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Workers' Compensation

The Resilience of the Self-Employed

Higher Quality of Life and Preventative Health Measures are Associated With Less Absenteeism and Presenteeism

Technological advances, combined with the layoffs of the Great Recession, have altered the landscape of the American workforce. Some displaced workers have opened their own businesses, while others have turned to contract or part-time work. These recent rapid changes have affected millions of workers. It is fair to ask, therefore, whether employment status affects one’s overall health and, if so, does this impact one’s productivity at work? A study out of Iowa looks at this issue– albeit on a limited scale. Published in the Journal of Occupational and Environmental Medicine, Employment Status Matters: A Survey of Quality-of-Life, Prevention Behaviors, and Absenteeism and Presenteeism, the survey looked at a small subsection of Iowans and concluded that an individual’s employment status affects his or her sense of well-being, which in turn affects absenteeism and presenteeism (showing up for work sick.) In other words, employment status, quality of life and worker productivity are all interrelated, with the self-employed posting the most positive results.

Why is this important?

The researchers noted that wellness programs previously implemented by large employers (and which are now encouraged by the 2010 Affordable Care Act) have been effective in improving employee health and reducing disability and workers’ compensation costs. Not as much is known about the health of the self-employed and unemployed. Given the fact that their ranks have swelled in recent years, this survey, and the data it provides on their health status, health behaviors and related work productivity, is both useful and timely.

What the Survey Looked At

The survey analyzed whether there were measurable differences between the self-employed, unemployed and those employed by a company in the following areas: quality of life (QoL), primary care, health insurance and prevention behaviors. It then looked at whether these measures were related to absenteeism and presenteeism. The final study group comprised 1271 Iowans aged between 18 and 65 who were identified through the voting rolls. They were each sent a survey questionnaire which included questions from the Centers for Disease Control and Prevention QoL and Behavioral Risk Factor Surveillance System Survey questionnaires used to assess employee well-being, and also the World Health Organization’s Health and Work Performance Questionnaire used for assessment of sickness absenteeism and presenteeism. The questions included those relating to age, sex, marital status, employment status, health insurance, primary doctor, educational status, smoking history, body mass index (BMI) and income.

While the overall conclusion was that employment status is related to well-being, which in turn is related to absenteeism and presenteeism, there were several other interesting findings that came to light. With respect to quality-of-life indicators (measured by such metrics as “healthy days” i.e. where physical and mental health was good and there were no health-related activity limitations, and “health symptoms” i.e. feeling anxious, sad, tense and/or experiencing sleep issues) the unemployed consistently turned in poorer measures of general health, physical and mental health, health related restrictions and days when they simply weren’t feeling good. By contrast, the self-employed scored the highest in all quality-of-life categories. In other words, being self-employed “positively influenced” overall good physical health. The survey found that this, in turn, positively affects productivity at work.

Who Are the Self-Employed?

In this admittedly limited survey, the self-employed were primarily older, married and with over a third earning more than $50,000 per year. The survey also showed that they often worked longer hours yet had greater financial insecurity. However, they also had more job control. Where employed (as opposed to running their own business), it was predominantly by small rather than large employers. Indeed 90% of the self-employed reported working in workplaces with 9 or fewer employees. While most of them had health insurance (87%), their coverage was not as robust as their organizationally employed counterparts (95% of whom had health insurance) and was derived mainly through the self-employed marketplace or through a spouse. Having health insurance “strongly influenced” such positive factors as having a primary care doctor, not smoking and getting a flu vaccine. Having reduced healthcare coverage reduced the self-employeds’ access to healthcare, including primary care visits. Additionally, as the survey noted, the self-employed are shouldering increasingly burdensome healthcare and health insurance costs, a fact which should be of concern to policymakers. Nevertheless, the self-employed, as least as far as the survey results go, score the highest in quality of life indicators.

The Importance of Preventative Health Measures

So why is this? Why did the self-employed make such a strong showing on quality-of-life indicators? The survey found that these indicators were influenced, in part, by “prevention behavior” identified as including health insurance, a primary doctor, smoking history, exercise habits, dietary habits, getting a flu shot and BMI. “Positive influencers” on overall well-being included BMI under 30, non-smoker, married, college degree and a higher household income. Smoking and obesity were found to be the two main risk factors for adversely affecting overall health.

As noted, the self-employed were disadvantaged in such categories as health insurance and access to primary care. However, in the majority of the remaining categories, the self-employed posted the strongest showing. They exercised more than the organizationally employed and the unemployed. They also had a better diet, eating more fruits, vegetables and grains on a daily basis than the other two groups. The self-employed also got more sleep, with a third getting 8 hours or more per night, compared to a quarter of the organizationally employed. As for the two main risk factors—smoking and obesity—the self-employed again reported positively. Nearly two-thirds of the self-employed had never smoked and, at the time of the survey, only 12% were smokers. By contrast nearly 60% of the unemployed had smoked at some point and twice as many (24%) were current smokers. (The organizationally employed posted numbers closer to the self-employed—61% and 13% respectively.) As for obesity rates, the survey showed approximately two-thirds of the self-employed had a BMI of less than 30. The rate for the organizationally employed was nearly identical (within 0.2 percentage points) whereas only a little over half of the unemployed had a BMI under 30.

The survey showed that these “prevention behaviors” were associated with better quality-of-life scores as measured by “healthy days” and healthy symptoms”. This in turn affected sickness absenteeism and presenteeism. Those whose QoL indicators were higher showed lower rates of absenteeism and presenteeism. Similarly, most prevention behaviors resulted in lower rates of absenteeism and presenteeism. In short, the survey found higher quality-of-life measures and higher prevention behaviors are associated with lower absenteeism and presenteeism.

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Risk Management Tip: According to Rebecca Shafer, JD, President of Amaxx Risk Solutions and author of Your Ultimate Guide to Mastering Workers’ Comp Costs, “It goes to bolster employers’ long time suspicions that injured employees do better if they return to work quickly; thus, Early Return to Work Programs help employees feel better about themselves and are less likely to become depressed. Staying at home, or not having a destination to go to each day and a regular routine (e.g., going to work at 8am and returning home at 5pm), negatively impacts employees’ overall well-being.”

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The Need for Further Research

There are, of course, some limitations to this survey, most prominent being its small and concentrated study group of less than 1300—all of whom were Iowans and all of whom were registered voters. It may be difficult to extrapolate data obtained from a small group in a primarily rural state and apply it to a diverse population nationwide. Nevertheless, the survey does raise some interesting findings and illustrates the need for further research to be done on this subject. This becomes particularly true when the cost of lost employee productivity is considered. The researchers pointed out that studies have estimated losses from sickness absenteeism and presenteeism may exceed $150 billion annually, far exceeding the combined employer cost of pharmacy and medical claims. With losses of this magnitude, this survey may be in the vanguard of research on how to address the problem by promoting employee quality of life and wellness.

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