The union advantage: union membership, access to care, and the Affordable Care Act.

We describe a "union advantage" in health insurance coverage and access to care. Using multiple statistical models and data from the Medical Expenditure Panel Survey for 1996-2019, we show that-compared to non-union workers-union workers are more likely to have health insurance coverage (98% vs. 86%), more likely to have a regular care provider (83% vs. 74%), visited office-based providers 31% more often (5.64 vs. 4.27 visits), spend $832 more on healthcare annually, and pay a lower share of their expenditures out-of-pocket (26% vs. 37%). When we control for demographic characteristics across variety of specifications, these differences almost always remain at a statistically significant level. Further, we show that the union advantage is greater for low-income workers. Next, we demonstrate that-although the Affordable Care Act (ACA) appears to have reduced the union advantage in health insurance coverage by increasing coverage rates among non-union workers-a substantial union advantage in access to care remains after the ACA's main provisions become effective. Finally, we explore how the ACA interacted with the trade union  goal of maintaining employer-based health insurance. We show that unionized workers are less likely to contribute to "enrollment shifting," which occurs when individuals shift from existing employer-based insurance to a new government funded program. This suggests that union bargaining over fringe benefits may have positive externalities in the form of cost reductions to the public sector.

Politics by Automatic Means? A Critique of Artificial Intelligence Ethics at Work.

Calls for "ethical Artificial Intelligence" are legion, with a recent proliferation of government and industry guidelines attempting to establish ethical rules and boundaries for this new technology. With few exceptions, they interpret Artificial Intelligence (AI) ethics narrowly in a liberal political framework of privacy concerns, transparency, governance and non-discrimination. One of the main hurdles to establishing "ethical AI" remains how to operationalize high-level principles such that they translate to technology design, development and use in the labor process. This is because organizations can end up interpreting ethics in an ad-hoc way with no oversight, treating ethics as simply another technological problem with technological solutions, and regulations have been largely detached from the issues AI presents for workers. There is a distinct lack of supra-national standards for fair, decent, or just AI in contexts where people depend on and work in tandem with it. Topics such as discrimination and bias in job allocation, surveillance and control in the labor process, and quantification of work have received significant attention, yet questions around AI and job quality and working conditions have not. This has left workers exposed to potential risks and harms of AI. In this paper, we provide a critique of relevant academic literature and policies related to AI ethics. We then identify a set of principles that could facilitate fairer working conditions with AI. As part of a broader research initiative with the Global Partnership on Artificial Intelligence, we propose a set of accountability mechanisms to ensure AI systems foster fairer working conditions. Such processes are aimed at reshaping the social impact of technology from the point of inception to set a research agenda for the future. As such, the key contribution of the paper is how to bridge from abstract ethical principles to operationalizable processes in the vast field of AI and new technology at work.

Mediación de conflictos, competencia no difundida en médicos en formación: revisión / Conflict mediation, an undisclosed skill among medical students: A review

RESUMEN El ser humano es un ser social por naturaleza, y los desacuerdos y conflictos son situaciones comunes e inherentes a sus diferentes actividades sociales. En esta revisión se pretende describir el origen de los conflictos y las técnicas de mediación en la atención sanitaria. Se sabe de la necesidad de aprender las habilidades para la solución de conflictos, y se reconocen dentro de las prioridades cambiantes de los educandos del profesional sanitario. El desacuerdo y el conflicto son inevitables entre los miembros de los equipos clínicos, así como con los pacientes y sus familias durante el curso de la atención sanitaria. A pesar de la importancia que representa esta competencia, no se ha establecido como una necesidad educacional en los planes de estudio de los profesionales de la salud, no obstante de que los médicos requieren negociar y resolver conflictos de manera continua en los entornos sanitarios. Nuestra función como educadores es la de analizar el contexto profesional empírico cambiante y otorgar a los educandos las herramientas pertinentes para su desarrollo profesional con la mayor posibilidad de éxito en sus actividades cotidianas. Los invitamos a leer, analizar y criticar esta propuesta, que consideramos muy importante para que sea contemplada en los planes de estudio desde el pregrado y posgrado de las diferentes ramas de los profesionales de la salud, que incluyen tanto a médicos de las diferentes especialidades, el personal de enfermería y todos aquellos profesionales que trabajamos con el objetivo común de brindar asistencia sanitaria de calidad.

ABSTRACT Human beings are social beings by nature, and disagreements and conflicts are common situations inherent in their different social activities. This review aims to describe the origin of conflicts and the mediation techniques in healthcare. It is well known that conflict resolution skills are needed to be learned, and such skills are considered within the changing priorities of healthcare students. Disagreement and conflict are inevitable between members of clinical care teams, as well as with patients and their families during healthcare. Despite the importance of these skills, they have not been established as an educational need in healthcare professionals' curricula, even though physicians are required to negotiate and resolve conflicts on an ongoing basis in healthcare settings. Our role as educators is to analyze the changing empirical professional context, and provide our students with the relevant tools with the greatest chance of success for their professional development in their daily activities. We invite you to read, analyze and criticize this proposal, which we consider very important to be included in the undergraduate and graduate curricula of the different fields of healthcare professionals, i.e. specialist physicians, nursing staff and all those professionals who work with the common goal of providing quality healthcare.

Shortage of Skilled Labor, Unions and the Wage Premium: A Regression Analysis with Establishment Panel Data for Germany.

The author investigates the different influences of labor shortage on wages in firms with or without collective bargaining agreements. In addition to training, technological solutions, and organizational flexibility, employers can also offer higher wages at a constant employment level to fill vacancies if the current payments are lower than the marginal revenue of the workers. Firms with collective bargaining agreements probably already pay wages according to marginal revenue or, in the case of rent sharing, above it, and the remuneration is probably also not adjusted. Using wage regressions with panel data for German establishments, this paper shows that collective bargaining and a lack of skilled workers can lead to higher wages. However, the latter only applies to firms that are not bound by collective agreements. Hence, wage differentials between these firms decrease, providing further explanation for a countercyclical development of the wage premium from the collective bargaining agreement. Supplementary Information: The online version contains supplementary material available at 10.1007/s12122-022-09334-1.

A Standpoint Approach to Return-to-Work Coordination: Understanding Union Roles.

Purpose This study examined how the participation of union representatives impacted return-to-work (RTW) processes, and explored key activities undertaken by union representatives involved in return-to-work coordination. Methods Forty-seven RTW coordinators (RTWCs) participated in in-depth, semi-structured interviews in 2018 as part of a cross-Canadian study investigating their strategies for managing challenges in the RTW process. The study included RTWCs from a variety of organisation types, including unionized organizations. Audio-recordings were transcribed, coded, and analysed using constant case comparison and deviant case analysis leading to the development of findings themes. Results Our findings highlight the role of union representatives in RTW processes and how their activities are seen by other parties involved with work accommodation. First, we describe Union RTWC's administrative functions and the extent of their involvement in RTW accommodation negotiations. Second, we examine how Union and Non-union RTWCs framed the same RTW processes differently, according to their own accountabilities. Finally, we identify the positive ways that union participation figured into the RTW process, including playing a role in identifying viable modified work and serving as a trusted party to help reluctant workers engage with RTW plans. Conclusions We introduce a standpoint perspective to shed light on how Union and Non-union RTWCs approached accommodation issues and consider acknowledgement of power relations as a starting point for managing divergent interests.

Trajectories of precarious employment and the risk of myocardial infarction and stroke among middle-aged workers in Sweden: A register-based cohort study.

BACKGROUND: The aim is to identify trajectories of precarious employment (PE) over time in Sweden to examine associations of these with the subsequent risk of myocardial infarction (MI) and stroke. METHODS: This is a nation-wide register-based cohort study of 1,583,957 individuals aged 40 to 61 years old residing in Sweden between 2003-2007. Trajectories of PE as a multidimensional construct and single PE components (contractual employment relationship, temporariness, income levels, multiple job holding, probability of coverage by collective agreements) were identified for 2003-2007 by means of group-based model trajectories. Risk Ratios (RR) for MI and stroke according to PE trajectories were calculated by means of generalized linear models with binomial family. FINDINGS: Adjusted estimates showed that constant PE and borderline PE trajectories increased the risk of MI (RR: 1·08, CI95%:1·05-1·11 and RR:1·13, CI95%: 1·07-1·20 respectively) and stroke (RR:1·14, CI95%: 1·10-1·18 and HR:1·24, CI95%: 1·16-1·33 respectively) among men. A higher risk of stroke in men was found for the following unidimensional trajectories: former agency employees (RR:1·32, CI95%:1·04-1·68); moving from high to a low probability of having collective agreements (RR: 1·10, CI95%:1·01-1·20). Having constant low or very low income was associated to an increased risk of MI and Stroke for both men and women. INTERPRETATION: The study findings provide evidence that PE increases the risk of stroke and possibly MI. It highlights the importance of being covered by collective bargaining agreements, being directly employed and having sufficient income levels over time. FUNDING: The Swedish Research Council for Health, Working Life and Welfare, no. 2019-01226.

African Americans and Law Enforcement: Tackling a Foundational Component of Structural Reform-Union Disciplinary Procedures.

Despite numerous high-profile deaths of African Americans at the hands of law enforcement, little attention has been paid to the issue of police reform in the social work literature. To address this gap, this article focuses on a topic that has been singled out as the most important area of potential reform: restructuring the disciplinary provisions embedded in the contracts negotiated between police unions and municipalities. These provisions frequently shield problematic officers from public accountability by hindering their identification, sanctioning, and dismissal. Given that collective bargaining agreements are typically negotiated behind closed doors, social workers can play an essential role by advocating for public negotiations between municipal and union leaders, so provisions that obstruct public accountability for unfit officers can be identified and eliminated. The article concludes by delineating three alternative models to the status quo-increased neighborhood policing, disbanding or defunding police departments, and police abolition zones-and notes that no model can be successful if those who abuse their power cannot be removed from their positions of public trust. The authors suggest that social workers collaborate with African American residents in a given community to ensure that their preferences regarding community justice are enacted in a manner that reflects their aspirations.

A bibliometric analysis of Health Promotion International content regarding unions, unionization and collective agreements.

A recent article brought together the health benefits of unionization and working under collective agreements. It was noted how Canadian health promotion texts, reports and statements made no mention of unionization and working under collective agreements as promoting health. This was seen as a significant omission and reasons for this were considered. In this article this analysis is extended to consider how contributors to the flagship health promotion journal Health Promotion International (HPI) conceptualize unions, unionization and working under collective agreements as promoting health. Of 2443 articles published in HPI since its inception, 87 or 3.6% make mention of unions, unionization, collective agreements or collective bargaining, with most saying little about their promoting health. Instead, 20 make cursory references to unions or merely see them as providing support and engagement opportunities for individuals. Forty-five depict unions or union members as involved in a health promotion programme or activity carried out by the authors or by government agencies. Only 33 articles explicitly mention unions, unionization or collective agreements as potentially health promoting, representing 1.3% of total HPI content since 1986. We conclude that the health promoting possibilities of unionization and working under collective agreements is a neglected area amongst HPI contributors. Reasons for this are explored and an Organisation for Economic Cooperation and Development report on the importance of collective bargaining is drawn upon to identify areas for health promotion research and action.

Essential jobs, remote work and digital surveillance: Addressing the COVID-19 pandemic panopticon.

An unprecedented COVID-19-induced explosion in digital surveillance has reconfigured power relationships in professional settings. This article critically concentrates on the interplay between technology-enabled intrusive monitoring and the augmentation of managerial prerogatives in physical and digital workplaces. It identifies excessive supervision as the common denominator of "essential" and "remotable" activities, besides discussing the various drawbacks faced by the two categories of workers during (and after) the pandemic. It also assesses the adequacy of the current European Union legal framework in addressing the expansion of data-driven management. Social dialogue, workers' empowerment and digital literacy are identified as effective ways to promote organizational flexibility, well-being and competitiveness.

Uneven Use of Remote Work to Prevent the Spread of COVID-19 in South Korea's Stratified Labor Market.

Background: This research analyzed whether South Korean companies adopted remote work during the COVID-19 pandemic by focusing on the dual labor market structure comprising of primary sector (large corporations) and secondary sector [small and medium enterprises (SMEs)]. Companies in the dual labor market were classified based on firm size. Methods: We used August supplementary data from the Economically Active Population Survey covering 2017-2020 provided by Statistics Korea. In this empirical study, a Linear Probability Model was used to analyze the probability that employees would work for companies that introduced remote work since COVID-19 depending on the size of the company. Results: This study showed three main results. First, unlike other flexible work systems, the use of remote work has increased rapidly since COVID-19. Second, the larger the size of the company, the higher the probability that employees would work for companies that introduced remote work after COVID-19. Third, according to the analysis by industry, the difference in remote work utilization between large corporations and SMEs was relatively small because of a similar working method in manufacturing. Conclusion: Results of this study suggested that polarization within the dual labor market structure also spilled over to adoption of remote work, which was initially introduced to prevent the spread of the pandemic. This study examined the system and factors of labor-management relations contributing to such polarization and presented policy directions for the current labor market structure.

The health effects of wage setting institutions: How collective bargaining improves health but not because it reduces inequality.

Do wage-setting institutions, such as collective bargaining, improve health and, if so, is this because they reduce income inequality? Wage-setting institutions are often assumed to improve health because they increase earnings and reduce inequality and yet, while individual-level studies suggest higher earnings improve well being, the direct effects of these institutions on mortality remains unclear. This paper explores both the relationship between wage-setting institutions and mortality rates whether income inequality mediates this relationship. Using 50 years of data from 22 high-income countries (n ~ 825), I find mortality rates are lower in countries with collective bargaining compared to places with little or no wage protection. While wage-setting institutions may reduce economic inequality, these institutions do not appear to improve health because they reduce inequality. Instead, collective bargaining improves health, in part, because they increase average wage growth. The political and economic drivers of inequality may not, then, be correlated with health outcomes, and, as a result, health scholars need to develop more nuanced theories of the political economy of health that are separate from but in dialogue with the political economy of inequality.

Globalization, Work, and Health: A Nordic Perspective.

The Nordic countries are among the world's leading countries in international rankings on prosperity, productivity, social equity, trust, and health. Such positive results may be linked to how these countries have organized their working life. The aim of this article is to describe core elements of the Nordic working life model (emphasizing Norway) and discuss how globalization may challenge the model, and thereby influence public health. Based on an extensive review of relevant research, we show that the Nordic working life model with a coordinated wage bargaining system between well-organized employers and employees results in productive enterprises, small wage differences, good working environments, and a high level of well-being. Global trends of liberalization of working life, increased labor migration, the platform economy, reduced unionization, and more precarious work challenge the Nordic working life model and its reliance on standard working contracts. Such a trend may result in increased inequity, reduced generalized trust, and poorer public health. Politicians and other stakeholders in the Nordic countries should cope appropriately with globalization and technological changes so that the Nordic countries will uphold their well-organized working life and good societal achievements.

Nursing strike, America, 2019: Concept analysis to guide practice.

BACKGROUND: In 2018 a nursing 'sympathy strike' occurred. Although unionized nurses were directed to participate, many expressed questions about what a strike or sympathy strike was. Literature revealed no seminal article to define the term. A concept analysis for the nursing workforce was created. METHOD: The Hybrid Method of Concept Analysis, (theoretical literature analysis, qualitative stakeholder interviews; applicability) was used. 33 articles and 7 books were reviewed. Nine interviews took place. RESULTS: The literature and interviews agreed on the definition, antecedents, and consequences of a nursing strike. Strikes in the United States were defined as "a last resort effort, after significant bargaining on the issue between nurses and management has not allowed for agreement, where a work stoppage occurs and nurses leave the bedside." Interviews alone introduced the concept of duty to patients. A model case, contrary case and borderline case are offered. CONCLUSION: This study contains recommendations for practice.

Teacher Power and the Politics of Union Organizing in the Charter Sector.

Despite the growing media attention paid to charter-school unions, comparatively little empirical research exists. Drawing on interview data from two cities (Detroit, MI, and New Orleans, LA), our exploratory study examined charter-school teachers' motivations for organizing, the political and power dimensions, and the framing of unions by both teachers and administrations. We found that improving teacher retention, and thus school stability, was a central motivation for teacher organizers, whereas, simultaneously, high teacher turnover stymied union drives. We also found that charter administrators reacted with severity to nascent unionization drives, harnessing school-as-family metaphors and at-will contracts to prevent union formation. As the charter sector continues to grow, understanding why teachers want unions and how those unions differ from traditional public school unions is crucial to analyzing the long-term viability of these schools and the career trajectories of the teachers who work in them.

A negociação coletiva e as possibilidades de intervenção nas situações de risco à saúde no trabalho / Collective bargaining and the possibilities to intervene in health risk situations at work

Resumo Introdução: neste ensaio, a negociação coletiva é vista como um processo político no qual os diferentes e desiguais atores sociais definem parâmetros para as relações de trabalho. Objetivo: discutir possibilidades e limites da negociação coletiva para modificar as situações de riscos à saúde dos trabalhadores, considerando aspectos sociais, políticos e econômicos. Métodos: analisamos a negociação coletiva no Brasil sobre a temática da saúde do trabalhador, incluindo temas como inovação tecnológica, intensidade, assédio moral organizacional e teletrabalho. Foram estudados acordos e convenções coletivas negociados entre os anos de 2010 e 2014, registrados no Sistema de Acompanhamento de Contratações Coletivas do Departamento Intersindical de Estatística e Estudos Socioeconômicos (Sacc-Dieese). Entre 2010 e 2012, tomamos por base estudos já realizados, a partir dessa mesma fonte, e para anos de 2013 e 2014, analisamos a partir de acesso direto a esse sistema. Resultados: embora tenham sido identificadas cláusulas inovadoras, grande parte das outras reproduz parâmetros previstos na legislação, com alcance limitado para modificar as condições adoecedoras. Conclusão: a aprovação da Lei nº 13.467/2017, aa chamada "reforma trabalhista", sob a premissa de uma relação entre "iguais", poderá resultar na desconstrução da proteção social do trabalho e na subestimação dos riscos e do sofrimento humano.

Abstract Introduction: this paper accounts for collective bargaining as a political process in which differing and unequal social actors define parameters for work relations. Objective: to discuss the possibilities and limits of collective bargaining for modifying situations of workers' health risks, considering its social, political and economical aspects. Methods: we analyze collective bargaining related to workers' health in Brazil, including subjects like tecnological innovation, intensity, moral organizational harassment, and home office. We verified collective agreements negotiated between 2010 and 2014 recorded on the Sistema de Acompanhamento de Contratações Coletivas do Departamento Intersindical de Estatística e Estudos Socio-econômicos (Sacc-Dieese). Analysis of studies based on Sacc-Dieese were conducted between 2010 and 2012, whereas direct access to this system was used for the period between 2013 and 2014. Results: although innovative clauses have been found, most clauses reproduce parameters established by law, which are limited in modifying conditions that lead to sickness. Conclusion: the approval of Law No. 13.467/2017, called "Brazil Labor Reform", under the false premise of agreements between "equals", can result in the deconstruction of social protection laws and the underestimation of health risks and human suffering.

Comparing disability and return to work outcomes between alternative and traditional workers' compensation programs.

BACKGROUND: The Union Construction Workers' Compensation Program (UCWCP) was developed in 1996 as an alternative workers' compensation arrangement. The program includes use of a preapproved medical and rehabilitation network and alternative dispute resolution (ADR), and prioritizes a quick and safe return-to-work. The aim of this study is to determine if differences in recovery-related outcomes exist between UCWCP and the statutory workers' compensation system (SWCS). METHODS: Claims data from 2003 to 2016 were classified as processed through UCWCP or SWCS. Outcomes included: temporary total disability (TTD), vocational rehabilitation (VR), claim duration and costs, and permanent partial disability (PPD). The relative risk of incurring TTD, VR, and PPD in UCWCP vs SWCS was calculated using log-binomial regression. Linear regression examined the relationship between programs and continuous outcomes including costs and duration. Estimates were adjusted for age, sex, wage, and severity. RESULTS: The UCWCP processed 15.8% of claims; higher percentages of UCWCP claimants were older and earned higher wages. Results point to positive findings of decreased TTD incidence and cost, lower risk of TTD extending over time, higher likelihood of VR participation, and less attorney involvement and stipulation agreements associated with UCWCP membership. Differences were more apparent in workers who suffered permanent physical impairment. CONCLUSION: Findings suggest that the defining programmatic elements of the UCWCP, including its medical provider and rehabilitation network and access to ADR, have been successful in their aims. Claims with increased severity exhibited more pronounced differences vs SWCS, potentially due, in part, to greater use of programmatic elements.

Reforming private drug coverage in Canada: inefficient drug benefit design and the barriers to change in unionized settings.

Prescription drugs are the highest single cost component for employees' benefits packages in Canada. While industry literature considers cost-containment for prescription drug costs to be a priority for insurers and employers, the implementation of cost-containment measures for private drug plans in Canada remains more of a myth than a reality. Through 18 semi-structured phone interviews conducted with experts from private sector companies, unions, insurers and plan advisors, this study explores the reasons behind this incapacity to implement cost-containment measures by examining how private sector employers negotiate drug benefit design in unionized settings. Respondents were asked questions on how employee benefits are negotiated; the relationships between the players who influence drug benefit design; the role of these players' strategies in influencing plan design; the broad system that underpins drug benefit design; and the potential for a universal pharmacare program in Canada. The study shows that there is consensus about the need to educate employees and employers, more collaboration and data-sharing between these two sets of players, and for external intervention from government to help transform established norms in terms of private drug plan design.

Time trends for injuries and illness, and their relation to performance in the National Basketball Association.

OBJECTIVES: To survey injury/illness in the National Basketball Association over a 25-year period and examine the relationship of injury/illness to team performance. DESIGN: A retrospective correlational design. METHODS: Trends were examined in reported numbers of players injured/ill during a season and games missed due to injury/illness from seasons ending in 1986 through 2005. This period was compared to years 2006-2010, when NBA teams were allowed to increase the total number of players on the team from 12 to 15. RESULTS: There was a highly significant trend (p<0.0001) of increasing numbers of players injured/ill and games missed from 1986 through 2005. After the team expansion in 2006, these rates fell abruptly by 13% and 39% respectively (both p<0.0001 compared to the previous 5-year period). We also found a significant inverse association between games missed due to injury/illness and percent games won (r=-0.29, p<0.0001). CONCLUSIONS: Results demonstrate an increased rate of injury in the National Basketball Association up until the expansion of team size in 2006. Following 2006, team expansion was positively associated with decreased injury/illness rates. The latter finding suggests the importance of maintaining a healthy roster with respect to winning outcomes.