Gaps in the welfare state: A role-based model of poverty risk in the U.S.

BACKGROUND: Research clearly demonstrates that income matters greatly to health. However, income distribution and its relationship to poverty risk is often misunderstood. METHODS: We provide a structural account of income distribution and poverty risk in the U.S., rooted in the 'roles' that individuals inhabit with relation to the 'factor payment system' (market distribution of income to individuals through wages and asset ownership). Principal roles are child, older adult, and, among working-age adults, disabled individual, student, unemployed individual, caregiver, or paid laborer. Moreover, the roles of other members of an individual's household also influence an individual's income level. This account implies that 1) roles other than paid laborer will be associated with greater poverty risk, 2) household composition will be associated with poverty risk, and 3) income support policies for those not able to engage in paid labor are critical for avoiding poverty. We test hypotheses implied by this account using 2019 and 2022 U.S. Census Current Population Survey data. The exposure variables in our analyses relate to roles and household composition. The outcomes relate to income and poverty risk. RESULTS: In 2019, 40.1 million individuals (12.7% of the population) experienced poverty under the U.S. Census' Supplemental Poverty Measure. All roles other than paid laborer were associated with greater poverty risk (p < .001 for all comparisons). Household composition, particularly more children and disabled working-age adults, and fewer paid laborers, was also associated with greater poverty risk (p < .001 for all comparisons). Five key policy areas-child benefits, older-age pensions, disability and sickness insurance, unemployment insurance, and out-of-pocket healthcare spending-represented gaps in the welfare state strongly associated with poverty risk. CONCLUSIONS: The role one inhabits and household composition are associated with poverty risk. This understanding of income distribution and poverty risk may be useful for social policy.

Financial Impact of COVID-19 on Dental Care for Pediatric Patients: a Dental Claims Review.

PURPOSE: The purpose of this study was to quantify the impact of the COVID-19 pandemic on private dental insurance claims for pediatric dental care. METHODS: Commercial dental insurance claims for patients in the United States ages 18 and younger were obtained and analyzed. The claims dates ranged from January 1, 2019, to August 31, 2020. Total claims paid, average paid amount per visit, and the number of visits were compared between provider specialties and patient age groups from 2019 to 2020. RESULTS: Total paid claims and total number of visits per week were significantly lower in 2020 compared to 2019 from mid-March to mid-May (P<0.001). There were generally no differences from mid-May through August (P>0.15), except for significantly lower total paid claims and visits per week for "other" specialists in 2020 (P<0.005). The average paid amount per visit was significantly higher during the COVID shutdown period for 0-5 year-olds (P<0.001) but significantly lower for all other ages. CONCLUSIONS: Dental care was greatly reduced during the COVID shutdown period and was slower to recover for "other" specialties. Younger patients ages zero to five years had more expensive dental visits during the shutdown period.

Global evidence of gender equity in academic health research: a scoping review.

OBJECTIVES: To chart the global literature on gender equity in academic health research. DESIGN: Scoping review. PARTICIPANTS: Quantitative studies were eligible if they examined gender equity within academic institutions including health researchers. PRIMARY AND SECONDARY OUTCOME MEASURES: Outcomes related to equity across gender and other social identities in academia: (1) faculty workforce: representation of all genders in university/faculty departments, academic rank or position and salary; (2) service: teaching obligations and administrative/non-teaching activities; (3) recruitment and hiring data: number of applicants by gender, interviews and new hires for various rank; (4) promotion: opportunities for promotion and time to progress through academic ranks; (5) academic leadership: type of leadership positions, opportunities for leadership promotion or training, opportunities to supervise/mentor and support for leadership bids; (6) scholarly output or productivity: number/type of publications and presentations, position of authorship, number/value of grants or awards and intellectual property ownership; (7) contextual factors of universities; (8) infrastructure; (9) knowledge and technology translation activities; (10) availability of maternity/paternity/parental/family leave; (11) collaboration activities/opportunities for collaboration; (12) qualitative considerations: perceptions around promotion, finances and support. RESULTS: Literature search yielded 94 798 citations; 4753 full-text articles were screened, and 562 studies were included. Most studies originated from North America (462/562, 82.2%). Few studies (27/562, 4.8%) reported race and fewer reported sex/gender (which were used interchangeably in most studies) other than male/female (11/562, 2.0%). Only one study provided data on religion. No other PROGRESS-PLUS variables were reported. A total of 2996 outcomes were reported, with most studies examining academic output (371/562, 66.0%). CONCLUSIONS: Reviewed literature suggest a lack in analytic approaches that consider genders beyond the binary categories of man and woman, additional social identities (race, religion, social capital and disability) and an intersectionality lens examining the interconnection of multiple social identities in understanding discrimination and disadvantage. All of these are necessary to tailor strategies that promote gender equity. TRIAL REGISTRATION NUMBER: Open Science Framework: https://osf.io/8wk7e/.

The short-term economic consequences of COVID-19: Exposure to disease, remote work and government response.

We examine the determinants of the consequences of COVID-19 on employment and wages in the United States. Guided by a pre-analysis plan, we investigate whether the economic consequences of COVID-19 were larger for certain occupations, using four indexes: workers relatively more exposed to disease, workers that work with proximity to coworkers, essential/critical workers and workers who can easily work remotely. We find that individuals that work in proximity to others are more affected while individuals able to work remotely and essential workers are less affected by the pandemic. We also present suggestive evidence that our indexes are likely explanations why certain demographic groups such as younger and minority workers have worse labor market outcomes during the pandemic.

Evaluation of Claim Reports for Potential Impact of COVID-19 on Pediatric Dental Procedures.

PURPOSE: To evaluate whether the postponement of dental elective procedures at the start of the COVID-19 pandemic was associated with an increased number of simple dental extractions, and/or decreased restorative procedures by analyzing data obtained from state-funded insurance dental claims. METHODS: Paid dental claims collected from March 2019 to December 2019 and from March 2020 to December 2020 for children ages two to 13 years old were analyzed. Dental procedures were selected based on Current Dental Terminology (CDT) codes for simple dental extractions and restorative procedures. Statistical analyses were performed to compare the rates of procedure types between 2019 and 2020. RESULTS: No differences in dental extractions but full-coverage restoration procedure rates per month and child were significantly lower than pre-pandemic (P=0.016). CONCLUSION: Further study required to determine the impact of COVID-19 on pediatric restorative procedures and access to pediatric dental care in the surgical setting.

Does paid sick leave encourage staying at home? Evidence from the United States during a pandemic.

We study the impact of a temporary U.S. paid sick leave mandate that became effective April 1st, 2020 on self-quarantining, proxied by physical mobility behaviors gleaned from cellular devices. We study this policy using generalized difference-in-differences methods, leveraging pre-policy county-level heterogeneity in the share of workers likely eligible for paid sick leave benefits. We find that the policy leads to increased self-quarantining as proxied by staying home. We also find that COVID-19 confirmed cases decline post-policy.

The ACGME's New Paid Family and Medical Leave Policy: Just the Beginning.

The COVID-19 pandemic has laid bare a problem that many people have managed behind the scenes for years: how to balance work and family caregiving responsibilities. For physicians, many of whom were already experiencing burnout prior to the pandemic, the extra burden of COVID-19-related work stress combined with fewer options for childcare and other support has made coping all but untenable. In early 2022, the Accreditation Council for Graduate Medical Education (ACGME) promulgated new paid family and medical leave policy for residents and fellows. This editorial considers the importance of this step by the ACGME as well as the remaining gaps in paid leave policy in medical education, graduate training, and practice.

Disparities in Access to Paid Sick Leave During the First Year of the COVID-19 Pandemic.

OBJECTIVE: This study sought to assess disparities in access to paid sick leave in the first year of the COVID-19 pandemic based on demographic and socioeconomic factors. METHODS: The percentage of workers with access to paid sick leave was calculated according to age group, sex, race/ethnicity, educational attainment, region, health insurance coverage, receiving public assistance, income, occupation, and industry. RESULTS: A total of 65.6% of workers had access to paid sick leave. Access was lowest among Hispanic workers, workers with less than a high school education, and workers without health insurance coverage. CONCLUSIONS: There were wide disparities in access to paid sick leave during the first year of the COVID-19 pandemic, which may be associated with disparities in the risk for COVID-19. The introduction of mandatory paid sick leave may serve to protect workers from the spread of infectious diseases.

American College of Radiology Paid Family/Medical Leave Policy: A Call to Action for the House of Medicine.

The American College of Radiology (ACR) passed a historic paid family/medical leave (PFML) resolution at its April 2022 meeting, resolving that "diagnostic radiology, interventional radiology, radiation oncology, medical physics, and nuclear medicine practices, departments and training programs strive to provide 12 weeks of paid family/medical leave in a 12-month period for its attending physicians, medical physicists, and members in training as needed." The purpose of this article is to share this policy beyond radiology so that it may serve as a call to action for other medical specialties. Such a PFML policy (1) supports physician well-being, which in turn supports patient care; (2) is widely needed across American medical specialties; and (3) should not take nearly a decade to achieve, as it did in radiology, especially given increasing physician burnout and the ongoing COVID-19 pandemic. Supported by information on the step-by-step approach used to achieve radiology-specific leave policies and considering current and normative policies at the national level, this article concludes by reviewing specific strategies that could be applied toward achieving a 12-week PFML policy for all medical specialties.

Laws, Policies, and Collective Agreements Protecting Low-wage and Digital Platform Workers During the COVID-19 Pandemic.

In the context of the COVID-19 pandemic, this commentary describes and compares shifting employment and occupational health social protections of low-wage workers, including self-employed digital platform workers. Through a focus on eight advanced economy countries, this paper identifies how employment misclassification and definitions of employees were handled in law and policy. Debates about minimum wage and occupational health and safety standards as they relate to worker well-being are considered. Finally, we discuss promising changes introduced during the COVID-19 pandemic that protect the health of low-wage and self-employed workers. Overall, we describe an ongoing "haves" and a "have not" divide, with on the one extreme, traditional job arrangements with good work-and-health social protections and, on the other extreme, low-wage and self-employed digital platform workers who are mostly left out of schemes. However, during the pandemic small and often temporary gains occurred and are discussed.

The American Society for Clinical Pathology's 2021 Wage Survey of Medical Laboratories in the United States.

OBJECTIVES: To inform the pathology and laboratory field of the most recent national wage data. Historically, the results of this biennial survey have served as a basis for additional research on laboratory recruitment, retention, education, marketing, certification, and advocacy. METHODS: The 2021 Wage Survey was conducted through collaboration between the American Society for Clinical Pathology (ASCP) Institute of Science, Technology, and Policy in Washington, DC, and the ASCP Board of Certification in Chicago, IL. RESULTS: Compared with 2019, results show that mean hourly wage for staff-level personnel increased for only two occupations-cytologist and medical laboratory scientist/medical technologist/clinical laboratory scientist-after adjusting for inflation. Geographically, laboratory professionals from urban areas continue to earn more than their rural counterparts. Most respondents reported no change in their salaries during the coronavirus disease 2019 pandemic. CONCLUSIONS: The pandemic had a significant effect on staffing, workload, and work-life balance of many laboratory professionals. Even with the salary increases reported from the results of this survey, it is evident that the increases have not kept up with the current inflation. Focus on visibility, recruitment and retention, and diversity are essential to develop long- and short-term solutions.

Hourly Wages and Turnover of Community Health Workers According to US State Certification Policy and Medicaid Reimbursement, 2010-2021.

Objectives. To evaluate the effects of state community health worker (CHW) certification programs and Medicaid reimbursement for CHW services on wages and turnover. Methods. A staggered difference-in-differences design was used to compare CHWs in states with and without CHW certification or CHW Medicaid reimbursement policies. Data were derived from the 2010 to 2021 Current Population Survey in the United States. Results. CHW wages increased by $2.42 more per hour in states with certification programs than in states without programs (P = .04). Also, hourly wages increased more among White workers, men, and part-time workers (P = .04). Wages increased by $14.46 in the state with the earliest CHW certification program adoption (P < .01). Neither of the policies assessed had an effect on occupational turnover. Conclusions. CHW wages are higher in states with certification programs. However, wage gaps exist between Whites and non-Whites and between men and women. Public Health Implications. Federal, state, and employer-based strategies are needed to establish and sustain effective CHW programs to meet the needs of communities experiencing health and access disparities. (Am J Public Health. 2022;112(10):1480-1488. https://doi.org/10.2105/AJPH.2022.306965).

Repercussions of the labor reform on nursing work in the context of the covid-19 pandemic.

OBJECTIVE: To reflect on the repercussions of the Labor Reform on nursing work during the COVID-19 pandemic. METHODS: This is a reflective study based on the legal aspects of the Labor Reform in dialog with scientific productions pertaining to nursing work. RESULTS: With the rise of the COVID-19 pandemic, the flexibilization of labor is being intensified, legally backed up by the Labor Reform. For nursing workers, the repercussions are felt in the work relationship, during the workday, in the salary, in union action, and in job protection. FINAL CONSIDERATIONS: It is evident that, after the legislative changes, there's no certainty that the flexibilization of labor and social security laws will bring favorable results in terms of economic growth, reduction of inequalities, and lower unemployment rates for the nursing workers. Therefore, the political organization of the professional categories is the way to overcome this scenario.

Leveraging diversity, equity and inclusion for promoting wellness in the radiology workplace.

Over the last decade, health care professionals in the field of radiology have experienced increasing rates of burnout. A study in 2017 showed high prevalence of burnout in pediatric radiology, and other studies have identified several drivers for burnout. An important factor in promoting wellness and mitigating burnout is leveraging diversity, equity and inclusion in the workplace. This manuscript highlights the importance of diversity in high-functioning teams as well as the critical role of equity and inclusion in the workplace to help create an organization where people belong and can effectively succeed.

Wage Theft and Worker Exploitation in Health Care.

The COVID-19 pandemic has revealed a great irony in the labor market: workers essential to social functioning and safety are among the least valued by pay. Support workers (eg, medical assistants), direct care workers (eg, nursing assistants and personal care aides), and service workers (eg, janitors and food preparers) have long experienced wage theft and exploitation, although health care organizations would cease functioning without them. The health sector has opportunities to revisit wage hierarchies and to ensure living wages for these workers.

How Should Clinicians of Status Express Solidarity With Workers Earning Low Wages in Health Care?

What clinicians of status owe health workers earning low wages has been changed by the events of the past 2 years of the COVID-19 pandemic, national racial reckoning, and increasing national income and wealth inequality. Reasons why clinicians of status should actively promote the interests of health workers earning low wages are numerous and urgent.