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PubMed2000

Sources of health insurance and characteristics of the uninsured: analysis of the March 1999 Current Population Survey.

This Issue Brief provides summary data on the insured and uninsured populations in the nation and in each state. It discusses the characteristics most closely related to an individual's health insurance status. Based on EBRI estimates from the March 1999 Current Population Survey (CPS), it represents 1998 data--the most recent data available. In 1998, 194.7 million nonelderly Americans--81.6 percent--had some form of health insurance. More than 64 percent had it through an employment-based health plan; 6.5 percent purchased it on their own; and 14.3 percent were covered by a public program, mostly through Medicaid (10.4 percent). In 1998, 18.4 percent of the nonelderly population was uninsured (43.9 million people), compared with 14.8 percent in 1987. The percentage of uninsured Americans has generally been increasing since at least 1987, although the percentage uninsured in 1998 was not statistically different from the percentage uninsured in 1997 (18.3 percent). The increase in the uninsured prior to 1993 can be attributed to the erosion of employment-based health insurance. However, since 1993, the percentage of nonelderly Americans covered by an employment-based health plan has increased from 63.5 percent to 64.9 percent. The decline in public sources of health insurance would mostly explain the recent increase in the uninsured. For example, between 1994 and 1998 the percentage of nonelderly Americans covered by CHAMPUS/CHAMPVA declined from 3.8 percent to 2.9 percent, in large part due to downsizing in the military. Similarly, between 1993 and 1998, the percentage of nonelderly Americans covered by Medicaid declined from 12.7 percent to 10.4 percent as people left welfare. The increase in employment-based coverage since 1994 was due mainly to a higher likelihood that children were covered by an employment-based health plan. Between 1994 and 1998, the percentage of children covered by an employment-based health plan increased from 58.1 percent to 60.2 percent. For adults, it increased less than one percentage point, from 66.1 percent to 66.9 percent. Adults started to realize gains in employment-based health insurance between 1997 and 1998. Between 1994 and 1997, the percentage of working adults with employment-based health insurance coverage held steady at roughly 72.3 percent. During this period, health care cost inflation was essentially nonexistent. However, between 1997 and 1998, the percentage of working adults with employment-based health insurance increased from 72.2 percent to 72.8 percent, despite the apparent return of health care cost inflation in 1998. It is likely that the changing composition of the labor force accounted for some of the increase in employment-based coverage.

Adolescent↗

PubMed2000

Lag time between onset of symptoms and access to rheumatology care and DMARD therapy in a cohort of patients with rheumatoid arthritis.

OBJECTIVE: To study demographic and clinical variables associated with a longer delay in disease modifying antirheumatic drug (DMARD) therapy initiation in a cohort of patients with rheumatoid arthritis (RA). METHODS: We studied 527 new RA patients (74.3% female, median age at symptom onset 55 yrs) in a hospital setting who fulfilled the ACR criteria for the diagnosis of RA. Demographic, clinical, laboratory, and treatment variables were collected longitudinally into a computerized research database. Risk factors for delay in use of DMARD therapy and first evaluation by a rheumatologist were analyzed using a Cox regression model. RESULTS: The median lag time between symptom onset and first rheumatologist encounter was 17 months and between onset of symptoms and first DMARD therapy 19 months. Variables associated with longer delay to DMARD therapy were the lag time between symptom onset and first rheumatologist visit (RR 0.73, 95% CI 0.71-0.76) and years of education. Variables associated with longer delay in first visit with rheumatologist were swollen/tender joint count, age at symptom onset, home support, labor force status, marital status, and years of education. CONCLUSION: Awareness of factors associated with a longer delay in access to rheumatology care and DMARD therapy may help break down barriers that prevent their early access, irrespective of patient age, socioeconomic status, initial symptoms, or need for treatment.

Adult↗

PubMed1997

An approach to human work systems development under the circumstances of an aging society and international business operations.

At least three serious aspects of problems exist as obstacles for the national economy in Japan to grow or even to maintain its present level: the lack of natural resources, the trends of a decreasing young labor force, and an increase in the shift of domestic business operations to foreign countries. Although top managers make the decisions of product or service planning, or both, work systems designers are also responsible for conserving the resources. An action against the decrease of the young work force is needed to maintain work systems in an operable condition. The business shifts to foreign countries affect all the people, who are losing job opportunities. The present paper presents an approach to reorienting human work systems within the scope of the work systems designers' roles under the circumstance of these social environments. The following discussion is based on the assumptions that work organizations be productive for themselves and the world, effective and efficient for themselves, and contributive to their communities and the world. In essence, an approach to human work systems development should be fair to managers and workers alike. Presented are cases of these work systems as developed along the perspectives mentioned.

Aged↗

PubMed2000

Social Security privatization in Latin America.

The new, partially privatized social security system adopted by Chile in 1981 has attracted attention in many parts of the world. Since then, a number of Latin American countries have implemented the Chilean model, with some variations: either with a single- or multi-tier system, or with a period of transition to take care of those in the labor force at the time of the change. The single-tier version consists of a privatized program with individual accounts in pension fund management companies. Multi-tier systems have a privatized component and retain some form of public program. This article describes each of the new programs in Latin America, their background, and similarities and differences among them. Much more information is available for Chile than for the other countries (in part because Chile has the oldest system), enough to be able to evaluate what, in most cases, is the most accurate information. That is often not the case for the other countries, especially when dealing with subjects such as transition costs and net rates of return (rates of return minus administrative fees). No country has copied the Chilean system exactly. Bolivia, El Salvador, and Mexico have closed their public systems and set up mandatory individual accounts. Argentina has a mixed public/private system with three tiers. In Colombia and Peru, workers have a choice between the public and private programs. Uruguay created a two-tier mixed system. Costa Rica has a voluntary program for individual accounts as a supplement to the pay-as-you-go program and has just passed a law setting up mandatory accounts containing employer contributions for severance pay. All of the countries continue to face unresolved issues, including: High rates of noncompliance--the percentage of enrollees who do not actively and regularly contribute to their accounts--which could lead to low benefits and greater costs to the governments that offer a guaranteed minimum benefit; Proportionately lower benefits for women and lower earners than for men and higher earners; A minimum required rate of return among the pension fund management companies (in most of these countries) that has resulted in similarity among the companies and the consequent lack of meaningful choice; and High administrative fees in most of these countries, which reduce the individual's effective rate of return. To what extent these issues can be mitigated or resolved in the future is not yet clear. In general, a definitive assessment of the Chilean model and its Latin American variations will not be possible until a cohort of retirees has spent most of its career under the new system.

Aged↗

PubMed2000

Nursing shortage takes toll on CM departments.

News of the nation's shrinking health care labor force was made official with the publication of population data in a recent issue of the Journal of the American Medical Association. The report claimed that 40% of RNs will be over 50 before 2010. What does this mean for hospital case managers? Transition, according to industry experts. The role of the case manager will need better definition as shortages blur lines between patient care and traditional management.

Case Management↗

PubMed2000

Counting the uninsured: a comparison of national surveys.

This Issue Brief reviews surveys that provide estimates of the uninsured population in the United States. It includes a discussion of why the estimates from the various surveys differ. It is important to understand the differences in the estimates of the uninsured population. The projected cost of implementing policy proposals depends on the estimates of the number of people affected by the proposals; for instance, the allocation of funding for the State Children's Health Insurance Program (S-CHIP) depends heavily on the available estimates. In addition, the estimated effectiveness of policy proposals to reduce the uninsured population will be accurate only if the correct count is known and the precise make-up of the uninsured population is understood. Currently, seven surveys can be used to make nationally representative estimates of the number of people without health insurance coverage. Some of the surveys collect health insurance information in the context of obtaining general information on health care, while other surveys are focused on other topics such as labor force participation and public assistance program participation. The most widely used survey that collects information on health insurance coverage is the Current Population Survey (CPS), conducted by the Census Bureau. The most recent estimates from the CPS suggests that 44.3 million Americans were uninsured in 1998. Besides the CPS, a number of other surveys collect information on the uninsured population. They include the Survey of Income and Program Participation (SIPP), Behavioral Risk Factor Surveillance System (BRFSS), Community Tracking Study (CTS), Medical Expenditure Panel Survey (MEPS), National Health Interview Survey (NHIS), and the National Survey of America's Families (NSAF). Estimates of the uninsured from these surveys range from 19 million to 44 million and vary depending on the time frame the survey covers. A number of states have started to question the validity of the uninsured estimates from the CPS, and other surveys, because of the small sample size in many states. As a result, some states have begun to conduct their own surveys to determine the number of uninsured residents. States that regularly conduct their own surveys include Florida, Massachusetts, Minnesota, New Mexico, Oregon, Vermont, and Wisconsin. Unfortunately, the various state surveys are not easily comparable. Research needs to continue to increase understanding of the differences among the surveys and to improve on methodologies to count the uninsured, as the future of public programs, such as S-CHIP and other state and local initiatives to expand health insurance coverage, depends on the accuracy of these estimates. Whatever survey is used, the results show that a substantial number of Americans do not have any health insurance coverage, and the number has been growing.

Censuses↗

PubMed2000

Women and pensions: a decade of progress?

This Issue Brief compares changes from 1989 to 1998 in pension participation, accumulation, and allocation for employed women, versus employed men, ages 18-62. In addition, it provides an estimate of the gender "pension gap" in defined contribution accumulations, contrasts this with the gender "earnings gap," and provides explanations for these differences. Between 1989 and 1998, the percentage of employed women with a pension or retirement plan at their current job increased from 43 percent to 45 percent, compared with a decline from 53 percent to 52 percent for employed men. For both women and men, the percentage with defined contribution retirement plans increased dramatically, while the percentage with defined benefit pension plans dropped sharply. Between 1989 and 1998, the ratio of women's to men's defined contribution plan accumulations increased from 40 percent to 44 percent, indicating a narrowing of the gender pension gap. However, the narrowing was concentrated among the cohort ages 45-53 in 1998. The gender pension gap increased for women in other age groups. Gender differences in defined contribution plan accumulations can be attributed to differences in earnings and job characteristics. Between 1989 and 1998, for workers with defined contribution plans, the ratio of women's to men's earnings remained unchanged at 57 percent. Employed women with defined contribution plans are more than twice as likely to earn less than $25,000 per year than employed men with defined contribution plans, but almost five times less likely to earn more than $100,000 per year. From 1989 to 1998, the percentage of employed men with defined contribution balances invested mostly in low-risk, low-return assets declined much more than the percentage of employed women who followed that investment strategy. Whereas the percentages of men and women with retirement plans invested mostly in bonds were nearly equal at 31 percent and 32 percent in 1989, respectively, by 1998, 20 percent of women (compared with 14 percent of men) had their retirement plans invested mostly in bonds. The trend toward defined contribution plans and riskier retirement portfolios has resulted in significant wealth accumulation over the decade. In real terms, both men and women have greater retirement plan wealth, but increases have been larger for men than for women. Since there is no evidence that plan provisions vary by gender, improvements in the gender pension gap will come only with changes in women's labor force experience and investment decision-making.

Adolescent↗

PubMed2000

[Factors related to attitudes toward medical facility choice by the elderly why do the elderly favor large hospitals?].

PURPOSE: Factors associated with large hospital choice by the elderly were examined. Possible factors were divided among three domains; predisposing factors, need factors, and enabling or restraining factors. Both direct effects and interactive effects of those factors on choice attitudes were examined. METHODS: The data were obtained from a face-to-face interview survey with a national sample aged 60 and over. The survey was conducted in 1996, and 2,447 elderly were interviewed. Choice attitudes were measured in two ways: 1) preference to use a large hospital regardless of disease, and 2) complaint of not being able to use a large hospital without an referral system by a clinic. Predisposing factors were age, sex and educational attainment. Need factors were assessed in terms of activities of daily living (ADL) and number of illnesses. Enabling or restraining factors included attitudes toward medical care, accessibility of medical facilities, home doctor existence at a clinic, and labor force participation. RESULTS: 18.5 percent of respondents reported a preference for large hospitals regardless of disease, and 51.3 percent had complaints about the referral system. Respondents with a higher number of illnesses were more likely to report a preference for use of a large hospital, regardless of the type of disease, and respondents with low ADL had more complaints about the referral system than those with higt ADL. The group who employed high technology as a criteria in choosing medical facilities, did not have a home doctor at a clinic, and had good access only to a large hospital, reported a strong preference for use of a large hospital regardless of disease type, and they also complained about the referral system. Regarding preference, an interactive effect between the number of illnesses and the existence of home doctor at a clinic was observed. CONCLUSION: Existence of a home doctor in a clinic, attitudes toward medical care, and accessibility to medical facilities might have direct effects on choice of a large hospital, and only the existence of a home doctor at a clinic might have a strong influence decreasing this preference among the elderly with a higher number of illnesses.

Aged↗

PubMed2001

[Medical demography: the portrait of pathologic anatomy and cytology].

Assessment of care supply in terms of medical labor force is difficult because of the disparity of available data. Using the medical specialty of pathology as an example, we present for the first time a demographic analysis based on the confrontation of main data sources. This study underlines some of the structural and dynamic problems which threaten the demographic stability of the specialty. The public service suffers from a lack of practitioners, especially in regional hospitals. Whereas one third of French pathologists work in the larger hospitals around Paris, in some other regions private services constitute the main component of the supply. Projections based on the aging phenomenon and a reduction in entry indicate a future problem in the renewal of generations of pathologists. The consequences of this programmed decrease in the number of French pathologists will be further exacerbated by the movement of the sex ratio in favor of women.

Demography↗

PubMed2001

How does a changing country change family practice?

The US population is changing. Ethnic minorities are now the fastest growing segment of the US population, and they have higher mortality rates than the remainder of Americans. Members of minority groups also earn less and are twice as likely as other residents to lack medical insurance. Minority communities have poorer health and access to care than the remainder of the population. Women constitute more than half the total population of the United States and are half of the labor force. Family structure has changed such that 53% of African-American, 32% of Hispanic, and 27% of all families were headed by a single parent in 1992. The elderly population has also increased and has a greater prevalence of chronic disease. The physician workforce has more female and younger physicians than in the past but a still-inadequate number of minority physicians. In contrast to the low proportion of minorities in the US physician workforce, women now comprise approximately half of medical students. A major economic trend affecting health care access in the United States is the lack of secure insurance coverage for 44 million people in 1998. Rates of no insurance are higher among minorities, households with no full-time worker, the near poor, and among persons with less education. Private charitable services, as well as the formal safety net systems, are experiencing financial pressure in the United States, further jeopardizing access to care for the uninsured. The average family in the United States is now working harder--but earning less money. The changing population mix, shifting gender balance, increasing proportion of elderly, and major socioeconomic trends and income disparities occurring in the United States today have shaped a practice environment that differs from whatfacedfamily physicians 30 years ago. Thus, a change in approach to training and practice is needed, while preserving the critical relationship we have with our patients and continuing to meet their needs.

Education, Medical↗

PubMed2001

Women and employment: a decade review.

Contemporary women fulfill multiple social roles: wife or partner, parent and caregiver to elders, worker in the labor force. This chapter focuses on women and employment. Nursing research from the past decade on women and their role in the work force, with emphasis on the relationships between paid work and women's other social roles and their health is reviewed. Major categories of nursing research contributions are summarized, including populations studied, methodological approaches, and major findings. Suggestions for emphases in future research are included.

Employment↗

PubMed2000

Vocational outcomes for persons with severe physical disabilities: Design and implementation of workplace supports.

Clearly, the need for a skilled labor pool is great in today's economy. Yet, many people with significant disabilities are struggling to find jobs with the majority of them unemployed or underemployed [6]. There is a need to develop strategies that can effectively empower these individuals to become part of the nation's labor force. This article describes one model project that used person-centered career plans, supported employment, and on-the-job assistive technology assessment and training to assist 21 individuals to become competitively employed. Customers worked an average of 15.66 months earning an average of $7,271 in total wages. They were hired by both small and large businesses to do a variety of tasks to include data entry, customer service, clerical assistance, as well as food prep. While the findings are preliminary, the results indicate that individuals with severe physical disabilities can maintain employment by combining supported employment and assistive technology within the workplace.

Journal Article↗

PubMed1975

Caring for children and working: dilemmas of contemporary womanhood.

American women are entering the labor force in increasing numbers; currently 53% of women in intact families are in paid employment as are 41% of those with children under 18; this despite the fact that women earn less than 60% of the wages paid men in similar occupations. Women are responding to the pressures of an inflationary economy, to the costs of higher education for their children, to opportunities for personal fulfillment, and to a growing market for service occupations. Yet married women continue to carry 70% to 80% of child care and household duties when both parents work. Conventional stereotypes of feminine passivity, formalized in the last century, grossly misperceive women's roles and abilities and constitute a psychological barrier to self-realization for both men and women. Social innovations in child care will be necessary if we are to provide optimal conditions for child development at a time when family roles are in sharp transition. The pediatrician, as family counselor, can help to support mothers and fathers seeking to fulfill parental, occupational and personal needs in a rapidly changing society.

Africa, Southern↗

PubMed1975

Constructing increment-decrement life tables.

A life table model which can recognize increments (or entrants) as well as decrements has proven to be of considerable value in the analysis of marital status patterns, labor force participation patterns, and other areas of substantive interest. Nonetheless, relatively little work has been done on the methodology of increment-decrement (or combined) life tables. The present paper reviews the general, recursive solution of Schoen and Nelson (1974), develops explicit solutions for three cases of particular interest, and compares alternative approaches to the construction of increment-decrement tables.

Adult↗

PubMed1979

[Not Available].

Explore the source record for details and available documents.

Contraception↗

PubMedDate not supplied

Employer supports for parents with young children.

The competing interests of employers, working parents, and very young children collide in decisions over work schedules, child care arrangements, promotions, children's sicknesses, and overtime hours. With the rising number of women in the labor force, more and more employers are concerned about how their workers balance work and family priorities. This article examines the supports that employers provide to help parents with young children juggle demands on their time and attention. It reviews the availability of traditional benefits, such as vacation and health insurance, and describes family-friendly initiatives. Exciting progress is being made in this arena by leading employers, but coverage remains uneven: Employers say they provide family-friendly policies and programs to improve staff recruitment and retention, reduce absenteeism, and increase job satisfaction and company loyalty. Evaluations demonstrate positive impacts on each of these valued outcomes. Employee benefits and work/family supports seldom reach all layers of the work force, and low-income workers who need assistance the most are the least likely to receive or take advantage of it. Understandably, employer policies seek to maximize productive work time. However, it is often in the best interests of children for a parent to be able to set work aside to address urgent family concerns. The author concludes that concrete work/family supports like on-site child care, paid leave, and flextime are important innovations. Ultimately, the most valuable aid to employees would be a family-friendly workplace culture, with supportive supervision and management practices.

Child Care↗

PubMed1998

Overview of trauma care and its prospect.

Trauma is a prominent problem in modern society, which is called "the disease of developed society" or "the twin brother of modern civilization". Nowadays, over one million people die of trauma and several ten million people are injured worldwide each year. In China, over one hundred thousand people die of trauma and several millions are injured each year. Therefore, trauma has become the fifth cause of death in urban districts and the fourth cause of death in the countryside. According to the calculation of years of potential life lost (YPLL), trauma then turns into the first cause of death, indicating that the hazard to the society and loss of labor forces induced by trauma is more severe than any other diseases. Therefore, much attention has been paid to trauma research at home and abroad. This paper is to review the recent advances in trauma care and to offer some prospects for the next century's development.

Journal Article↗

PubMedDate not supplied

Occupational health in China.

China has been experiencing rapid industrialization and economic growth, resulting in a transformed industrial structure and expansion of the labor force. Occupational health and safety services, nonexistent before 1949, have made remarkable advances over the past decades. However, these services face greater challenges, consisting of both traditional and new occupational health problems. Poorly regulated work environments often lacking health services in recently developed and thriving small-scale industries and joint venture enterprises have created increasing risks for occupational diseases and work-related injuries. A special strategy based on cooperation among and contributions from the legal, administrative, social, economic, and scientific communities is critical to achieving the ultimate goal of control and prevention of these occupational health problems.

China↗