laura pizzi, pharmd, mph jefferson medical college slide # 1 health-related work productivity: how...

Laura Pizzi, PharmD, MPHJefferson Medical College

Slide # 1

Health-Related Work Productivity: How is it defined and measured?

Presented to the ISPOR Student NetworkNovember 8, 2007

Laura Pizzi, PharmD, MPHResearch Associate ProfessorDivision Director, Pharmacoeconomics and Outcomes ResearchDepartment of Health PolicyJefferson Medical CollegePhiladelphia, [email protected]


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Overview

Who’s interested in productivity? Productivity as a measure of employee healthIntroduction to Productivity Theory

Human capital approachFriction cost method

Data sourcesSelf-reported: survey instrumentsAdministrative data sets

Case Study on using retrospective database to estimate productivity loss


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Productivity Loss

An indirect cost


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Who’s interested in productivity?

Do patients care?

Do clinicians care?

Do insurers care?

Do employers care?


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Rationale for Research Interest in Productivity

U.S.: Employer-sponsored healthcare

Everywhere: Cost of illness studies; CEA input


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How do employers define productivity loss?

*Source: Pizzi LT and Lofland JH. Concepts and measurement of health-related work productivity: Results of a qualitative telephone survey, 2002.


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What are the determinants of Health-Related Work Productivity (HRWP)?

Individual Factors Health status

(physical and cognitive ability to work)

Ability to do the job (knowledge, skills, training)

Interpersonal abilities Motivation level

Organizational Factors Job satisfaction Culture of the work

environment Availability of necessary

resources Job structure (job is well-

defined) Job support (employees

receive the guidance that they need)


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Who should measure HRWP?

1

3

4

13

13

14

15

16

19

0 5 10 15 20

Charity/Social Support Groups

Manufacturers (Drug or Device)

Schools/Academia

Special Interest Groups

Insurers

Professional/Trade Organizations

Government Agencies

Consultants

Employers

Stak

ehol

der

Number of Experts Who Stated the Stakeholder Should Measure HRWP

*Source: Pizzi LT and Lofland JH. Concepts and measurement of health-related work productivity: Results of a qualitative telephone survey, 2002.


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Criteria for Determining Productivity Impact of Specific Conditions

Chronicity and/or recurrence tendency of the diseasePrevalence of the disease on the working age populationSymptoms occur when and where work impact is likely to be the greatestEconomic impact of the disease on the working age population (indirect and direct costs)Disability level is such that affected individuals can remain in the workforceConditions for which there are opportunities for functional improvementTraining and replacement costs associated with replacing experienced workers with new workers (also referred to as “friction costs”)


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Economic Theory

Human Capital Approach

Friction Cost Method


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Human Capital Approach (HCA)

All costs, other than direct, can be estimated by calculating expected earnings of work productivity foregone because of disease

Assumes that an employee’s lost workplace productivity is a function of income

One hour of lost productivity is valued as one hour of an individual’s salary


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Elements of Productivity Loss Under HCA

Absenteeism + Presenteeism

Allocates a $0 to individuals who work outside the labor force

Homemakers

Elderly


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HCA: Advantages

Credible-- founded in economic theory

Most established / popular method

Easier method to apply

Intuitive from employer perspective


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HCA: DisadvantagesWorking-age, higher earning potential are valued over the old, young

Men

White

Educated

May over-estimate real production losses

Assumes earnings reflect productivity

Excludes social impact of productivity loss


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Friction Cost Method (FC)

Introduced by KoopmanschapEstimating the productivity costs by calculating the value of production losses during the friction period (i.e. between start of absences of work and replacement)

ConceptNew or existing workers make up for production losses


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FC Method, continued

Concept:Amount of production lost due to disease depends on the time-span organizations need to restore the initial production level

Example: costs of replacing a disabled worker

Friction costs:Recruitment of new employees

Training of new employees

Loss of production during the friction period


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FC Method:Information Requirements

1. Can the work be completed by a sick employee?

Bus driver vs. lawyer

2. Frequency of the friction periods

3. Economic cost of lost productionCost per day ($) x length of friction period(s)


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FC: Advantages and Disadvantages

AdvantagesMore accurate measure of lost productivity because not measuring potential loss

DisadvantagesAssume perfect market for supply of workers

Does every occupation have a friction period?

Does every disease/illness cause friction in the workplace?


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Question:What about the social impact of disease on work productivity?


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How do we research HRWP?

Productivity InstrumentsDatabases


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Productivity Instruments

Used for prospective or cross-sectional studies

Typically based on HCA: Most incorporate absenteeism & presenteeism

Some also include questions on the social impact of reduced productivity

Conceptually related to quality of life

Most are generic; some are disease-specific


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Measuring HRWP Using Databases

Used for retrospective studiesDatabases must include elements of health:

DiseasesMedicationsHealthcare services

Must also include elements of productivity:AbsencesDisability (short- vs. long-term)Worker’s compensation

Presenteeism and social impact of disease on productivity generally not available


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Methodological Challenges in Measuring HRWP

What to do about part-time workers or contracted employees?What about teenagers? Home-makers? Students?What’s the importance of “wages lost” due to a given disease/condition?

White collar workers vs. blue collar workersUnique to databases:

EligibilityEmployer shift towards “banking” of personal time


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HRWP Challenges, cont.Dealing with Employers

Does the organizational culture embrace HRWP measurement?

Is there a “champion” of HRWP?Is there an influence from labor unions?

Are the data siloed?Who should be involved?Do the people involved have the right expertise?OHSA concernsEmployee’s right to confidentialityHow do healthcare interventions really effect “the bottom line”?


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Examples of Productivity Databases

Medstat Inc.MarketScan Health and Productivity Management

Ingenix

Medical Expenditure Survey (MEPS)

Others– mostly employer and/or health plan-specific


Slide # 26

Questions?

laura pizzi, pharmd, mph jefferson medical college slide # 1 health-related work productivity: how...

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