Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
Institute for Work and Health, Toronto, Ontario, Canada.
J Epidemiol Community Health. 2020 Mar;74(3):211-218. doi: 10.1136/jech-2019-213151. Epub 2020 Jan 8.
Over the past several decades, governments have enacted far-reaching reforms aimed at reducing the generosity and coverage of welfare benefits. Prior literature suggests that these policy measures may have deleterious effects on the health of populations. In this study, we evaluate the impact of one of the largest welfare reforms in recent history-the 2005 Hartz IV reform in Germany-with a focus on estimating its effect on the health of the unemployed.
We employed a quasi-experimental difference-in-differences (DID) design using population-based data from the German Socio-Economic Panel Study, covering the period between 1994 and 2016. We applied DID linear probability modelling to examine the association between the Hartz IV reform and poor self-rated health, adjusting for a range of demographic and socioeconomic confounders.
The Hartz IV reform was associated with a 3.6 (95% CI 0.9 to 6.2) percentage point increase in the prevalence of poor self-rated health among unemployed persons affected by the reform relative to similar but unaffected controls. This negative association appeared immediately following the implementation of the reform and has persisted over time.
Governments in numerous European and North American jurisdictions have introduced measures to further diminish the generosity and coverage of welfare benefits. In line with growing concerns over the potential consequences of austerity and associated policy measures, our findings suggest that these reform efforts pose a threat to the health of socioeconomically disadvantaged populations.
在过去几十年中，各国政府实施了影响深远的改革，旨在降低福利津贴的慷慨程度和覆盖范围。先前的文献表明，这些政策措施可能对人口健康产生有害影响。在这项研究中，我们评估了最近历史上最大的福利改革之一——2005 年德国哈茨四世改革的影响，重点估计其对失业者健康的影响。
我们使用基于人群的德国社会经济面板研究数据，采用准实验性差分（DID）设计，涵盖了 1994 年至 2016 年期间。我们采用 DID 线性概率模型来检验哈茨四世改革与自我评估健康状况不佳之间的关联，同时调整了一系列人口统计学和社会经济混杂因素。
哈茨四世改革与受改革影响的失业人群中自我评估健康状况不佳的比例增加了 3.6（95%置信区间 0.9 至 6.2）个百分点，而类似但未受影响的对照组则没有这种增加。这种负向关联在改革实施后立即显现，并持续存在。
许多欧洲和北美的司法管辖区的政府已经采取措施进一步降低福利津贴的慷慨程度和覆盖范围。考虑到对紧缩政策及其相关政策措施潜在后果的担忧日益增加，我们的研究结果表明，这些改革努力对社会经济弱势群体的健康构成了威胁。
