department of Health and Social Behavior, Harvard School of Public Health,
Boston, MA 02115, USA.
OBJECTIVE. Parents have always played a critical role in the care of sick
children. Although parents' roles remain crucial to children's health, parental
availability has declined during the past half century. The percentage of women
with preschool children who work has risen almost fivefold in 45 years from 12%
in 1947 to 58% in 1992. The percentage of women in the paid work force with
school-aged children has almost tripled in the same period, from 27.3% to 75.9%.
Research has examined the effects of a variety of parental work conditions on
children. However, past research has not examined how working conditions affect
the ability of parents to care for their sick children. In this article, we
examine how often the children of working parents get sick and whether parents
receive enough paid leave to care for their sick children. METHODOLOGY. This
analysis makes use of two national surveys, which provide complementary
information regarding the care of sick children. The National Longitudinal Survey
of Youth is a longitudinal survey of a nationally representative probability
sample of 12,686 men and women; the National Medical Expenditure Survey is a
panel survey of 34,459 people. First, we estimated the family illness burden.
Second, we looked in detail at the number of days of sick leave mothers had.
Third, we examined whether mothers who had sick leave had it consistently during
a 5-year period. Finally, we conducted a logistic regression to determine what
factors were significant predictors of both lacking sick leave. RESULTS. More
than one in three families faced a family illness burden of 2 weeks or more each
year. Yet, 28% of mothers had sick leave none of the time they were employed
between 1985 and 1990. Employed mothers of children with chronic conditions had
less sick leave than other employed mothers. Thirty-six percent of mothers whose
children had chronic conditions had sick leave none of the time they were
employed. Although 20% of working parents who did not live in poverty lacked sick
leave, 38% of parents who did live in poverty lacked sick leave. The problem is
also more marked for nonwhite parents. Although 23% of working white parents
lacked paid sick leave, 31% of nonwhite parents lacked sick leave. One in six
families that lacked sick leave had to cover for more than 4 weeks of family
illness during the year. CONCLUSION. In 1993, the US Congress passed the Family
and Medical Leave Act (FMLA). However, by limiting the medical leave to the care
of major illnesses, primarily those requiring hospitalization, the FMLA does not
address the majority of children's sick care needs. For the common childhood
illnesses that are not covered by the FMLA, employed parents often must rely on
their sick leave if they are to care for their sick children themselves. Yet, we
found that many employed parents lack sick leave. This is particularly true of
parents of children with chronic conditions and poor and minority families.
PMID: 8692622 [PubMed - indexed for MEDLINE]
1. Matern Child Health J.. [Epub ahead of print]
Household Exposure to Secondhand Smoke is Associated with Decreased Physical and
Mental Health of Mothers in the USA.
Sobotova L, Liu YH, Burakoff A, Sevcikova L, Weitzman M.
Institute of Hygiene, Faculty of Medicine, Comenius University, Spitalska 24, 813
72, Bratislava, Slovakia, Europe.
Secondhand smoke is one of the most common toxic environmental exposures to
children, and maternal health problems also have substantial negative effects on
children. We are unaware of any studies examining the association of living with
smokers and maternal health. To investigate whether non-smoking mothers who live
with smokers have worse physical and mental health than non-smoking mothers who
live in homes without smokers. Nationally representative data from the 2000-2004
Medical Expenditure Panel Survey were used. The health of non-smoking mothers
with children <18 years (n = 18,810) was assessed, comparing those living with
one or more smokers (n = 3,344) to those living in households with no adult
smokers (n = 14,836). Associations between maternal health, household smoking,
and maternal age, race/ethnicity, and marital, educational, poverty and
employment status were examined in bivariable and multivariable analyses using
SUDAAN software to adjust for the complex sampling design. Scores on the Medical
Outcomes Short Form-12 (SF-12) Physical Component Scale (PCS) and Mental
Component Scale (MCS) were used to assess maternal health. About 79.2% of mothers
in the USA are non-smokers and 17.4% of them live with >/=1 adult smokers: 14.2%
with 1 and 3.2% with >/=2 smokers. Among non-smoking mothers, the mean MCS score
is 50.5 and mean PCS is 52.9. The presence of an adult smoker and increasing
number of smokers in the home are both negatively associated with MCS and PCS
scores in bivariable analyses (P < 0.001 for each). Non-smoking mothers with at
least one smoker in the household had an 11% (95% CI = 0.80-0.99) lower odds of
scoring at or above the mean MCS score and a 19% (95% CI = 0.73-0.90) lower odds
of scoring at or above the mean PCS score compared to non-smoking mothers with no
smokers in the household. There is an evidence of a dose response relationship
with increasing number of smokers in the household for PCS (P < 0.001). These
findings demonstrate a previously unrecognized child health risk: living with
smokers is independently associated with worse physical and mental health among
non-smoking mothers.
PMID: 20012677 [PubMed - as supplied by publisher]
2. Diabetes Care. 2009 Dec;32(12):2187-92. Epub 2009 Sep 3.
Health care and productivity costs associated with diabetic patients with
macrovascular comorbid conditions.
Fu AZ, Qiu Y, Radican L, Wells BJ.
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio,
USA. fuz@ccf.org
OBJECTIVE: To examine and quantify from the societal perspective the impact of
macrovascular comorbid conditions (MVCCs) on health care and productivity costs
in diabetic patients in the U.S. RESEARCH DESIGN AND METHODS: With use of the
pooled Medical Expenditure Panel Survey (MEPS) 2004 and 2006 data, a nationally
representative adult sample (aged >or=18 years) was included in the study. Health
care cost was measured by the annual health care expenditure. Productivity cost
was calculated from the lost productivity from missed work days and additional
bed days due to illness/injury based on the 2006 average national hourly wage.
Both 2004 and 2006 cost data were adjusted to 2006 dollars. Given the heavily
right-skewed distribution of the cost data, the generalized linear model with
log-link function and gamma variance was used to identify the relationship
between MVCCs and costs after controlling for age, sex, race, ethnicity,
education, income, employment status, smoking status, health insurance, diabetes
severity, and comorbidities. Negative binomial models were applied to analyze the
outcomes of missed work days and bed days. All statistics were adjusted using the
proper sampling weight from MEPS. RESULTS: Compared with diabetic patients
without MVCCs (n = 3,320), those with MVCCs (n = 913) had statistically
significant higher annual health care costs (5,120 USD, P < 0.001), more missed
work days (13.03 days, P < 0.001), and more bed days (7.60 days, P = 0.025) per
patient after controlling for differences in sociodemographics, smoking, diabetes
severity, and comorbidities. The marginal lost productivity cost was 2,388 USD
annually per patient. CONCLUSIONS: From the U.S. societal perspective, MVCCs in
diabetic patients are associated with increased health care and lost productivity
costs.
PMCID: PMC2782975 [Available on 2010/12/1]
PMID: 19729528 [PubMed - in process]
3. Am J Public Health. 2009 Jul;99(7):1315-21. Epub 2009 May 14.
The relationship between living arrangement and preventive care use among
community-dwelling elderly persons.
Lau DT, Kirby JB.
Buehler Center on Aging, Health & Society, Northwestern University, Feinberg
School of Medicine, 750 North Lake Shore Dr, Suite 601, Chicago, IL 60611, USA.
D-Lau@northwestern.edu
Comment in:
Am J Public Health. 2009 Oct;99(10):1733-4.
OBJECTIVES: We sought to examine the relationship between living arrangements and
obtaining preventive care among the elderly population. METHODS: We obtained data
on 13,038 community-dwelling elderly persons from the 2002 to 2005 Medical
Expenditure Panel Survey and used multivariate logistic regression models to
estimate the likelihood of preventive care use among elderly persons in 4 living
arrangements: living alone (38%), living with one's spouse only (52%), living
with one's spouse and with one's adult offspring (5%), and living with one's
adult offspring only (5%). Preventive care services included influenza
vaccination, physical and dental checkup, and screenings for hypertension,
cholesterol, and colorectal cancer. RESULTS: After we controlled for age, gender,
race, education, income, health insurance, comorbidities, self-reported health,
physical function status, and residence location, we found that elderly persons
living with a spouse only were more likely than were those living alone to obtain
all preventive care services, except for hypertension screening. However, those
living with their adult offspring were not more likely to obtain recommended
preventive care compared with those living alone. These results did not change
when the employment status and functional status of adult offspring were
considered. CONCLUSIONS: Interventions to improve preventive care use should
target not only those elderly persons who live alone but also those living with
adult offspring.
PMCID: PMC2696673 [Available on 2010/7/1]
PMID: 19443817 [PubMed - indexed for MEDLINE]
4. Diabetes Care. 2009 Jun;32(6):983-9. Epub 2009 Feb 27.
Usual source of care as a health insurance substitute for U.S. adults with
diabetes?
DeVoe JE, Tillotson CJ, Wallace LS.
Department of Family Medicine, Oregon Health and Science University, Portland,
Oregon, USA. devoej@ohsu.edu
OBJECTIVE: The purpose of this study was to examine the effects of health
insurance and/or a usual source of care (USC) on receipt of diabetic-specific
services and health care barriers for U.S. adults with diabetes. RESEARCH DESIGN
AND METHODS: Secondary analyses of data from 6,562 diabetic individuals aged
>or=18 years from the nationally representative Medical Expenditure Panel Survey
from 2002 to 2005 were performed. Outcome measures included receipt of seven
diabetic services plus five barriers to care. RESULTS: More than 84% of diabetic
individuals in the U.S. had full-year coverage and a USC; 2.3% had neither one.
In multivariate analyses, the uninsured with no USC had one-fifth the odds of
receiving A1C screening (odds ratio 0.23 [95% CI 0.14-0.38]) and one-tenth the
odds of a blood pressure check (0.08 [0.05-0.15]), compared with insured diabetic
individuals with a USC. Similarly, being uninsured without a USC was associated
with 5.5 times the likelihood of unmet medical needs (5.51 [3.49-8.70]) and three
times more delayed urgent care (3.13 [1.53-6.38]) compared with being insured
with a USC. Among the two groups with either insurance or a USC, diabetic
individuals with only a USC had rates of diabetes-specific care more similar to
those of insured individuals with a USC. In contrast, those with only insurance
were closer to the reference group with fewer barriers to care. CONCLUSIONS:
Insured diabetic individuals with a USC were better off than those with only a
USC, only insurance, or neither one. Policy reforms must target both the
financing and the delivery systems to achieve increased receipt of diabetes
services and decreased barriers to care.
PMCID: PMC2681031 [Available on 2010/6/1]
PMID: 19252167 [PubMed - indexed for MEDLINE]
5. Matern Child Health J. 2008 Nov 26. [Epub ahead of print]
The Well-Being of Parental Caregivers of Children with Activity Limitations.
Kuhlthau K, Kahn R, Hill KS, Gnanasekaran S, Ettner SL.
Center for Child and Adolescent Health Policy, Massachusetts General Hospital, 50
Staniford Street, 02114, Boston, MA, USA, kkuhlthau@partners.org.
This paper describes well-being (health status/quality of life, healthcare
utilization, employment, and financial status) of parental caregivers of children
with activity limitations and compares their well-being to parental caregivers
with children without activity limitations. Using Medical Expenditure Panel
Survey data from 1996 to 2001, we examined the well-being of parents of children
with and without an activity limitation. Children were considered as having an
activity limitation if they reported a limitation in school, play or social
activities. Analyses include weighted descriptive statistics and multivariable
regressions. Seventy-five percentage of parents of children with activity
limitations experienced at least one adverse outcome compared to 66% of parents
of children without activity limitations. Parents of children with activity
limitations exhibited poorer reported quality of life as indicated by lower SF-12
physical health scores (coefficient = -2.24 CI -3.38 to -1.11) and lower EuroQol
scores (coefficient = -.07 CI -.10 to -.03). Parents of children with activity
limitations have slightly higher utilization of sick visits. One measure of
preventive care use was not significant and one showed a slight increase in use
among parents of children with activity limitations. Employment and financial
outcomes were less favorable for parents of children with activity limitations.
Across a variety of domains, parental caregivers of children with activity
limitations are at a disadvantage compared to other parents suggesting that
public and private parental supports might be helpful.
PMID: 19034635 [PubMed - as supplied by publisher]
6. Pediatrics. 2008 Aug;122(2):e480-486.
Access to and use of paid sick leave among low-income families with children.
Clemans-Cope L, Perry CD, Kenney GM, Pelletier JE, Pantell MS.
The Urban Institute, 2100 M St NW, Washington, DC 20037, USA.
lclemans@ui.urban.org
OBJECTIVE: The ability of employed parents to meet the health needs of their
children may depend on their access to sick leave, especially for low-income
workers, who may be afforded less flexibility in their work schedules to
accommodate these needs yet also more likely to have children in poor health. Our
goal was to provide rates of access to paid sick leave and paid vacation leave
among low-income families with children and to assess whether access to these
benefits is associated with parents' leave taking to care for themselves or
others. METHODS: We used a sample of low-income families (<200% of the federal
poverty level) with children aged 0 to 17 years in the 2003 and 2004 Medical
Expenditure Panel Survey to examine bivariate relationships between access to and
use of paid leave and characteristics of children, families, and parents'
employer. RESULTS: Access to paid leave was lower among children in low-income
families than among those in families with higher income. Within low-income
families, children without >or=1 full-time worker in the household were
especially likely to lack access to this benefit, as were children whose parents
work for small employers. Among children whose parents had access to paid sick
leave, parents were more likely to take time away from work to care for
themselves or others. This relationship is even more pronounced among families
with the highest need, such as children in fair or poor health and children with
all parents in full-time employment. CONCLUSIONS: Legislation mandating paid sick
leave could dramatically increase access to this benefit among low-income
families. It would likely diminish gaps in parents' leave taking to care for
others between families with and without the benefit. However, until the
health-related consequences are better understood, the full impact of such
legislation remains unknown.
PMID: 18676534 [PubMed - indexed for MEDLINE]
7. J Cancer Surviv. 2007 Sep;1(3):237-45.
Marriage, employment, and health insurance in adult survivors of childhood
cancer.
Crom DB, Lensing SY, Rai SN, Snider MA, Cash DK, Hudson MM.
Department of Oncology, St. Jude Children's Research Hospital, 332 N. Lauderdale
St., Mail Stop 735, Memphis, TN 38105-2794, USA. debbie.crom@stjude.org
INTRODUCTION: Adult survivors of childhood cancer are at risk for disease- and
therapy-related morbidity, which can adversely impact marriage and employment
status, the ability to obtain health insurance, and access to health care. Our
aim was to identify factors associated with survivors' attainment of these
outcomes. METHODS: We surveyed 1,437 childhood cancer survivors who were >18
years old and >10 years past diagnosis. We compared our cohort's data to
normative data in the Medical Expenditure Panel Survey and the U.S. Census
Bureau's Current Population Surveys. Respondents were stratified by hematologic
malignancies, central nervous system tumors, or other solid tumors and by whether
they had received radiation therapy. RESULTS: Most respondents were survivors of
hematologic malignancies (71%), white (91%), and working full-time (62%); 43%
were married. Compared with age- and sex-adjusted national averages, only
survivors of hematologic malignancies who received radiation were significantly
less likely to be married (44 vs. 52%). Full-time employment among survivors was
lower than national norms, except among survivors of hematologic malignancies who
had not received radiation therapy. The rates of coverage of health insurance,
especially public insurance, were higher in all diagnostic groups than in the
general population. While difficulty obtaining health care was rarely reported,
current unemployment and a lack of insurance were associated with difficulty in
obtaining health care (P < 0.05 and P < 0.001, respectively).
CONCLUSIONS/IMPLICATIONS FOR CANCER SURVIVORS: Subgroups of cancer survivors do
experience long-term differences in functional outcomes that should be addressed
early. Survivors who are unmarried, unemployed, and uninsured experience
difficulty accessing health care needed to address long-term health concerns.
PMID: 18648974 [PubMed - indexed for MEDLINE]
8. Dis Manag. 2008 Jun;11(3):153-60.
Co-occurring mental illness and health care utilization and expenditures in
adults with obesity and chronic physical illness.
Shen C, Sambamoorthi U, Rust G.
Department of Economics, Rutgers University, New Brunswick, New Jersey, USA.
The objectives of the study were to compare health care expenditures between
adults with and without mental illness among individuals with obesity and chronic
physical illness. We performed a cross-sectional analysis of 2440 adults (older
than age 21) with obesity using a nationally representative survey of households,
the Medical Expenditure Panel Survey. Chronic physical illness consisted of
self-reported asthma, diabetes, heart disease, hypertension, or osteoarthritis.
Mental illness included affective disorders; anxiety, somatoform, dissociative,
personality disorders; and schizophrenia. Utilization and expenditures by type of
service (total, inpatient, outpatient, emergency room, pharmacy, and other) were
the dependent variables. Chi-square tests, logistic regression on likelihood of
use, and ordinary least squares regression on logged expenditures among users
were performed. All regressions controlled for gender, race/ethnicity, age,
martial status, region, education, employment, poverty status, health insurance,
smoking, and exercise. All analyses accounted for the complex design of the
survey. We found that 25% of adults with obesity and physical illness had a
mental illness. The average total expenditures for obese adults with physical
illness and mental illness were $9897; average expenditures were $6584 for those
with physical illness only. Mean pharmacy expenditures for obese adults with
physical illness and mental illness and for those with physical illness only were
$3343 and $1756, respectively. After controlling for all independent variables,
among adults with obesity and physical illness, those with mental illness were
more likely to use emergency services and had higher total, outpatient, and
pharmaceutical expenditures than those without mental illness. Among individuals
with obesity and chronic physical illness, expenditures increased when mental
illness is added. Our study findings suggest cost-savings efforts should examine
the reasons for high utilization and expenditures for those with obesity, chronic
physical illness, and mental illness.
PMID: 18564027 [PubMed - indexed for MEDLINE]
9. BMC Health Serv Res. 2008 May 9;8:101.
Body mass index and employment-based health insurance.
Fong RL, Franks P.
Department of Family & Community Medicine, University of California, Davis,
Sacramento, CA 95817, USA. rlfong@ucdavis.edu
BACKGROUND: Obese workers incur greater health care costs than normal weight
workers. Possibly viewed by employers as an increased financial risk, they may be
at a disadvantage in procuring employment that provides health insurance. This
study aims to evaluate the association between body mass index [BMI, weight in
kilograms divided by the square of height in meters] of employees and their
likelihood of holding jobs that include employment-based health insurance [EBHI].
METHODS: We used the 2004 Household Components of the nationally representative
Medical Expenditure Panel Survey. We utilized logistic regression models with
provision of EBHI as the dependent variable in this descriptive analysis. The key
independent variable was BMI, with adjustments for the domains of demographics,
social-economic status, workplace/job characteristics, and health
behavior/status. BMI was classified as normal weight (18.5-24.9), overweight
(25.0-29.9), or obese (> or = 30.0). There were 11,833 eligible respondents in
the analysis. RESULTS: Among employed adults, obese workers [adjusted probability
(AP) = 0.62, (0.60, 0.65)] (P = 0.005) were more likely to be employed in jobs
with EBHI than their normal weight counterparts [AP = 0.57, (0.55, 0.60)].
Overweight workers were also more likely to hold jobs with EBHI than normal
weight workers, but the difference did not reach statistical significance [AP =
0.61 (0.58, 0.63)] (P = 0.052). There were no interaction effects between BMI and
gender or age. CONCLUSION: In this nationally representative sample, we detected
an association between workers' increasing BMI and their likelihood of being
employed in positions that include EBHI. These findings suggest that obese
workers are more likely to have EBHI than other workers.
PMCID: PMC2387152
PMID: 18471293 [PubMed - indexed for MEDLINE]
10. J Rural Health. 2008 Winter;24(1):1-11.
Uninsured rural families.
Ziller EC, Coburn AF, Anderson NJ, Loux SL.
Maine Rural Health Research Center, Muskie School of Public Service, University
of Southern Maine, Portland, Maine 04101, USA. eziller@usm.maine.edu
CONTEXT: Although research shows higher uninsured rates among rural versus urban
individuals, prior studies are limited because they do not examine coverage
across entire rural families. PURPOSE: This study uses the Medical Expenditure
Panel Survey (MEPS) to compare rural and urban insurance coverage within
families, to inform the design of coverage expansions that build on the current
rural health insurance system. METHODS: We pooled the 2001 and 2002 MEPS
Household Component survey, aggregated to the family level (excluding households
with all members 65 and older). We examined (1) differences in urban,
rural-adjacent, and rural nonadjacent family insurance coverage, and (2) the
characteristics of rural families related to their patterns of coverage.
FINDINGS: One out of 3 rural families has at least 1 uninsured member, a rate
higher than for urban families-particularly in nonadjacent counties. Yet, three
fourths of uninsured rural families have an insured member. For 42% of rural
nonadjacent families, this is someone with public coverage (Medicaid/SCHIP or
Medicare); urban families are more likely to have private health insurance or a
private/public mix. CONCLUSIONS: Strategies to expand family coverage through
employers may be less effective among rural nonadjacent than urban families.
Instead, expansions of public coverage or tax credits enabling entire families to
purchase an individual/self-employment plan would better ensure that rural
nonadjacent families achieve full coverage. Subsidies or incentives would need to
be generous enough to make coverage affordable for the 52% of uninsured rural
nonadjacent families living below 200% of the federal poverty level.
PMID: 18257865 [PubMed - indexed for MEDLINE]
11. Value Health. 2007 Nov-Dec;10(6):443-50.
Productivity costs associated with cardiometabolic risk factor clusters in the
United States.
Sullivan PW, Ghushchyan V, Wyatt HR, Wu EQ, Hill JO.
University of Colorado at Denver and Health Sciences Center, Pharmaceutical
Outcomes Research Program, School of Pharmacy, 4200 East Ninth Avenue, C238,
Denver, CO 80262, USA. patrick.sullivan@uchsc.edu
OBJECTIVE: Cardiometabolic risk factors such as overweight/obesity,
hyperlipidemia, diabetes, and hypertension are prone to cluster together in the
same individual and result in an elevated risk of cardiovascular disease and
mortality. The purpose of this study was to examine and quantify the impact of
cardiometabolic risk factor clusters independent of heart disease on productivity
in a nationally representative sample of US adults. METHODS: The current study
estimated the impact of cardiometabolic risk factor clusters on missed work days
and bed days, controlling for sociodemographic characteristics, comorbidity, and
smoking status in a nationally representative, pooled 2000 and 2002 Medical
Expenditure Panel Survey sample. Cardiometabolic risk factor clusters included
BMI >or= 25 and two of the following three: diabetes, hyperlipidemia, and/or
hypertension. All estimates were expressedin $US 2005. Sensitivity analyses were
conducted to examine the impact of varying assumptions on the results. RESULTS:
After controlling for differences in sociodemographics, smoking and comorbidity,
individuals with cardiometabolic risk factor clusters missed 179% more work days
and spent 147% more days in bed (in addition to lost work days) than those
without. Lost work days and bed days resulted in $17.3 billion annually in lost
productivity attributable to cardiometabolic risk factor clusters in the United
States. Sensitivity analyses resulted in a range of annual lost productivity
costs from $3.2 to $23.1 billion. CONCLUSIONS: Common cardiometabolic risk factor
clusters have a significant deleterious impact on the US economy, resulting in
$17.3 billion in lost productivity.
PMID: 17970926 [PubMed - indexed for MEDLINE]
12. Res Social Adm Pharm. 2006 Jun;2(2):232-53.
Drug insurance instability and its correlates: results from the 2000 Medical
Expenditure Panel Survey.
Gupta K, Cline RR, Schondelmeyer SW.
Department of Pharmaceutical Care and Health Systems, College of Pharmacy,
University of Minnesota, Minneapolis, MN 55455, USA.
BACKGROUND: Health insurance instability (ie, temporal gaps in health insurance
coverage) is a prevalent phenomenon in the United States. To date, most studies
have focused on the factors that affect the intermittent lack of health insurance
coverage. However, no studies known to the authors have examined the factors
associated with prescription drug insurance instability (ie, temporal gaps in
drug insurance coverage) among working-age adults. Developing an accurate profile
of persons with unstable drug insurance is essential to formulate rational policy
to address this problem. OBJECTIVES: The objectives of this study were to (1)
document the prevalence of prescription insurance instability among working-age
adults and (2) describe the association between prescription drug insurance
instability and demographic, socioeconomic status, and employment
characteristics. METHODS: The data source used in this study was the 2000 Medical
Expenditure Panel Survey. This study used a cross-sectional design using data
provided by respondents at each of the 3 interviews conducted during the year
2000. Chi-square and hierarchical multinomial logistic regression analyses were
used to describe the associations among (1) demographics, (2) socioeconomic
status, and (3) employment characteristics and drug insurance status (classified
as continuous, absent, or unstable). RESULTS: During the year 2000, 12.5% (21.1
million) of the working-age adults in the United States had unstable prescription
drug coverage. Persons aged 35-54 years had lower rates of drug insurance
instability compared with those aged 18-24 [adjusted odds ratio 0.66 (95%
confidence interval 0.54-0.80)]. The least educated (12 or fewer years of
education) were more likely than those with more education (13-16 years) to
experience at least one period without drug coverage (62% vs 32%, P<0.01). The
poorest respondents (those at less than 200% of the federal poverty level) were
more likely than the wealthiest respondents (those at more than 400% of the
poverty level) to report at least some time without drug coverage (37% vs 28%,
P<0.01). Those experiencing a divorce or death of a spouse were more than twice
as likely as stably married persons to experience at least one period without
drug insurance [adjusted odds ratio 2.23 (95% confidence interval 1.68-2.96)].
Adults who were unstably employed during the year and/or who worked for small
firms generally experienced higher rates of drug insurance instability.
CONCLUSIONS: Prescription drug insurance instability is a prevalent phenomenon
among working-age adults in the United States, with approximately 1 in 8
experiencing this problem during 2000. Our results suggest that demographics,
socioeconomic status, and employment characteristics all play important roles in
predicting prescription drug insurance status, with the least educated and
poorest being particularly vulnerable to interruptions in drug coverage. Premium
assistance programs providing subsidies to small firms' low-income employees and
permitting small firms to form insurance pools may help to decrease the number of
drug coverage uninsurance spells in this population.
PMID: 17138510 [PubMed - indexed for MEDLINE]
13. Health Aff (Millwood). 2006 Nov-Dec;25(6):1568-79.
Tax subsidies for employment-related health insurance: estimates for 2006.
Selden TM, Gray BM.
Center for Financing, Access, and Cost Trends, Division of Modeling and
Simulation, Agency for Healthcare Research and Quality (AHRQ), in Rockville,
Maryland, USA. tselden@ahrq.gov
Employment-related health insurance is subsidized through exemptions from federal
and state income taxes, as well as from taxes for Social Security and Medicare.
Proposals to modify this subsidy are a perennial subject of policy debate. We
present tax-subsidy projections from a new data resource constructed using a
statistical linkage between the establishment and household components of the
Medical Expenditure Panel Survey (MEPS). We project that the total federal and
state tax subsidy in 2006 for employment-related coverage of active workers will
exceed 200 billion dollars. We present per worker tax-subsidy estimates and an
analysis of insurance incidence by establishment characteristics.
PMID: 17102182 [PubMed - indexed for MEDLINE]
14. Med Care. 2006 May;44(5 Suppl):I12-8.
Workers who decline employment-related health insurance.
Bernard DM, Selden TM.
Division of Modeling and Simulation, Center for Financing, Access and Cost
Trends, Agency for Healthcare Research and Quality, Rockville, Maryland 20850,
USA. dbernard@ahrq.gov
BACKGROUND: Families of workers who decline coverage represent a substantial
share of the uninsured and publicly-insured population in the United States.
OBJECTIVE: We examined health status, access to health care, utilization, and
expenditures among families that declined health insurance coverage offered by
employers using data from the Medical Expenditure Panel Survey for 2001 and 2002.
RESULTS: We found differences in insurance status for adults and children among
families with offers. We found that among low-income families with offers,
children are less likely to have private insurance compared with adults. However,
the majority of children who decline private insurance end up with public
coverage, whereas most of adults who decline offers remain uninsured. Decliners
are more likely to report poor health, yet they are also less likely to have high
cost medical conditions. Families declining coverage have weaker preferences for
insurance than families that take up. Although access to care is lower among the
decliners who remain uninsured, decliners with public insurance have similar
access to care as those with private insurance. Families turning down coverage
are more likely to face high expenditure burdens as a percentage of income and
more likely to have financial barriers to care. Families who decline coverage
rely heavily on the safety net. Public sources and uncompensated care account for
72% of total expenditures among adults who decline coverage. CONCLUSIONS: Our
results suggest that policy initiatives aimed at increasing take up among workers
need to take into account the incentives workers face given the availability of
care through public sources and uncompensated care.
PMID: 16625059 [PubMed - indexed for MEDLINE]
15. Int J Health Care Finance Econ. 2006 Mar;6(1):25-47.
Employer choices of family premium sharing.
Vistnes JP, Morrisey MA, Jensen GA.
Center for Financing, Access and Cost Trends, Agency for Healthcare Research and
Quality, USA.
In 1997, nearly two-thirds of married couples with children under age 18 were
dual-earner couples. Such families may have a variety of insurance options
available to them. If so, declining a high employee premium contribution may be a
mechanism for one spouse to take money wages in lieu of coverage while the other
spouse takes coverage rather than high wages. Employers may use these preferences
and the size of premium contributions to encourage workers to obtain family
coverage through their spouse. The purpose of this paper is to explore the
effects of labor force composition, particularly the proportion of dual-earner
couples in the labor market, on the marginal employee premium contribution
(marginal EPC) for family coverage. We analyze data from the 1997-2001 Medical
Expenditure Panel Survey--Insurance Component (MEPS-IC) List Sample of private
establishments. We find strong evidence that the marginal EPC for family coverage
is higher when there is a larger concentration of women in the workforce, but
only in markets with a higher proportion of dual-earner households.
PMID: 16612570 [PubMed - indexed for MEDLINE]
16. J Rural Health. 2005 Winter;21(1):21-30.
Rural-urban differences in employment-related health insurance.
Larson SL, Hill SC.
Center for Financing, Access and Cost Trends, Agency for Healthcare Research and
Quality, Rockville, MD 20850, USA. slarson@ahrq.gov
CONTEXT: Rural residents are disproportionately represented among the uninsured
in the United States. PURPOSE: We compared nonelderly adult residents in 3 types
of nonmetropolitan areas with metropolitan workers to evaluate which
characteristics contribute to lack of employment-related insurance. RESEARCH
DESIGN AND ANALYSIS: Data were obtained from the Medical Expenditure Panel
Survey, pooled across 3 panels (1996--1998) to enhance the rural sample size.
Econometric decomposition was used to quantify the contribution of employment
structure to differences in the probability of being offered employment-related
health insurance. FINDINGS: The most rural workers are 10.4 percentage points
less likely to be offered insurance compared with urban workers; the difference
is smaller for residents of other rural areas. In rural counties not adjacent to
urban areas, lower wages and smaller employers each account for about one-third
of the total difference. CONCLUSIONS: Health insurance disparities associated
with rural residence are related to the structure of employment. Major factors
include smaller employers, lower wages, greater prevalence of self-employment,
and sociodemographic characteristics.
PMID: 15667006 [PubMed - indexed for MEDLINE]
17. Arthritis Rheum. 2004 Jul;50(7):2317-26.
Medical care expenditures and earnings losses of persons with arthritis and other
rheumatic conditions in the United States in 1997: total and incremental
estimates.
Yelin E, Cisternas MG, Pasta DJ, Trupin L, Murphy L, Helmick CG.
Rosalind Russell Medical Research Center for Arthritis, University of California,
San Francisco 94143-0920, USA. yelin2@itsa.ucsf.edu
OBJECTIVE: To provide estimates of the total medical care expenditures and
earnings losses associated with arthritis and other rheumatic conditions (AORC),
as well as the increment in such costs specifically attributable to these
conditions, in the US in 1997. METHODS: The estimates were derived from the 1997
Medical Expenditures Panel Survey (MEPS), a national probability sample of 14,147
households including 34,551 persons, of whom 4,776 self-reported arthritis. After
weighting, those who self-reported AORC represent 38.4 million persons. We
tabulated all medical care expenditures of the adult MEPS respondents, stratified
by arthritis and comorbidity status, and then used regression techniques to
estimate the increment in health care expenditures attributable to AORC, after
taking comorbidity, demographic characteristics, and insurance status into
account. Using the same methods, we also estimated the magnitude of the earnings
losses sustained by persons of working ages (18-64 years) who had AORC. RESULTS:
Persons with AORC incurred mean total medical care expenditures of 4,865 dollars
(total 186.9 billion dollars). The largest components of these expenditures were
inpatient care (39%), ambulatory care (29%), and prescriptions (14%). The mean
increment in medical care expenditures specifically attributable to AORC among
those ages 18 years and older was 1,391 dollars(total approximately 51.1 billion
dollars). Persons with AORC ages 18-64 years earned 3,812 dollars less on average
than did other persons of these ages (total 82.4 billion dollars). Of this
average, 1,579 dollars was attributable to the AORC (total 35.1 billion dollars).
CONCLUSION: In 1997, persons with AORC incurred direct and indirect costs of
269.3 billion dollars, of which 86.2 billion dollars was attributable to these
conditions.
PMID: 15248233 [PubMed - indexed for MEDLINE]
18. J Occup Rehabil. 2004 Mar;14(1):1-11.
Employment and disability: evidence from the 1996 medical expenditures panel
survey.
Findley PA, Sambamoorthi U.
Program for Disability Research, Rutgers University, New Brunswick, New Jersey
08901, USA. pfindley@rci.rutgers.edu
The relationship between employment and disability has gained national attention,
as the ability to maintain employment is inconsistent among those with
limitations. This cross-sectional study of employment among individuals (N =
1691, age 21-62 years) with self-reported limitations in the 1996 Medical
Expenditures Panel Survey seeks to identify predictors of employment despite
physical and/or cognitive limitations. Two predictive models of employment
including 10 variables are explored; 1 included insurance (chi2 = 3856.85, p < or
= 0.00) and the other removed the insurance variable (chi2 = 280.21, p < or =
0.00). Individuals with limitations who are employed are more likely to have a
college-level education, have better physical and mental health perceptions and
have private insurance. This analysis demonstrates that people do work despite
reported activity, functional or sensory limitations and that socioeconomic
factors are crucial in why someone is able to attain employment.
PMCID: PMC1805460
PMID: 15055500 [PubMed - indexed for MEDLINE]
19. Int J Health Care Finance Econ. 2002 Nov;2(4):297-318.
Employer offers, private coverage, and the tax subsidy for health insurance: 1987
and 1996.
Bernard D, Selden TM.
Division of Modeling and Simulation, Center for Cost and Financing Studies,
Agency for Healthcare Research and Quality, Rockville, MD, USA. dbernard@ahrq.gov
Economists have long been interested in the effect of tax-based subsidies on
private health insurance coverage. We examine this relationship using pooled data
from the 1987 National Medical Expenditure Survey and the 1996 Medical
Expenditure Panel Survey. Our main tax price elasticity estimates for employer
offers and for private coverage are near the mid-point of the existing
literature. However, these estimates may mask substantial differences in
tax-price responsiveness across subsets of workers. Our more disaggregated
analysis reveals tax price responsiveness to be significantly above average for
low-income workers, workers with low health risks, and workers in small
firms--precisely those groups whose continued participation in employment-related
risk pooling is of greatest policy concern. In addition, we present family-level
elasticities that allow for joint decision-making in two-worker families.
PMID: 14625996 [PubMed - indexed for MEDLINE]
20. Med Care. 2003 Jul;41(7 Suppl):III53-III64.
Persistence in health expenditures in the short run: prevalence and consequences.
Monheit AC.
School of Public Health, University of Medicine and Dentistry of New Jersey,
Piscataway 08854-5635, USA. monheiac@umdnj.edu
BACKGROUND: Knowing whether persons in the top percentiles of the health
expenditure distribution exhibit persistently high expenditure is fundamental to
developing health plan payment policies, containing costs, and understanding the
consequences of costly illnesses. OBJECTIVES: To determine the extent of high
expenditure persistence over a 2-year period. To identify the correlates and
consequences of expenditure persistence. SUBJECTS: A national sample of the
population from a longitudinal panel of the Medical Expenditure Panel Survey
(MEPS). METHODS: Changes in a person's position in the expenditure distribution
were examined. chi2 tests were used to identify differences in characteristics
between high and low spenders. Logistic regression was used to predict the
likelihood of expenditure persistence. Changes in income, employment,
out-of-pocket expenditure burden, and health insurance were compared for high and
low spenders. RESULTS: Of the top 5% of spenders in 1996, 30% retain this
position in 1997 and 45% are in the top decile of 1997 spenders. High
expenditures begin to regress to the mean over the study period. Cancer, mental
disorders, diabetes, and infectious diseases and being in the top decile of 1996
spenders increase the probability of expenditure persistence (P < 0.05 for all).
This probability also has a strong random component. An increased proportion of
persons in the top expenditure decile for both years had out-of-pocket health
spending greater than 20% of income in 1997 (P < 0.10). Persons with persistently
high expenditures were less likely than low spenders to lose employment-based
coverage (5.4% vs. 8.8%, P < 0.05) but no changes in income or employment status
were detected. CONCLUSIONS: A sizable minority of persons exhibits persistently
high expenditures, creating incentives for favorable risk selection. Few
consequences of short-run expenditures persistence are observed.
PMID: 12865727 [PubMed - indexed for MEDLINE]
21. Med Care. 2003 Jul;41(7 Suppl):III35-III43.
Workers' decisions to take-up offered health insurance coverage: assessing the
importance of out-of-pocket premium costs.
Cooper PF, Vistnes J.
Center for Cost and Financing Studies, Agency for Healthcare Research and
Quality, Rockville, MD 20852, USA. pcooper@ahrq.gov
BACKGROUND: Many proposed policy initiatives involve subsidies directed toward
encouraging employers to offer coverage and toward workers to encourage
enrollment in offered plans. Given that insurance coverage reflects employers'
decisions to offer coverage, eligibility requirements for such coverage, and
employees' take-up decisions, all three elements are important when considering
mechanisms to decrease the number of uninsured individuals. RESEARCH DESIGN: In
this study, we examine the relationship between workers' decisions to take-up
offers of health insurance and annual out-of-pocket contributions, total
premiums, and employer and workforce characteristics. We model the take-up
decision using cross-sectional data from approximately 18,000 establishments per
year from the 1997 to 1999 Medical Expenditure Panel Survey - Insurance
Component. RESULTS: We find that workers are less likely to enroll in coverage as
single employee contributions increase. Our results for family contributions are
much smaller than for single contributions and are not statistically significant
in all years. Our simulation results suggest that reducing employee contribution
levels for single coverage from existing levels in 1999 to zero would yield an
increase in take-up rates of roughly 6% points in establishments that had
required a positive level of contributions. Our results also indicate that of the
13.8 million private sector workers who decline coverage from their employers,
2.5 million would potentially enroll in employer-sponsored coverage if the cost
of single coverage were to fall to zero. CONCLUSION: Reducing employee
contributions will increase take-up rates; however, even when employees pay
nothing for their coverage, some employees elect not to enroll.
PMID: 12865725 [PubMed - indexed for MEDLINE]
22. J Public Health Dent. 2003 Spring;63(2):104-11.
Charges for oral health care during a period of economic growth in the US:
1987-96.
Chattopadhyay A, Slade GD, Shugars DA.
Department of Dental Ecology, School of Dentistry, University of North Carolina,
Chapel Hill, NC 27599-7450, USA.
OBJECTIVES: This study aimed to provide estimates of amounts charged for dental
care during 1996 for the US adult population and its major sociodemographic
subgroups, and to evaluate whether charges had increased since 1987. METHODS: We
used data from the 1996 Medical Expenditures Panel Survey and report results for
12,931 adults aged 19-64 years. For comparison with previously published charges,
we converted 1987 charges to their 1996 "constant dollar" value to control for
inflation. Data were analyzed using SUDAAN and the results can be generalized to
the US adult population. RESULTS: In 1996, 43.7 percent (95% CI=42.7%, 44.6%) of
the US population incurred dental care charges, which did not differ
significantly from the 1987 estimate of 44.5 percent. In 1996, mean per capita
charge for dental care was 182 dollars (95% CI=171 dollars, 192 dollars), which
did not differ significantly from the inflation-adjusted 1987 estimate of 174
dollars. The average charge per patient who incurred charges in 1996 was 416
dollars (95% CI=394 dollars, 438 dollars), which was only 7 percent greater than
the inflation-adjusted 1987 estimate of 389 dollars (P=.08). Sociodemographic
variations were observed in per capita charges, but were less apparent in mean
charge per patient who incurred charges. CONCLUSIONS: During a period when
economic growth and other market forces were expected to increase delivery of
dental services, there was little or no change in percentage of US adults
incurring charges or in mean per capita charges. The booming US economy did not
raise dental charges significantly and did not increase utilization of dental
care services.
PMID: 12816141 [PubMed - indexed for MEDLINE]
23. Health Aff (Millwood). 2003 May-Jun;22(3):203-13.
Health insurance for workers who lose jobs: implications for various subsidy
schemes.
Kapur K, Marquis MS.
RAND, Santa Monica, California, USA.
A number of proposals have been made to help laid-off workers purchase health
insurance. We use data from the 1996 Medical Expenditure Panel Survey to profile
the insurance status of workers who left a job. Our descriptive analysis suggests
that it might be difficult to design policies that target those who would
otherwise be uninsured and that large subsidies might be needed to help laid-off
workers.
PMID: 12757286 [PubMed - indexed for MEDLINE]
24. Health Aff (Millwood). 2003 Mar-Apr;22(2):139-53.
Pathways to access: health insurance, the health care delivery system, and
racial/ethnic disparities, 1996-1999.
Zuvekas SH, Taliaferro GS.
Center for Cost and Financing Studies, Agency for Healthcare Research and
Quality, Rockville, Maryland, USA.
We examine the roles that insurance coverage, the delivery system, and external
factors play in explaining persistent disparities in access among racial and
ethnic groups of all ages. Using data from the 1996-1999 Medical Expenditure
Panel Surveys and regression-based decomposition methods, we find that our
measures of health care system capacity explain little and that while insurance
clearly matters, external factors are equally important. Employment, job
characteristics, and marital status are key determinants of disparities in access
to insurance but are difficult for health policy to affect directly. Much of
existing disparities remains unexplained, presenting a challenge to developing
policies to eliminate them.
PMID: 12674417 [PubMed - indexed for MEDLINE]
25. Value Health. 2003 Mar-Apr;6(2):107-15.
Economic costs of influenza-related work absenteeism.
Akazawa M, Sindelar JL, Paltiel AD.
Yale School of Medicine, New Haven, CT 06520, USA.
BACKGROUND: Influenza vaccinations are currently advocated only for individuals
over age 50. However, vaccination of all working-age people may be warranted
based on reduced absenteeism from work. OBJECTIVE: This study aims to quantify
the association between lost workdays and influenza, controlling for other
factors. A secondary aim of the study is to assess the net benefit of expanded
vaccination in a workplace setting. RESEARCH DESIGN: Multivariate regression
analyses of the 1996 Medical Expenditure Panel Survey Household Component are
used to estimate the number of workdays missed because of influenza-like illness
(ILI) when controlling for other health, demographic, and employment factors.
Mean productivity costs are measured in terms of absences from work and valued in
dollar terms. The net benefit of influenza vaccination is estimated using a
simple decision analysis. SUBJECTS AND MEASURES: Health, demographic, and
employment data for employed individuals between the ages of 22 and 64 years are
analyzed. RESULTS: The average number of workdays missed due to ILI was 1.30
days, and the average work loss was valued at 137 US dollars per person. The
vaccine strategy was not preferred in the baseline analysis; however, this result
was sensitive to assumptions regarding the incidence of influenza, the cost of
delivering the vaccine, and the productivity impact of worker absenteeism.
Moreover, nonproductivity benefits of vaccination were omitted. CONCLUSIONS: The
economic attractiveness of expanded investment in influenza vaccination hinges on
employer- and population-specific assumptions. Our analysis provides a simple
framework within which competing considerations of disease epidemiology, worker
productivity, and economic cost may be weighed.
PMID: 12641861 [PubMed - indexed for MEDLINE]
26. Health Care Financ Rev. 2002 Spring;23(3):115-30.
Employment-related health insurance: federal agencies' roles in meeting data
needs.
Wiatrowski W, Harvey H, Levit KR.
Employer-sponsored health insurance accounts for almost one-third of all health
care spending. As health care cost growth accelerates affecting the availability
of employer-sponsored insurance and depth of coverage, the importance of timely
and accurate information for measuring and monitoring these changes and
formulating policy options increases. Identifying a growing gap between the need
for and availability of data to inform policy on employment-related health
insurance issues, the Office of Management and Budget (OMB) established a
committee of Federal agency representatives to evaluate and advise data
collection efforts. This article reports on the committee's current efforts,
focusing on evaluation of results from the Medical Expenditure Panel
Survey-Insurance Component (MEPS-IC) and the National Compensation Survey (NCS).
PMID: 12500352 [PubMed - indexed for MEDLINE]
27. Am J Psychiatry. 2002 Nov;159(11):1914-20.
National trends in the use of outpatient psychotherapy.
Olfson M, Marcus SC, Druss B, Pincus HA.
New York State Psychiatric Institute, Department of Psychiatry, College of
Physicians and surgeons of Columbia University, 1051 Riverside Dr., New York, NY,
USA. olfsonm@child.cpmc.columbia.edu
OBJECTIVE: This article reports recent trends in the use of outpatient
psychotherapy in the United States. METHOD: Data from the household sections of
the 1987 National Medical Expenditure Survey and the 1997 Medical Expenditure
Panel Survey were analyzed. Trends in the rate of psychotherapy use from these
nationally representative samples are presented by age, sex, race/ethnicity,
marital status, education, employment status, and income. Psychotherapy users are
compared over time by provider specialty, concomitant psychotropic medication
use, number of annual visits, and costs. In addition, trends in payment source
and primary diagnosis are assessed for psychotherapy visits. RESULTS: Between
1987 and 1997, there was no statistically significant change in the overall rate
of psychotherapy use (3.2 per 100 persons in 1987 and 3.6 per 100 in 1997).
However, significant increases were observed in psychotherapy use by adults aged
55-64 years and by unemployed adults. Among psychotherapy patients, there was a
marked increase in the use of antidepressant medications (14.4% to 48.6%), mood
stabilizers (5.3% to 14.5%), stimulants (1.9% to 6.4%), and psychotherapy
provided by physicians (48.1% to 64.7%). A smaller proportion of patients made
more than 20 psychotherapy visits in 1997 (10.3%) than in 1987 (15.7%). Over this
period, psychotherapy visits for mood disorders became more common. In 1997, 9.7
million Americans spent $5.7 billion on outpatient psychotherapy. CONCLUSIONS:
From 1987 to 1997, access to psychotherapy in the United States remained constant
overall but was characterized by increased use by some socioeconomically
disadvantaged groups. However, the number of visits per user markedly decreased
during this period. Psychotherapy was increasingly administered by physicians and
provided in conjunction with psychotropic medications. These changes occurred
during a period of expansion in the number of available psychotropic medications
and growth in managed behavioral health care.
PMID: 12411228 [PubMed - indexed for MEDLINE]
28. J Health Care Poor Underserved. 2002 Nov;13(4):504-25.
Latino adults' health insurance coverage: an examination of Mexican and Puerto
Rican subgroup differences.
Vitullo MW, Taylor AK.
Gallaudet University, USA.
Lack of health insurance is a serious problem in the United States. Using data
from the 1996 Medical Expenditure Panel Survey, this paper examines how insurance
varies between black, white, and Latino adults. Because Latino subgroups are not
homogeneous, the paper also compares the factors associated with health insurance
status for Mexican and Puerto Rican adults. Results indicate that access to
private health insurance for Latino adults was more closely associated with
workplace characteristics than employment itself. Time lived in the United States
was a major factor associated with being uninsured for Mexican adults, while
language barriers were a major factor limiting Puerto Rican individuals' access
to private health insurance. The paper suggests two approaches for decreasing
uninsurance among Latino adults: (1) strengthening the link between employment
and private health insurance and (2) addressing disparities in access to public
coverage for racial and ethnic groups, including recent immigrants.
PMID: 12407965 [PubMed - indexed for MEDLINE]
29. Acad Emerg Med. 2002 Sep;9(9):916-23.
Usual source of care and nonurgent emergency department use.
Sarver JH, Cydulka RK, Baker DW.
Case Western Reserve University School of Medicine Cleveland, OH, USA.
sarver@po.cwru.edu
OBJECTIVE: To examine whether dissatisfaction with one's usual source of care
(USC) and perceived access difficulties to one's USC were associated with
nonurgent emergency department (ED) use. METHODS: Variables that measured USC
satisfaction and access were identified in the 1996 cohort of the Medical
Expenditure Panel Survey (MEPS), a nationally representative sample administered
by the Agency for Healthcare Research and Quality. The main outcome measured was
nonurgent ED use at least once during 1996. RESULTS: A total of 9,146 adults had
a USC other than the ED, had at least one contact with the health care system or
were unable to get needed care, and had complete data for all the variables in
the final model. Dissatisfaction with the USC, dissatisfaction with the USC
staff, lack of confidence in the USC's ability, difficulty scheduling an
appointment, difficulty reaching the USC by phone, and long waiting times with an
appointment were all associated with having a nonurgent ED visit in 1996 (all at
p < 0.05). The positive associations between both dissatisfaction and perceived
access barriers and nonurgent ED use persisted even in multiple logistic
regression that adjusted for age, sex, race, education, health status, employment
status, income, insurance, region of residence, and rural vs. urban residence.
CONCLUSIONS: Patients who are dissatisfied with their USC or perceive access
barriers to their USC are more likely to have a nonurgent ED visit.
PMID: 12208681 [PubMed - indexed for MEDLINE]
30. Pediatr Dent. 2002 Jan-Feb;24(1):11-7.
Child dental expenditures: 1996.
Edelstein BL, Manski RJ, Moeller JE.
Division of Community Health, Columbia University, School of Dental and Oral
Surgery, and Children's Dental Health Project of Washington, DC, USA.
ble22@columbia.edu
PURPOSE: Because little has been reported about child dental expenditures,
federal data were used to estimate dental care expenditures for U.S. children by
age, sex, ethnic/ racial background, family income, parental education and
parental employment. METHODS: Parentally reported data on dental expenditures and
sources of expenditures were extracted from the most recent available federal
healthcare expenditures studies, the 1996 federal Medical Expenditure Panel
Survey (MEPS). Using the survey's large sample and complex design, these data
represent the entire U.S. child population. RESULTS: Nearly 12 billion dollars
were expended for children's dental care averaging $375 per child who obtained
care. Overall sources of payment were 47% out of pocket, 45% insurance and 8%
"other" including primarily Medicaid. Disproportionately litde spending was made
on behalf of low-income and minority children despite their higher disease
experience. The proportion of spending that was paid out of pocket was high for
all groups of children including those eligible for Medicaid even though Medicaid
prohibits cost sharing. CONCLUSIONS: Dental care for children accounts for
approximately one-quarter of U.S. dental spending and is a major component of
child health care costs. Income and racial disparities in expenditures favor
higher income children despite Medicaid coverage for lower income children. High
levels of reported out-of-pocket costs for Medicaid eligible children suggest
that Medicaid fails to meet families' needs in obtaining care. Meeting the oral
health needs of poor children will require considerably greater expenditures,
particularly through improved Medicaid financing and administration.
PMID: 11874052 [PubMed - indexed for MEDLINE]
31. J Am Dent Assoc. 2001 May;132(5):655-64.
Dental services. An analysis of utilization over 20 years.
Manski RJ, Moeller JF, Maas WR.
Department of Oral Health Care Delivery, Dental School, University of Maryland,
666W. Baltimore St., Baltimore, Md. 21201, USA. Manski@Dental.umaryland.edu
BACKGROUND: Utilization studies serve as an important tool for oral health policy
decision-making. A number of important reports have been published that help to
characterize the dental utilization patterns of most Americans. For the most
part, these studies have focused on utilization estimates for a particular survey
period or year. Fewer studies have examined changing utilization patterns over
time. METHODS: This article focuses on dental utilization and the changes in
utilization for the civilian, community-based U.S. population during 1977, 1987
and 1996. Using data from the National Medical Care Expenditure Survey, National
Medical Expenditure Survey and Medical Expenditure Panel Survey, the authors
provide national estimates of dental visits for each of several socioeconomic and
demographic categories during 1977, 1987 and 1996. RESULTS: Although the dental
use rates for children between 6 and 18 years of age were the highest of any age
group in each of the three years studied, the use rate for children and the
elderly increased during this same 20-year period. Data also showed that the gap
in use rates between lower- and higher-income people widened during the 20-year
period. Generally, use rates according to sex and race/ethnicity were unchanged
in each of the survey years, except for a narrowing of the gap between whites and
nonwhites by 1996. CONCLUSION: These data are unique and comparable and establish
a mechanism by which dental visits can be compared during a 20-year period. While
aggregate utilization rates generally were stable during this 20-year period,
some differences within socioeconomic and demographic groups are notable. For
instance, the use rate increased during the 20-year period for people 65 years of
age and older and for children younger than 6 years of age. PRACTICE
IMPLICATIONS: By understanding these analyses, U.S. dentists will be better
positioned to provide care and meet the needs of all Americans.
PMID: 11367970 [PubMed - indexed for MEDLINE]
32. Health Aff (Millwood). 2001 Jan-Feb;20(1):267-75.
Assessing the impact of health plan choice.
Schone BS, Cooper PF.
Many health policy researchers have argued that increased insurance plan choice
will enhance the efficiency of the health care system. However, relatively little
is known about plan choice and its association with insurance coverage and access
to and satisfaction with health care. Using data from the 1996 Medical
Expenditure Panel Survey, we find that 55 percent of workers had plan choice in
that year. Approximately 26 percent of workers with choice obtained it through a
family member. Controlling for other factors, plan choice is associated with
higher levels of employment-based insurance coverage and a greater likelihood
that workers are satisfied that their families' health care needs are being met.
PMID: 11194850 [PubMed - indexed for MEDLINE]
33. Health Aff (Millwood). 2001 Jan-Feb;20(1):240-6.
Patterns of insurance coverage within families with children.
Hanson KL.
Robert J. Milano Graduate School of Management and Urban Policy, New School
University, New York City, USA.
This paper examines patterns of health insurance within families with children,
using the 1996 Medical Expenditure Panel Survey (MEPS). Four and a half million
families (14 percent) had insurance for some, but not all, family members. These
partially insured families generally obtained coverage because of one of three
situations: (1) A parent earned relatively higher wages and received the
concomitant benefits of such jobs but could not afford dependent coverage; (2)
the family had young children who were covered by Medicaid through more generous
eligibility thresholds for children under age six, while other family members
were ineligible; or (3) the family had a member who was eligible for public
coverage because of a disability. Each of these situations offers the platform
from which incremental policies might efficiently expand coverage to families.
PMID: 11194847 [PubMed - indexed for MEDLINE]
34. Womens Health Issues. 2000 Sep-Oct;10(5):268-77.
Gender impacts on health insurance coverage: findings for unmarried full-time
employees.
Dewar DM.
Department of Health Policy, Management and Behavior, Department of Economics,
University of Albany, State University of New York, Albany, New York, USA.
Probit regression is applied to a sample of fully employed unmarried respondents
from the 1996 Medical Expenditure Panel Survey to determine the likelihood of
private health insurance vs. no insurance coverage. Gender-related employment
segregation is a strong indicator for insurance coverage, since those in
male-dominated industries are more likely to have coverage. The strong impact of
unions and number of plans offered on insurance coverage suggests that insurance
purchasing cooperatives and managed competition may increase availability of
affordable coverage, thus alleviating some of the financial barriers to health
care.
PMID: 10980444 [PubMed - indexed for MEDLINE]
35. Pediatrics. 1996 Aug;98(2 Pt 1):226-30.
Parental availability for the care of sick children.
Heymann SJ, Earle A, Egleston B.
Department of Health and Social Behavior, Harvard School of Public Health,
Boston, MA 02115, USA.
OBJECTIVE. Parents have always played a critical role in the care of sick
children. Although parents' roles remain crucial to children's health, parental
availability has declined during the past half century. The percentage of women
with preschool children who work has risen almost fivefold in 45 years from 12%
in 1947 to 58% in 1992. The percentage of women in the paid work force with
school-aged children has almost tripled in the same period, from 27.3% to 75.9%.
Research has examined the effects of a variety of parental work conditions on
children. However, past research has not examined how working conditions affect
the ability of parents to care for their sick children. In this article, we
examine how often the children of working parents get sick and whether parents
receive enough paid leave to care for their sick children. METHODOLOGY. This
analysis makes use of two national surveys, which provide complementary
information regarding the care of sick children. The National Longitudinal Survey
of Youth is a longitudinal survey of a nationally representative probability
sample of 12,686 men and women; the National Medical Expenditure Survey is a
panel survey of 34,459 people. First, we estimated the family illness burden.
Second, we looked in detail at the number of days of sick leave mothers had.
Third, we examined whether mothers who had sick leave had it consistently during
a 5-year period. Finally, we conducted a logistic regression to determine what
factors were significant predictors of both lacking sick leave. RESULTS. More
than one in three families faced a family illness burden of 2 weeks or more each
year. Yet, 28% of mothers had sick leave none of the time they were employed
between 1985 and 1990. Employed mothers of children with chronic conditions had
less sick leave than other employed mothers. Thirty-six percent of mothers whose
children had chronic conditions had sick leave none of the time they were
employed. Although 20% of working parents who did not live in poverty lacked sick
leave, 38% of parents who did live in poverty lacked sick leave. The problem is
also more marked for nonwhite parents. Although 23% of working white parents
lacked paid sick leave, 31% of nonwhite parents lacked sick leave. One in six
families that lacked sick leave had to cover for more than 4 weeks of family
illness during the year. CONCLUSION. In 1993, the US Congress passed the Family
and Medical Leave Act (FMLA). However, by limiting the medical leave to the care
of major illnesses, primarily those requiring hospitalization, the FMLA does not
address the majority of children's sick care needs. For the common childhood
illnesses that are not covered by the FMLA, employed parents often must rely on
their sick leave if they are to care for their sick children themselves. Yet, we
found that many employed parents lack sick leave. This is particularly true of
parents of children with chronic conditions and poor and minority families.
PMID: 8692622 [PubMed - indexed for MEDLINE]
1. J Occup Environ Med. 2008 May;50(5):527-34.
The association of diabetes with job absenteeism costs among obese and morbidly
obese workers.
Cawley J, Rizzo JA, Haas K.
Department of Policy Analysis and Management, Cornell University, Ithaca, New
York 14853, USA. JHC38@cornell.edu
Comment in:
J Occup Environ Med. 2008 Oct;50(10):1094; author reply 1094-5.
OBJECTIVE: To determine the extent to which absenteeism costs associated with
obesity and morbid obesity are traceable to diabetes, and whether obesity and
morbid obesity remain predictors of absenteeism costs after controlling for
diabetes. METHODS: Data from the Medical Expenditure Panel Survey for 2000-2004
are examined. Outcomes are probability of missing work in the previous year and
number of workdays missed. Predictors include diabetes, obesity and morbid
obesity, age, education, occupation category, and race. Models are estimated by
gender. RESULTS: Probability of missing work in the past year, number of days
missed, and absenteeism costs rise significantly with diabetes among the obese
and morbidly obese, with costs higher for the morbidly obese, after controlling
for diabetes. CONCLUSIONS: Diabetes is strongly predictive of absenteeism among
obese and morbidly obese workers. Employer efforts to reduce absenteeism should
include consideration of anti-obesity interventions and diabetes prevention.
PMID: 18469621 [PubMed - indexed for MEDLINE]
2. J Occup Environ Med. 2007 Dec;49(12):1317-24.
Occupation-specific absenteeism costs associated with obesity and morbid obesity.
Cawley J, Rizzo JA, Haas K.
Department of Policy Analysis and Management, Cornell University, Ithaca, NY
14853, USA. JHC38@cornell.edu
OBJECTIVE: To document the absenteeism costs associated with obesity and morbid
obesity by occupation. METHODS: Data from the Medical Expenditure Panel Survey
for 2000-2004 are examined. The outcomes are probability of missing any work in
the previous year and number of days of work missed in the previous year.
Predictors include clinical weight classification, age, education, and race.
Models are estimated separately by gender and occupation category. RESULTS: The
probability of missing work in the past year, number of days missed, and costs of
absenteeism rise with clinical weight classification for both women and men, and
vary across occupation. Absenteeism costs associated with obesity total $4.3
billion annually in the United States. CONCLUSION: Substantial absenteeism costs
are associated with obesity and morbid obesity. Employers should explore
workplace interventions and health insurance expansions to reduce these costs.
PMID: 18231079 [PubMed - indexed for MEDLINE]
1. J Occup Environ Med. 2007 Dec;49(12):1317-24.
Occupation-specific absenteeism costs associated with obesity and morbid obesity.
Cawley J, Rizzo JA, Haas K.
Department of Policy Analysis and Management, Cornell University, Ithaca, NY
14853, USA. JHC38@cornell.edu
OBJECTIVE: To document the absenteeism costs associated with obesity and morbid
obesity by occupation. METHODS: Data from the Medical Expenditure Panel Survey
for 2000-2004 are examined. The outcomes are probability of missing any work in
the previous year and number of days of work missed in the previous year.
Predictors include clinical weight classification, age, education, and race.
Models are estimated separately by gender and occupation category. RESULTS: The
probability of missing work in the past year, number of days missed, and costs of
absenteeism rise with clinical weight classification for both women and men, and
vary across occupation. Absenteeism costs associated with obesity total $4.3
billion annually in the United States. CONCLUSION: Substantial absenteeism costs
are associated with obesity and morbid obesity. Employers should explore
workplace interventions and health insurance expansions to reduce these costs.
PMID: 18231079 [PubMed - indexed for MEDLINE]