Employment-contingent health insurance, illness and labor supply of women: Evidence from married women with breast cancer

Department of Health Administration and Massey Cancer Center, Virginia Commonwealth University, USA.
Health Economics (Impact Factor: 2.23). 07/2007; 16(7):719-37. DOI: 10.1002/hec.1191
Source: PubMed


We examine the effects of employment-contingent health insurance (ECHI) on married women's labor supply following a health shock. First, we develop a theoretical framework that examines the effects of ECHI on the labor supply response to a health shock, which suggests that women with ECHI are less likely to reduce their labor supply in response to a health shock, relative to women with health insurance through their spouse's employer. Second, we empirically examine this relationship based on labor supply responses to breast cancer. We find that health shocks decrease labor supply to a greater extent among women insured by their spouse's policy than among women with health insurance through their own employer, suggesting that ECHI creates incentives to remain working when faced with a serious illness.

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Available from: Zhehui Luo, Jan 08, 2014
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    • "Second, as a part of a longitudinal study of newly diagnosed breast cancer patients identified by the Metropolitan Detroit Cancer Surveillance System, Bradley et al interviewed 201 women to examine the effects of employment-contingent health insurance on married women's labor supply after a breast cancer diagnosis.35 Overall, results suggest that women with employer-provided health insurance were more likely to stay attached to the labor market compared to women with health insurance provided by their spouse's employer.35 "
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    ABSTRACT: Breast cancer is the leading cause of cancer among women in the United States, costing the healthcare system, employers, and society billions of dollars each year. Despite improvements in screening and treatment, significant breast cancer treatment and survivorship disparities exist among various groups of women. One variable that has not been explored extensively as a possible contributor to breast cancer treatment disparities is employment. This is concerning, given the changing economic and employment trends in the United States favoring low-wage employment. Currently, one-quarter to one-third of all US workers are considered to be working poor, and women are disproportionally represented in this group. Characteristics of low-wage work-limited paid time off, minimal health benefits, schedule inflexibility, and economic insecurity-may become even more significant in the event of a breast cancer diagnosis. To date, there has been limited research into how job conditions inherent to low-wage work may influence working poor survivors' receipt of guideline-recommended breast cancer treatment. Therefore, the purpose of this narrative review was to critically examine the current literature to further our understanding of how employment context may impact treatment decisions and adherence-and therefore receipt of guideline-recommended care-among newly diagnosed, working poor breast cancer survivors. After undertaking a comprehensive review, we failed to identify any published literature that explicitly addressed low-wage employment and receipt of guideline-recommended breast cancer treatment. Four articles reported circumstances where women delayed, missed, or quit treatments due to work interference, or alternatively, developed strategies that allowed them to continue to work and obtain their breast cancer treatment concurrent with medical and economic challenges. An additional five articles, while focused on other cancer and employment outcomes, described the need for increased patient-provider communication about the influence of work on treatment decisions and the development of alternative treatment plans. Due to the paucity of research in this area, future policy, practice, and research efforts should focus on the employment context of working poor breast cancer survivors as a potential contributor to cancer disparities. Engagement of women, employers, oncology providers, healthcare systems, and interdisciplinary researchers is warranted to improve cancer outcomes among this disparate population of working women.
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    • "In the USA, employment rates remain relatively high after cancer, perhaps in part because many who are ineligible for Medicaid or Medicare have their health insurance linked to their employment or the employment of their spouse, frequently with large deductibles and copayments that can forestall treatment and bankrupt families [50]. Further, US breast cancer patients with health insurance tied to their own employment have been found to be more likely to work than those who are covered through their spouse [51]. This would be an irrelevant study question in Norway and other welfare states with universal health care. "
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    ABSTRACT: Cancer survivorship research includes the study of physical, psychosocial, and economic consequences of cancer diagnosis and treatment among pediatric and adult cancer survivors. Historically, the majority of cancer survivorship studies were from the United States, but survivorship issues are increasingly being addressed in other developed countries. Cross-cultural studies remain, however, scarce. The degree to which knowledge attained may or may not be transferred across cultures, countries, or regions is not known. Some important challenges for comparative research are therefore discussed in a cross-cultural perspective. Several substantive and methodological challenges that complicate the execution of cross-cultural cancer survivorship research are presented with examples and discussed to facilitate comparative research efforts in the establishment of new survivorship cohorts and in the planning and implementation of survivorship studies. Comparative research is one key to understanding the nature of cancer survivorship, distinguishing modifiable from nonmodifiable factors at individual, hospital, societal, and system levels and may thus guide appropriate interventions. Lastly, suggested future courses of action within the field of comparative cancer survivorship research are provided.
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    • "Some find that parents who have health insurance coverage for themselves or whose children are enrolled in a plan through their employment are less likely to willfully exit a job (Marquis and Kapur 2003). And others show that even when they experience a health shock, women who maintain employment-contingent health insurance are less likely to reduce their labor supply or exit work than women who have insurance through their spouse in order to maintain their insurance coverage (Bradley et al. 2007). "
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    ABSTRACT: Lack of access to health insurance for millions of Americans is an important component of the contemporary health care crisis. Low-income women are at particularly high risk of having no or inadequate insurance. Utilizing longitudinal data collected from 1,662 low-income women I conduct a series of logistic regression analyses to assess the role of individual-level welfare, work, and family changes in predicting women's access to insurance and changes in poverty status over time. The results provide evidence of a hierarchy of risk among low-income women, with those experiencing life changes at greater risk of being uninsured or having unmet health needs than those with more stable welfare, work, and family trajectories. These findings illustrate the complex effects of life changes on women's access to insurance, differential risks for different categories of low-income women, and the need for comprehensive health care reform in the U.S.
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