The Commission on the Future of Health Care in Canada asked whether Medicare is sustainable in its present form. Well, Medicare is not sustainable for at least six reasons. Given a long list of factors, such as Canada's changing dependency ratio, the phenomenon of diminishing returns from increased taxation, competing provincial expenditure needs, low labour and technological productivity in government-funded healthcare, the expectations held by baby boomers, and the evolving value sets of Canadians--Medicare will impoverish Canada within the next couple of decades if not seriously recast. As distasteful as parallel private-pay, private-choice healthcare may be to some policy makers and providers who grew up in the 1960s, the reality of the 2020s will dictate its necessity as a pragmatic solution to a systemic problem.
We used the Russia Longitudinal Monitoring Survey (RLMS) to investigate associations between employment, socioeconomic position, and mortality.
Data were from working-age respondents in 8 rounds (1994-2003) of the RLMS. We measured associations between education, occupation, unemployment, and insecure employment and mortality with Cox proportional hazards analyses.
Of 4465 men and 4158 women who were currently employed, 251 men and 34 women died. A third of employed respondents experienced wage arrears, and 10% experienced compulsory leave and payment in consumer goods. Insecure employment, more common among the less-educated and manual workers, fluctuated with macroeconomic measures. Mortality was significantly associated with payment in consumer goods among men (hazard ratio [HR] = 1.46; 95% confidence interval [CI] = 1.03, 2.07), compulsory unpaid leave among women (HR = 3.79; 95% CI = 1.82, 7.88), and male unemployment (HR = 1.88; 95% CI = 1.38, 2.55). Associations with death within 1 year of entry were generally somewhat stronger than the association with mortality over the whole study period.
Unemployment and job insecurity predicted mortality, suggesting that they contributed to Russia's high mortality during the transition from communism.
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We examined associations between workforce demographics and job characteristics, grouped by industrial sector, and declines in workers' compensation claim rates in Ontario, Canada, between 1990 and 2003. Gender, age, occupation, and job tenure were predictors for claim rates in 12 industrial sectors. The decline in claims was significantly associated with a decline in the proportion of employment in occupations with high physical demands. These findings should generate interest in economic incentives and regulatory policies designed to encourage investment in safer production processes.
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To follow the employment status of 5-year cancer survivors for 5 years after diagnosis with their first lifetime invasive cancer and to identify socio-demographic, work-related and cancer-related predictors of employment status after 5 years.
This prospective registry study concerned all 3278 people in Norway (18-61 years old) diagnosed with their first lifetime invasive cancer in 1999 and alive in 2004 and a cancer-free control group (n = 6368) matched by sex, age, educational level and employment status in 1998.
The employment rate among male cancer survivors declined steadily every year, from 94% the year before diagnosis (1998) to 77% 5 years after diagnosis (2004). This change did not differ significantly from that of male controls. The employment rate of female survivors also declined steadily, from 87% (1998) to 69% (2004). This decline was greater than that among female controls, and in 2004 survivors had a significantly lower employment rate. For both men and women, the significant pre-diagnosis predictors of being employed in 2004 concerned higher socio-economic position. For both sexes, lung cancer survivors had the highest decline in employment rate, and male skin cancer survivors had a lower decline in employment rate than controls. Socio-demographic and work-related factors explained more of the variance in employment status than did cancer diagnosis.
The employment rate among 5-year cancer survivors did not change significantly except for female survivors. Low socio-economic position is a risk factor for decline in employment rate and should be focused on to prevent cancer-related inequity.
Whereas the end of the 1980s was characterized by an economic boom, the early 1990s saw the worst recession since the 1930s. In Sweden, the crisis that started in the fall of 1991 and culminated in 1995 meant dramatically increased unemployment rates followed by cutbacks in welfare state programs. In addition, other major changes in economic and political conditions have taken place during this period, including tax reforms and EU membership. Although public health as well as health inequalities are likely to be linked with these kinds of macro changes, it is unclear what types of changes in health and health inequalities one would expect. In this paper analyses of Swedish data on health inequalities in the periods 1986-87 and 1994-95 are undertaken on the basis of the Swedish Surveys of Living Conditions. The main finding is that overall health levels as well as differences in health between men and women, different age groups, educational groups, social classes, and employment status groups have remained constant.
This article verifies if the increase in the percentage of women in the medical profession led to the convergence of male and female physicians' hours of work as well as income. Active physicians in Quebec in 1978 were compared to the ones in 1988. Data were obtained from the computerized files of the Quebec Corporation of Physicians and the Régie d'assurance-maladie du Quebec. Despite the increasing representation of women in the medical profession, gender differences in hours worked and income remained. However, results also showed a tendency toward a convergence in total hours of work, more behavioral variation among women physicians and some behavioral change among men. The experience of the past should thus not be used as the basis for projections of future physician productivity or for medical manpower planning purposes without a careful analysis of trends in behavioral changes.
To examine whether effort-reward imbalance (ERI) at work predicts onset of register-based long-term sickness absence (LTSA) in a representative sample of the Danish workforce.
We measured effort, reward, ERI, and covariates with self-administered questionnaires in a sample of 4775 employees. LTSA during 12-months of follow-up was assessed with a national register. We calculated hazard ratios (HRs) with Cox proportional hazard models.
The HR of LTSA for a one-SD increase in ERI was 1.03 (95% confidence interval [CI], 0.93-1.15) in the most-adjusted model. For effort, the HR for a one-SD increase was 0.95 (95% CI, 0.85-1.06) and for reward the HR for a one-SD decrease was 1.14 (95% CI, 1.03-1.26).
ERI was not associated with onset of LTSA. Low reward, however, predicted LTSA.
Temporal dynamics during the early adulthood transition among children in out-of-home care is a neglected research area, leaving the possibility of coping with childhood adversity over time a poorly understood topic.
To explore early adulthood education and employment trajectories among young adults who experienced out-of-home care during childhood and to examine how various care history factors predict these trajectories.
We use longitudinal birth cohort data comprising individual-level information from national registers of all children born in Finland in 1987 (N?=?59,476, of whom 1893 were in care).
We use trajectory clustering from a previous study on the 1987 birth cohort to compare trajectories between children in care and a propensity score-matched group of peers never in care. We investigated the association between care history factors and trajectories with multinomial logistic regression modeling.
Compared with the matched peer group, children in care were less likely to enter trajectories characterized by education and employment (38%) and more likely to enter trajectories involving early parenthood (14%) or long periods of fragmented social assistance benefit receipt and unemployment (21%). Those on early parenthood trajectories were almost exclusively women, whereas those receiving social assistance benefits and experiencing unemployment for lengthy periods were mostly men. Entering disadvantaged trajectories was associated with, inter alia, placement as an adolescent, residential care, and aging out of care.
The study demonstrates the relevance of examining longitudinal trajectories in children in care's early adulthood. Many young adults with care experience need support in education and employment beyond young adult age.
Trends in the Canadian registered nurse (RN) workforce during the past 3 decades are examined, and the implications of current hospital sector retrenchment for RN employment are considered.
A descriptive review using relevant literature and existing databases on the nurse workforce is presented.
From the 1960s through the 1980s, the Canadian RN workforce grew exponentially, fueled by expansions in the health-care delivery system under Medicare, rising inpatient acuity and skill-intensive patient care, enhanced access to nursing education, and increases in the numbers of women entering the workforce. Acute care hospitals have and continue to be the predominant employer of RNs. However, the 1990s have witnessed considerable hospital retrenchment, and with that retrenchment the growth of the hospital RN workforce has slowed dramatically.
The ultimate outcomes of hospital retrenchment for the RN workforce remain unclear. Some speculate that the quality of care and working conditions will deteriorate in hospitals, as hospital administrators replace RN staff with lesser trained personnel to reduce costs. Others see change in the hospital sector as an opportunity for RNs to expand their scope of practice and responsibility in outpatient settings. The need for national and international research on the outcomes of hospital restructuring on patient care and the work of RNs is critical to sound policy making.
The authors investigate three hypotheses on the influence of labor market deregulation, decommodification, and investment in active labor market policies on the employment of chronically ill and disabled people. The study explores the interaction between employment, chronic illness, and educational level for men and women in Canada, Denmark, Norway, Sweden, and the United Kingdom, countries with advanced social welfare systems and universal health care but with varying types of active and passive labor market policies. People with chronic illness were found to fare better in employment terms in the Nordic countries than in Canada or the United Kingdom. Their employment chances also varied by educational level and country. The employment impact of having both chronic illness and low education was not just additive but synergistic. This amplification was strongest for British men and women, Norwegian men, and Danish women. Hypotheses on the disincentive effects of tighter employment regulation or more generous welfare benefits were not supported. The hypothesis that greater investments in active labor market policies may improve the employment of chronically ill people was partially supported. Attention must be paid to the differential impact of macro-level policies on the labor market participation of chronically ill and disabled people with low education, a group facing multiple barriers to gaining employment.