Work Arrangement and Access to and Use of Healthcare Services

Workers Memorial Day is observed annually on April 28 to recognize workers who suffered or died because of exposures to hazards at work. The April 27, 2018, CDC Morbidity and Mortality Weekly Report (MMWR) contributed to the Worker Memorial Day remembrance with an article on fatalities in the fishing industry and a QuickStats, highlighted in this blog, showing a link between work and receiving an influenza vaccine. The QuickStats used data from the CDC National Center for Health Statistics, National Health Interview Survey (NHIS), to demonstrate clear differences among employment categories in frequency of receiving a flu shot. Promoting flu shots among workers is one of the recommended strategies for preventing the health and economic burden associated with the flu. According to the analysis, in both 2012 and 2016, a higher percentage of government employees had received a flu shot compared to private sector employees who had higher percentages than the self-employed. Those percentages increased over the years for government and private sector employees but not for the self-employed. These data demonstrate the importance of examining how aspects of employment might be linked to the access and use of healthcare services.

Employment categories relate to the broader issue of work arrangements. Despite some inconsistencies in definitions for “standard” and “non-standard” work arrangements, there appears to be a growing trend in the use of non-standard arrangements in the U.S. Those arrangements are characterized by temporariness, instability, irregularity, and fewer legal protections and social and financial benefits for workers. Non-standard work arrangements are under-studied, and their determinants and consequences for worker safety, health, and well-being are poorly understood. Therefore, non-standard work arrangements are a high priority issue for the new NIOSH Healthy Work Design and Well-being program. To address this issue, NIOSH is assessing the state of the science, drafting a research agenda, and communicating research findings. NIOSH is also conducting research with existing data sources as well as developing a taxonomy, or classification system, of related concepts and terms so that a common language can evolve among interested researchers and, ultimately, data collection can improve as well. Both of these strategies will improve opportunities for prevention.

Developing a taxonomy is an important early step in establishing a research program. A proposed NIOSH taxonomy was presented at the Work, Stress, and Health 2017 conference (Bushnell et al., 2017). The taxonomy is arranged in a matrix of categories and elements. Categories include being employed by others (permanent, temporary, or intern), being self-employed (with own businesses or without own business), or volunteering. Elements across categories include job security, work schedule, compensation type, pay level and security, having access to fringe benefits, and having single versus dual or multiple employers.

Research on work arrangements can include examination of characteristics within a job or looking at patterns of work that span multiple jobs. Recent studies by NIOSH researchers have begun to examine standard versus non-standard arrangements and also how fringe benefits might affect worker safety, health, and well-being. A study by Ray et al. (2017) found that work arrangement was an important predictor of job stress, and that compared with non-stressed workers, stressed workers across all arrangements reported experiencing more days in poor physical and mental health and more days with activity limitations.

Access to fringe benefits is a major element in the work arrangement matrix, potentially affecting both worker and family member use of healthcare services. A recent NIOSH analysis (Asfaw and Colopy, 2017) supports this notion. Based on NHIS data from 2011 through 2015, children with parental access to paid sick leave received a flu shot and annual medical checkups more frequently (12.5% and 13.2%, respectively) than children without parental access to paid sick leave.

Access to fringe benefits might also affect the spread of influenza-like illness (ILI) in the workplace. According to an analysis by Asfaw et al. (2017), providing paid sick leave might help reduce the frequency of employees coming to work with ILI. The authors suggested that providing paid sick leave might save employers $0.63 to $1.88 billion (in 2016 dollars) in reduced ILI absenteeism costs per year.

In summary, work arrangement and employment category can affect the safety, health, and well-being of workers and their families, including through access to and use of healthcare services. This includes receiving a flu shot and being able to take paid sick leave in order to have children get flu shots and to stay home when sick to avoid spreading infection in the workplace. Continuing research with existing data and improving the taxonomy of work arrangements will further inform their determinants and consequences for workers, their families, and their employers.

Regina Pana-Cryan, PhD, is the Director of the Economic Research and Support Office in the NIOSH Office of the Director and a Co-Manager of the Healthy Work Design and Well-being Cross-Sector.

Roger R. Rosa, PhD, is a Senior Scientist in the Office of the Associate Director for Science in the NIOSH Office of the Director.

Abay Asfaw, PhD, is an Economist in the Economic Research and Support Office in the NIOSH OD.

References

QuickStats: Percentage of Currently Employed Adults Aged ≥18 Years Who Received Influenza Vaccine in the Past 12 Months, by Employment Category — National Health Interview Survey, United States, 2012 and 2016. MMWR Morb Mortal Wkly Rep 2018;67:480. DOI: http://dx.doi.org/10.15585/mmwr.mm6716a8.

Asfaw A, Rosa R, Pana-Cryan R. Potential economic benefits of paid sick leave in reducing absenteeism related to the spread of influenza-like illness. J Occup Environ Med 2017 Sep; 59(9):822-829. DOI: http://dx.doi.org/10.1097/JOM.0000000000001076.

Asfaw A, Colopy M. Association between parental access to paid sick leave and children’s access to and use of healthcare services. Am J Ind Med 2017 Mar; 60(3):276-284. DOI: http://dx.doi.org/10.1002/ajim.22692.

Ray TK, Kenigsberg TA, Pana-Cryan R. Employment arrangement, job stress, and health-related quality of life. Saf Sci 2017 May; 100(Part A):46-56. DOI: https://doi.org/10.1016/j.ssci.2017.05.003.

Bushnell T, Scharf T, Alterman T, Cummings KJ, Luckhaupt SE, Ray TK, Rosa RR, Su CP (2017). Developing a Taxonomy of Work Arrangements to Examine Relationships with Worker Safety, Health, and Well-Being. Poster presented at Work, Stress and Health 2017, Minneapolis, MN, June 8, now http://www.apa.org/wsh/past/2017/preliminary-program.pdf