Examining the association of smoking with work productivity and associated costs in Japan

Aims: Smoking is associated with significant health and economic burden globally, including an increased risk of many leading causes of mortality and significant impairments in work productivity. This burden is attenuated by successful tobacco cessation, including reduced risk of disease and improved productivity. The current study aimed to show the benefits of smoking cessation for workplace productivity and decreased costs associated with loss of work impairment.

Materials and methods: The data source was the 2011 Japan National Health and Wellness Survey (n?=?30,000). Respondents aged 20–64 were used in the analyses (n?=?23,738) and were categorized into: current smokers, former smokers, and never smokers. Generalized linear models controlling for demographics and health characteristics examined the relationship of smoking status with the Work Productivity and Activity Impairment questionnaire (WPAI-GH) endpoints, as well as estimated indirect costs.

Results: Current smokers reported the greatest overall work impairment, including absenteeism (i.e. work time missed) and presenteeism (i.e. impairment while at work); however, after controlling for covariates, there were no significant differences between former smokers and never smokers on overall work impairment. Current smokers and former smokers had greater activity impairment (i.e. impairment in daily activities) than never smokers. Current smokers reported the highest indirect costs (i.e. costs associated with work impairment); however, after controlling for covariates, there were no significant differences between former smokers and never smokers on indirect costs.

Limitations and conclusions: Smoking exerts a large health and economic burden; however, smoking cessation attenuates this burden. The current study provides important further evidence of this association, with former smokers appearing statistically indistinguishable from never smokers in terms of work productivity loss and associated indirect costs among a large representative sample of Japanese workers. This report highlights the workplace benefits of smoking cessation across productivity markers and cost-savings.     

Smokeless tobacco,smoking cessation and harm reduction: an economic analysis

Good estimates place ‘hard core’ smoking rates in the United States at approximately 25%, with little change over the decade of the 1990s. This paper examines the possibilities of ‘harm reduction’ with the use of smokeless tobacco. Specifically, using an econometric model we seek to determine whether an increase in the use of smokeless tobacco would lead to reduced smoking rates in the United States. Applying our model to the NHANES III (National Health and Nutrition Examination Survey) we find that the use of smokeless tobacco by an average U.S. male smoker would increase the average probability of smoke cessation by over 10%. Approximately 3 million additional ‘quits’ would result for 26 million smokers. Our study permits an examination of cessation by age groups and we find that males who use smokeless tobacco between 16 and 65 have a 10–14% probability of quitting but that the probability falls beyond age 66. Important implications for life extension and health costs would attend these results with, under conservative assumptions, life years saved approximating 2.16 million and health care cost-savings of about $3 billion per year.     

Estimating the public economic consequences of introducing varenicline smoking cessation therapy in South Korea using a fiscal analytic framework

Background and aims: Smoking gives rise to many cross-sectorial public costs and benefits for government. Costs arise from increased healthcare spending and work-related social benefits, while smoking itself provides significant revenue for government from tobacco taxes. To better understand the public economic impact of smoking and smoking cessation therapies, this study developed a government perspective framework for assessing smoking-attributable morbidity and mortality and associated public costs. This framework includes changes in lifetime tax revenue and health costs, as well as changes in tobacco tax revenue, from fewer smokers.

Methods: A modified generational accounting framework was developed to assess relationships between smoking-attributable morbidity and mortality and public economic consequences of smoking, including lifetime tax revenue gains/losses, government social transfers, and health spending. Based on the current prevalence of smoking in South Korean males, a cohort model was developed for smokers, former-smokers, and never-smokers. The model simulated the lifetime discounted fiscal transfers for different age cohorts in 5 year age bands, and the return on investment (ROI) from smoking cessation therapy.

Results: Former smokers are estimated to generate higher lifetime earnings and direct tax revenues and lower lifetime healthcare costs due to the reduction of smoking-attributable mortality and morbidity compared to smokers, even after accounting for reduced tobacco taxes paid. Based on the costs of public investments in varenicline, this study estimated a ROI from 1.4–1.7, depending on treatment age, with higher ROI in younger cohorts, with an average ROI of 1.6 for those aged less than 65.

Conclusions: This analysis suggests that reductions in smoking can generate positive public economic benefits for government, even after accounting for lost tobacco tax revenues. The results described here are likely applicable to countries having similar underlying smoking prevalence, comparable taxation rates, and social benefit protection provided to individuals with smoking-related conditions.     

Occupational health nurses and case management

Employers, providers, consumers, regulators, and society are demanding a systematic method to determine quality and cost efficiency in the provision of health care services in a multidisciplinary continuum of care within a reasonable time limit. Societal and legislative pressure on employers to incorporate and accommodate workers with disabilities or limitations and rising health insurance costs have urged organizations to set up effective strategies. An overview of the historical evolution of case management, trends in engaging workers in a successful return to work process, and a case study are presented.     

How remote is the offshoring threat?

Advances in communication technology make it possible for workers in India to supply business services to head offices located anywhere. This has the potential to put high-wage workers in direct competition with much lower paid Indian workers. Service trade, however, like goods trade, is subject to strong distance effects, implying that the remote supply of services remains limited. We investigate this proposition by deriving a gravity-like equation for service trade and estimating it for a large sample of countries and different categories of service trade. We find that distance costs are high but are declining over time. Our estimates suggest that delivery costs create a significant advantage for local workers relative to competing workers in distant countries.     

Complex home care: Part I--Utilization and costs to families for health care services each year

As many as 120 persons per million people in the United States are dependent on the lifelong, complex, technology-based care of home parenteral nutrition (HPN) infusions. However, data for costs paid by families for HPN-related health care services and for non-reimbursed expenditures are rarely tabulated and most often underestimated. The goals of this study were to describe health care services used by families to manage HPN, report the frequency of each service used annually, and estimate the average annual non-reimbursed costs to families for these health services. The numerous and varied types of services reported and the time required to coordinate and access HPN services illustrates the challenges faced by patients and their family caregivers. The lack of a coordinated and efficient system for delivering complex chronic care results in poorer outcomes for HPN patients and their families on-reimbursed costs and the extensive amount of time required to coordinate multi-professional services negatively impacts the clinical outcomes and quality of life of complex chronic home care.     

PREVENTIVE CARE AND INSURANCE COVERAGE

This article examines how having a choice of health plans, HMO enrollment, and health status affect the use of preventive services. For preventive services use, HMO enrollment is endogenous for workers with a choice of plans, but is exogenous for workers who do not have a choice. Relative to a model that ignores the effect of a choice of plans, the effect of HMO enrollment on the use of preventive treatments is reduced. Individuals who do not have a choice of plans but are enrolled in HMOs are more likely to use preventive services than are individuals who choose HMOs. (JEL I10 , I11 , I12 )     

Labor Mobility and East Asian Integration

East Asian economic integration is commonly analyzed in the context of trade in goods and services and capital flows, while labor flows have been very much neglected. Yet labor flows in the region are rapidly growing, given the diversity in levels of economic development, employment opportunities and wage levels, and the existence of labor surplus and deficit countries. Labor migration poses more benefits than costs for both sending and receiving countries, but there are more sensitivities toward labor flows than trade and capital flows. The characteristics and government policies are different for the unskilled and semiskilled foreign workers and for the professionals and highly skilled. Regional cooperation among countries is needed to manage the flows, reduce the incidence of illegal and undocumented workers, reduce the transaction costs of migration, and protect the rights of these workers.     

A REDUCTION IN CONSUMER EXPENDITURE ON CIGARETTES AND ITS EFFECTS ON EMPLOYMENT: A CASE STUDY OF SOUTH AFRICA

This study estimates empirically the employment effects if stronger tobacco control policies result in reduced consumption in South Africa. Since 1995, the government has committed itself to a stronger tobacco control policy and increased excise taxes. Yet policy makers are sensitive to the need to pursue this public health policy in a way that will minimize job losses. This study uses input-output methodology and four expenditure scenarios to estimate output and employment effects following such policies. The analysis suggests that net employment effects will be positive if consumption expenditure is switched from tobacco to other goods and services in the economy. Further, this study suggests that these policy implications for tobacco control and public health hold, if a country has a self-sufficient industry like South Africa. (JEL 118, D57)     

Health insurance market reform and employee compensation: The case of pure community rating in New York

Pure community rating, which was enacted to improve access to health insurance in New York's small group market in 1993, prevents carriers from charging different premiums based on the ages of a firm's workers. If small firms were adjusting compensation packages prior to reform to offset higher health care costs of older workers, then community rating could lead to greater relative wages for older workers post reform and not necessarily induce adverse selection that results in changes in who is insured. I present evidence showing that relative wages of older workers in small firms increased in comparison with other states and with large firms within New York following reform.     

农民工大量占用城市公共资源了吗——基于上海市1 446个调查样本的实证分析

基于上海市1 446份农民工调查样本，应用描述性统计分析方法，从公共交通、医疗卫生、子女教育以及文化娱乐等方面，对农民工占用城市公共资源情况做了实证分析。研究发现，大量涌入城市的农民工确实占用了部分城市公共资源或公共服务，但这种占用是有限的，农民工并没有大量占有或公平享有城市的公共资源或公共服务。因此，完善制度设计，逐步实现农民工较公平、充分的享有城市公共资源，对于从根本上解决中国农民工“候鸟式”迁移以及城镇化战略的实现，都具有重要意义。     

Complex home care: Part 2- family annual income, insurance premium, and out-of-pocket expenses

Annual costs paid by families for intravenous infusion of home parenteral nutrition (HPN) health insurance premiums, deductibles, co-payments for health services, and the wide range of out-of-pocket home health care expenses are significant. The costs of managing complex chronic care at home cannot be completely understood until all out-of-pocket costs have been defined, described, and tabulated. Non-reimbursed and out-of-pocket costs paid by families over years for complex chronic care negatively impact the financial stability of families. National health care reform must take into account the long-term financial burdens of families caring for those with complex home care. Any changes that may increase the out-of-pocket costs or health insurance costs to these families can also have a negative long-term impact on society when greater numbers of patients declare bankruptcy or qualify for medical disability.     

“三位一体”农民工健康服务体系及其保障机制研究

分割型城乡二元劳动力市场与弱健康人力资本的交互累积效应、健康服务支出的沉没成本效应、伦理价值观的惯性约束效应、农民工主体的弱健康服务诉求及信息传递障碍的制约,使我国农民工健康服务供给明显不足,难以形成一个完善的农民工健康服务体系。因此应当构建一个以政府为中心、企业广泛参与的农民工健康服务体系的"三位一体"模式,并设立以企业为核心的制度保障机制,发挥政府的主导性作用。     

Post-secondary vocational education and on-the-job training

This study about firm training costs and methods is based on a survey of Pennsylvania employers who employ members of seven technical and clerical occupations. The study analyses data on training costs and length of training time by occupation and establishment size. It measures the effect of education (new hires may have completed secondary or post-secondary education) and prior occupational experience on firm training variables as observed by employers. One surprising result is that respondents who state that they provide only general training incur costs of several thousand dollars per workers.     

Forecasting requirements for health care personnel

Accurate forecasting of requirements for health care personnel is an important part of avoiding significant imbalances that create costly inefficiencies in health care markets. Manpower shortages threaten access, quality, and costs of health care. This article reviews five general approaches previously used to determine manpower requirements. Suggestions are made for the analytic components of a comprehensive model for identifying significant imbalances in supply or demand for health care workers.     

医疗卫生基本公共服务的城乡差距及均等化路径

当前,我国城乡之间的医疗卫生服务不均等已成为一个重要的社会问题。本文通过医疗卫生费用和医疗卫生资源的城乡数据分析得出城乡之间的医疗卫生公共服务差距巨大,并通过2000—2008年城乡医疗保健费用的泰尔指数分析,发现城乡组间对城乡医疗卫生公共服务差距的贡献基本上在80%以上,几乎是组内差距贡献的4倍,而从两组的内部差距来看,农村内部的不均等程度要稍高于城市内部的不均等程度,根据分析结果并从财政向农村医疗卫生的投入倾斜、城乡医疗保险制度的整合、医疗体制的深化改革等方面就如何促进医疗卫生公共服务城乡均等化进行探讨。     

Affordable defined contribution health plans can help employers get through challenging times

Defined contribution health plans, modeled on defined contribution retirement plans, seem to be the wave of the future. At a time when employers and employees alike are trying to contain their health care costs, and employers fight to retain their workers, defined contribution health plans can provide solutions for both employers and employees. The health purchasing alliance model has met with success in both the small and mid-size market.     

The effect of forest land use on the cost of drinking water supply: A spatial econometric analysis

Forest land use is often associated with the protection of water resources from contamination and the reduced cost of drinking water supply. This study attempted to measure the value of the forest on the quality of water resources from a contingent market, namely drinking water supply, by estimating variations in drinking water costs as a function of variations in land uses. Spatial correlations were taken into account because of the use of different geographical scales (i.e., water service area and land uses) and the potential existence of organizational and technological spillovers between water services. We found a significant negative effect of forest land use on water costs. We found no evidence of spatial spillovers concerning the management regime but did find that factors related to the scarcity of resources in neighboring water services have an impact on water costs.     

The cost of needle-stick injuries: the impact of safer medical devices

The cost of needle-stick injuries significantly impacts health care workers and their institutions. Safer medical devices can reduce both direct and indirect costs associated with these injuries.     

A double-hurdle approach to modelling tobacco consumption in Italy

This article analyzes the determinants of tobacco expenditures for a sample of Italian households. A Box–Cox double-hurdle model adjusted for heteroscedasticity is estimated to account for separate individual decisions concerning smoking participation and tobacco consumption and to correct for nonnormality in the bivariate distribution of the error terms. Nested univariate and bivariate models are found to be excessively restrictive, supporting the adequacy of a generalized specification. Estimation results show that consumption decisions are significantly affected by income and demographic characteristics. In particular, income positively impacts tobacco expenditure, while participation probability substantially declines as age increases. The existence of significant gender differences in both smoking participation and tobacco consumption patterns is found, while high education and white-collar occupation reduces the likelihood to smoke and tobacco expenditure levels. Single adult households have a lower probability of smoking initiation even if, conditional on smoking, they consume more. Finally, complementarity between tobacco and alcohol beverages suggests the necessity of joint public health strategies.