RESUMEN
We examine the relationship between disabled working-age Supplemental Security Income (SSI) enrollment and health care and social assistance employment and wages. County-level data are gathered from government and other publicly available sources for 3144 US counties (2012 to 2015). Population-weighted linear regression analyses examine associations between each health care and social assistance employment and wage measure and SSI enrollment, controlling for factors associated with health care and social assistance employment and wages. Results show positive associations between county-level percent of the population enrolled in the SSI program and health care and social assistance employment and wages with strong associations identified for social assistance employment. A one standard deviation increase in SSI enrollment is associated with a 5.6% increase in the health care and social assistance sector employment percent compared with the mean and 9.7% and 7.3% increases in health care and social assistance sector employment and wage shares, respectively, when compared with the means. We find working-age adult SSI enrollment is positively associated with employment outcomes, primarily in the social assistance organization subsector and in lower wage paying jobs. Evolving federal disability policy may influence existing and future SSI enrollment, which has implications for health care workforce employment and composition.
Asunto(s)
Atención a la Salud/economía , Medicare Part B , Bienestar Social , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Atención a la Salud/estadística & datos numéricos , Personas con Discapacidad , Femenino , Humanos , Renta , Masculino , Medicare Part B/economía , Medicare Part B/estadística & datos numéricos , Persona de Mediana Edad , Salarios y Beneficios/estadística & datos numéricos , Bienestar Social/economía , Bienestar Social/estadística & datos numéricos , Estados Unidos , Adulto JovenRESUMEN
OBJECTIVE: To examine the relationship between Social Security Disability Insurance (SSDI) enrollment and health care employment. DATA SOURCES: State-year level data from government and other publicly available sources for all states (2000-2014). STUDY DESIGN: Population-weighted linear regression analyses model associations between each health care employment measure and each SSDI enrollment measure (i.e., SSDI overall, physical, or mental health enrollment rates), controlling for factors associated with health care employment, state fixed effects, and secular time trends. DATA COLLECTION: Data are gathered from publicly available sources. PRINCIPAL FINDINGS: A one standard deviation increase in SSDI enrollment per 100,000 population is associated with a statistically significant 2.6 and 4.5 percent increase in the mean employment rate per 100,000 population for health care practitioner and technical occupations and health care support occupations, respectively. The size of this relationship varies by the type of disabling condition for SSDI enrollment (physical versus mental health). CONCLUSIONS: Social Security Disability Insurance enrollment is significantly associated with health care employment at the state level. Quantifying the magnitude of this relationship is important given high SSDI enrollment rates as well as evolving policy and demographic shifts related to the SSDI program.
Asunto(s)
Técnicos Medios en Salud/estadística & datos numéricos , Empleo , Seguro por Discapacidad , Seguridad Social , Adulto , Anciano , Atención a la Salud , Personas con Discapacidad , Determinación de la Elegibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados UnidosRESUMEN
BACKGROUND: Medicaid is the largest payer for mental health (MH) services. AIMS: This study examines associations between Medicaid provisions and the MH industry composition. METHODS: Medicaid data derived from the Centers for Medicare and Medicaid Services. MH facility gross payroll and occupational employment data derived from the Bureau of Labor Statistics. State fixed-effects regression models are performed to examine associations. RESULTS: In the 1999-2009 period, per-capita gross payroll gains are largest for residential MH and substance abuse (SA) facilities and MH practitioner offices, followed by MH clinics and physician offices. Likewise, occupational employment gains per 100 000 people are largest for MH and SA social workers and MH counselors, followed by psychiatrists and psychologists. The Medicaid beneficiary rate is related with gross payroll gains at residential MH and SA facilities (p < 0.001) and MH clinics (p < 0.001), and with employment gains for MH and SA social workers (p < 0.001) and MH counselors (p < 0.001). Smaller effect sizes exist with MH physician offices (p < 0.05) and psychiatric hospitals' (p < 0.01) gross payroll. No statistically significant relationship exists between the Medicaid beneficiary rate and psychiatrist and psychologist employment. CONCLUSION: Medicaid provisions are related with the MH industry composition. An imbalanced MH industry may lead to inadequate management of MH disorders.
Asunto(s)
Sector de Atención de Salud/economía , Medicaid/economía , Servicios de Salud Mental/economía , Costos de la Atención en Salud , Humanos , Beneficios del Seguro , Estados UnidosRESUMEN
The relationship between political power and the various pathways to health inequalities in Vieques, Puerto Rico, is explored. The U.S. Navy used the island for 62 years for bombing and other military exercises. The article focuses on the resulting changes to the island's socioeconomic positioning and the health inequalities over six decades. Secondary data analysis of census data using a revised World Health Organization model is used to examine the relationships of political power, labor markets, employment, material deprivation, social and family networks, and health inequalities. Findings are interpreted through a social justice lens and implications suggest the use of political advocacy for social change.
Asunto(s)
Disparidades en el Estado de Salud , Política , Empleo/estadística & datos numéricos , Humanos , Personal Militar , Modelos Teóricos , Pobreza , Puerto Rico , Apoyo Social , Factores Socioeconómicos , Estados UnidosRESUMEN
The healthcare sector was one of the few sectors of the US economy that created new positions in spite of the recent economic downturn. Economic contractions are associated with worsening morbidity and mortality, declining private health insurance coverage, and budgetary pressure on public health programs. This study examines the causes of healthcare employment growth and workforce composition in the US and evaluates the labor market's impact on healthcare spending and health outcomes. Data are collected for 50 states and the District of Columbia from 1999-2009. Labor market and healthcare workforce data are obtained from the Bureau of Labor Statistics. Mortality and health status data are collected from the Centers for Disease Control and Prevention's Vital Statistics program and Behavioral Risk Factor Surveillance System. Healthcare spending data are derived from the Centers for Medicare and Medicaid Services. Dynamic panel data regression models, with instrumental variables, are used to examine the effect of the labor market on healthcare spending, morbidity, and mortality. Regression analysis is also performed to model the effects of healthcare spending on the healthcare workforce composition. All statistical tests are based on a two-sided [Formula: see text] significance of [Formula: see text] .05. Analyses are performed with STATA and SAS. The labor force participation rate shows a more robust effect on healthcare spending, morbidity, and mortality than the unemployment rate. Study results also show that declining labor force participation negatively impacts overall health status ([Formula: see text] .01), and mortality for males ([Formula: see text] .05) and females ([Formula: see text] .001), aged 16-64. Further, the Medicaid and Medicare spending share increases as labor force participation declines ([Formula: see text] .001); whereas, the private healthcare spending share decreases ([Formula: see text] .001). Public and private healthcare spending also has a differing effect on healthcare occupational employment per 100,000 people. Private healthcare spending positively impacts primary care physician employment ([Formula: see text] .001); whereas, Medicare spending drives up employment of physician assistants, registered nurses, and personal care attendants ([Formula: see text] .001). Medicaid and Medicare spending has a negative effect on surgeon employment ([Formula: see text] .05); the effect of private healthcare spending is positive but not statistically significant. Labor force participation, as opposed to unemployment, is a better proxy for measuring the effect of the economic environment on healthcare spending and health outcomes. Further, during economic contractions, Medicaid and Medicare's share of overall healthcare spending increases with meaningful effects on the configuration of state healthcare workforces and subsequently, provision of care for populations at-risk for worsening morbidity and mortality.