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Healthcare Workers Join Ranks of Uninsured

By Karen Pallarito
Originally published by Reuters Health, March 4, 2002

NEW YORK (Reuters Health) — Healthcare workers are losing health insurance coverage at a faster clip than other people employed in other industries, a new study finds.

Virtually every health occupation in every type of institution experienced a decline in health insurance coverage between 1988 and 1998, researchers from Harvard Medical School report in the March issue of the American Journal of Public Health. At greatest risk, however, are workers at the lower end of the pay scale, particularly nurses’ aides, they found.

Employees making less than $25,000 a year were three times more likely than higher-income workers to lack health insurance coverage, the study found. Those at the lower end of the pay scale accounted for 52.7% of healthcare workers and 74.1% of uninsured healthcare workers.

Aides had the highest “uninsurance” rate in 1998—at 23.8%—and accounted for 37% of uninsured healthcare workers. Food, cleaning, building and laundry service workers, as a category, had the next highest percentage of uninsured workers—at 19.7%.

Denying caregivers health coverage may have serious quality-of-care implications, as highlighted in a new General Accounting Office study, said Dr. David U. Himmelstein, an associate professor of medicine at Cambridge Hospital in Massachusetts and co-author of the study.

The GAO report, released today at a hearing by the Senate Special Committee on Aging, finds that incidents of physical and sexual abuse of nursing home residents are not being reported to authorities in a timely manner (see Reuters Health report 2002-03-04).

“If you’re paying someone a minimum wage with no benefits to take care of patients, in a job that has the among highest incidence of occupational injury, can we really be surprised that they aren’t treating people right?” he wondered.

The American Health Care Association was not familiar with Dr. Himmelstein’s study and therefore had no comment.

Failing to cover healthcare workers also has serious implications for public health, Dr. Himmelstein told Reuters Health. By delaying seeing a doctor for a cough, for example, “they actually may be spreading illness to the people they’re supposed to be caring for,” he said.

Policies requiring healthcare workers to have annual physicals and to be up-to-date on their immunizations clearly are neither widespread nor widely enforced, he observed.

The Harvard team’s analysis is based on data from US Census Bureau’s Current Population Survey and excludes workers 65 years of age and older, who are generally covered by Medicare.

In the decade since Dr. Himmelstein and colleagues first looked at the issue of health insurance coverage for healthcare workers and their children, the situation has unexpectedly worsened. “We expected to find things roughly the same way that they were,” he said.

But as the study shows, the number of people who work in physicians offices, hospitals, nursing homes and other healthcare settings who were uninsured in 1998 rose to 1.36 million, an increase of 83.4% from 1988. During that period, the percentage of healthcare workers lacking health insurance coverage rose 3.8 percentage points to 12.2%.

Even as private-sector healthcare employers added jobs, the number of uninsured personnel in the private sector jumped 101.4% between 1998 and 1998, according to the report. Meanwhile, workers in public hospitals and nursing homes were much less likely to be insured than their private-sector counterparts.

On the bright side, unionized healthcare workers were more likely to have coverage in both 1988 and 1998 than those who did not belong to a union. They also experienced a milder decline in coverage, the study found.

African-American women, who traditionally have sought jobs in the healthcare sector, however, may be “particularly vulnerable,” they wrote.

Dr. Himmelstein sees “a certain irony and particular immorality” in caregivers not being able to get care themselves because they do not have health insurance coverage.

“What [the study] indicates is that the health industry is not immune to the same trends that affect other parts of the economy,” said Dr. Richard Levinson, associate executive director of the American Public Health Association.

But in an interview with Reuters Health, he suggested that the long-term implications of healthcare workers not getting care and potentially spreading illnesses are potentially devastating.

Dr. Levinson agreed with the report’s conclusion that the solution is to enact universal health insurance coverage.