Turenne M; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2001; 18: 88.
Department of Health Management and Policy, University of Michigan School of Public Health, 109 S. Observatory, Ann Arbor, MI 48109-2029, Phone: (734) 913-9249, Fax: (734) 764-4338, E-mail: turenne@umich.edu
RESEARCH OBJECTIVE: Workers who have a major chronic illness or a dependent with such an illness may be especially vulnerable to "job-lock," or reduced worker mobility due to employer-provided health insurance (EPHI). Changing jobs may become prohibitively costly in part due to the high cost of changing health plans. This study extends previous research on job-lock by evaluating how EPHI influences the mobility of married workers affected by chronic illness (of worker or spouse), and by examining recent trends.STUDY DESIGN: Data were obtained from the National Medical Expenditure Survey (NMES, 1987) and from the Medical Expenditure Panel Survey (MEPS, 1996-97). Health measures included (1) worker or spouse reported one of four major chronic illnesses (CI: diabetes, heart disease, cancer, emphysema) and (2) worker or spouse reported fair or poor health (HFP). Probit models of voluntary job separation (versus no voluntary separation) included demographics, wage, fringe benefits, and other job attributes. Interactions CI*EPHI and HFP*EPHI were used to test for job-lock (difference-in-difference). Other characteristics (e.g., strongly denying being an above average risk taker) were included in three-way interactions. Separate analyses were performed for 1987 and 1996-97.POPULATION STUDIED: Married workers ages 20-59, not self-employed or employed in the agricultural or construction industries. NMES: n=5,189; MEPS: n=3,882.PRINCIPAL FINDINGS: In 1987, both CI and HFP were associated with increased mobility for workers not holding EPHI, but not for workers holding EPHI. Based on CI*EPHI, there was only weak overall evidence of job-lock (p=0.08), but among risk averse workers the increased mobility due to CI was 76% lower for those holding EPHI relative to those not holding EPHI (p<0.01). Based on HFP*EPHI, the increased mobility due to HFP was 79% lower for those holding EPHI relative to those not holding EPHI (p<0.01). In 1996-97, job-lock was not indicated using either CI*EPHI or HFP*EPHI, although attitudes about risk were unavailable. Among dual earners, CI was actually associated with relatively higher mobility for workers holding EPHI.CONCLUSIONS: This study indicates possible job-lock for workers affected by chronic illness in 1987 but not in 1996-97. However, the lack of an overall finding in 1996-97 does not necessarily imply that job-lock was not a problem for some workers (e.g., risk averse).IMPLICATIONS FOR POLICY, DELIVERY, OR PRACTICE: A reduction in job-lock over time would be consistent with the effects of legislation enacted between the late 1980s and mid-1990s that addressed the portability of EPHI. Alternatively, due to sustained economic growth during the 1990s, the availability of other jobs offering EPHI or the affordability of transitions between jobs may have improved for some workers. These results may have implications for future policies aiming to reduce the cost of these transitions.
Publication Types:
Keywords:
- Career Mobility
- Chronic Disease
- Data Collection
- Employment
- Health Insurance Portability and Accountability Act
- Health Maintenance Organizations
- Insurance, Health
- Occupations
- Salaries and Fringe Benefits
- economics
- manpower
- hsrmtgs
Other ID:
UI: 102273324
From Meeting Abstracts