Absence of conflict of interest.
Citation
Datta Gupta, N., Kleinjans, K. J., & Larsen, M. (2015). The effect of a severe health shock on work behavior: Evidence from different health care regimes. Social Science and Medicine, 136-137, 44-51.
Highlights
- The study’s objective was to examine the impact of the national health policies of the United States and Denmark on employment of older workers after a health shock, defined as a new cancer or cardiovascular disease diagnosis.
- The authors used a nonexperimental approach to compare the impact of a health shock on the likelihood of nonemployment in the United States’ private multipayer system with Denmark’s nationalized universal health care model. The authors used the data from the RAND Health and Retirement Study survey from 1994 to 2002 and Danish population registers for 1993 to 2001.
- The study found no differences between the United States and Denmark in the relationship between a health shock and employment for older workers.
- The quality of causal evidence presented in this report is low because the authors did not account for unobserved differences between the countries. This means we are not confident that differences in the association between health shocks and employment in the United States and Denmark are attributable to the national health care policies; other factors are likely to have contributed.
Intervention Examined
National Healthcare Policy
Features of the Study
Using nationwide data from the United States and Denmark, the study used regression methods to estimate whether national health care policies are associated with the effect of a health shock on older worker’s employment. The authors assessed the effect of two health shocks: cancer and cardiovascular disease. The authors compared the United States' private multipayer system with Denmark’s nationalized universal health care model. The study used data from the RAND Health and Retirement Study survey data from 1994 to 2002 and the Danish population registers for 1993 to 2001. The sample included 3,799 people from the United States and 63,271 people from Denmark who were between ages 56 and 64 at the time of the analysis. People who were not working at any time during the sample period were not included in the study. Those in the United States who had applied for disability or were receiving Medicare or Medicaid at baseline were also not included.
Findings
Employment
- The study found no difference between the United States and Denmark in the likelihood of not working for men who have had a health shock. For women, the likelihood of not working is significantly lower for those with a new cancer diagnosis in the United States compared with Denmark.
Considerations for Interpreting the Findings
The study examined the impact of defined health shocks on employment to measure the effects of national health care policies. Although the authors controlled for many observable characteristics, other unobservable individual and national characteristics could explain the relationships between employment status and health shock between the two countries. These unobservable characteristics, rather than national health care policies, might explain the findings.
Causal Evidence Rating
The quality of causal evidence presented in this report is low because the authors did not account for unobserved differences between the countries. This means we are not confident that differences in the association between health shocks and employment in the United States and Denmark are attributable to the national health care policies; other factors are likely to have contributed.