Williams Jessica A R
Department of Health Policy and Management, UCLA Fielding School of Public Health; (current) Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, 9 Bow Street, Cambridge, MA, 02138, USA.
BMC Public Health. 2015 May 1;15:449. doi: 10.1186/s12889-015-1784-4.
Poor psychosocial workplace factors have been found to cause or exacerbate a variety of health problems, including pain. However, little work has focused on how psychosocial workplace factors, such as health-related employer support, relate to future medical expenditures after controlling for health. Health-related support has also not been well explored in previous literature as a psychosocial factor. This study estimated the association of health-related employer support and pain with future medical expenditures, after including many additional controls.
This study used a restricted data set comprised of medical claims and survey data for one company in the U.S. Participants were included in the sample if they had worked for their employer for at least 12 months prior to the survey and if they were continuously eligible for health insurance (N=1,570). Future medical expenditures were measured using administrative claims data covering inpatient, outpatient, mental health and pharmaceutical insurance claims during a year. Health-related employer support was measured using participants' answers about whether the employer would support their efforts to positively change their emotional or physical health. Pain was measured as recurring pain from any condition over the previous year.
Having any physical health-related employer support was associated with a 0.06 increase in the probability of having future medical expenditures greater than zero, 95% CI [0.01, 0.11], but not with total expenditures. Having pain was associated with a 0.06 increase, 95% CI [0.04, 0.09], in the probability of having future medical expenditures greater than zero and with $3,027 additional total expenditures, 95% CI [$1,077, $4,987].
After controlling for health and pain, psychosocial workplace factors were not robustly associated with future medical expenditures. Pain was associated with increased medical expenditures for the self-insured employer in this study, adjusting for a variety of factors.
不良的工作场所社会心理因素已被发现会导致或加剧各种健康问题，包括疼痛。然而，很少有研究关注工作场所社会心理因素，如与健康相关的雇主支持，在控制健康状况后如何与未来医疗支出相关联。在以往文献中，与健康相关的支持作为一种社会心理因素也未得到充分探讨。本研究在纳入许多其他控制因素后，估计了与健康相关的雇主支持和疼痛与未来医疗支出之间的关联。
本研究使用了一个受限数据集，该数据集由美国一家公司的医疗理赔和调查数据组成。如果参与者在调查前为其雇主工作至少12个月且持续符合健康保险资格，则纳入样本（N = 1570）。未来医疗支出通过行政理赔数据进行衡量，涵盖一年中的住院、门诊、心理健康和药品保险理赔。与健康相关的雇主支持通过参与者对雇主是否会支持他们积极改善情绪或身体健康努力的回答来衡量。疼痛被定义为前一年任何疾病引起的反复疼痛。
获得任何与身体健康相关的雇主支持与未来医疗支出大于零的概率增加0.06相关，95%置信区间为[0.01, 0.11]，但与总支出无关。有疼痛与未来医疗支出大于零的概率增加0.06相关，95%置信区间为[0.04, 0.09]，且总支出额外增加3027美元，95%置信区间为[1077美元, 4987美元]。
在控制健康和疼痛因素后，工作场所社会心理因素与未来医疗支出之间的关联并不显著。在本研究中，调整各种因素后，疼痛与自保雇主的医疗支出增加相关。
