laura pizzi, pharmd, mph jefferson medical college slide # 1 health-related work productivity: how...
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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]
Laura Pizzi, PharmD, MPHJefferson Medical College
Slide # 2
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
Laura Pizzi, PharmD, MPHJefferson Medical College
Slide # 3
Productivity Loss
An indirect cost
Laura Pizzi, PharmD, MPHJefferson Medical College
Slide # 4
Who’s interested in productivity?
Do patients care?
Do clinicians care?
Do insurers care?
Do employers care?
Laura Pizzi, PharmD, MPHJefferson Medical College
Slide # 5
Rationale for Research Interest in Productivity
U.S.: Employer-sponsored healthcare
Everywhere: Cost of illness studies; CEA input
Laura Pizzi, PharmD, MPHJefferson Medical College
Slide # 6
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.
Laura Pizzi, PharmD, MPHJefferson Medical College
Slide # 7
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)
Laura Pizzi, PharmD, MPHJefferson Medical College
Slide # 8
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.
Laura Pizzi, PharmD, MPHJefferson Medical College
Slide # 9
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”)
Laura Pizzi, PharmD, MPHJefferson Medical College
Slide # 10
Economic Theory
Human Capital Approach
Friction Cost Method
Laura Pizzi, PharmD, MPHJefferson Medical College
Slide # 11
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
Laura Pizzi, PharmD, MPHJefferson Medical College
Slide # 12
Elements of Productivity Loss Under HCA
Absenteeism + Presenteeism
Allocates a $0 to individuals who work outside the labor force
Homemakers
Elderly
Laura Pizzi, PharmD, MPHJefferson Medical College
Slide # 13
HCA: Advantages
Credible-- founded in economic theory
Most established / popular method
Easier method to apply
Intuitive from employer perspective
Laura Pizzi, PharmD, MPHJefferson Medical College
Slide # 14
HCA: DisadvantagesWorking-age, higher earning potential are valued over the old, young
Men
White
Educated
May over-estimate real production losses
Assumes earnings reflect productivity
Excludes social impact of productivity loss
Laura Pizzi, PharmD, MPHJefferson Medical College
Slide # 15
Friction Cost Method (FC)
Introduced by KoopmanschapEstimating the productivity costs by calculating the value of production losses during the friction period (i.e. between start of absences of work and replacement)
ConceptNew or existing workers make up for production losses
Laura Pizzi, PharmD, MPHJefferson Medical College
Slide # 16
FC Method, continued
Concept:Amount of production lost due to disease depends on the time-span organizations need to restore the initial production level
Example: costs of replacing a disabled worker
Friction costs:Recruitment of new employees
Training of new employees
Loss of production during the friction period
Laura Pizzi, PharmD, MPHJefferson Medical College
Slide # 17
FC Method:Information Requirements
1. Can the work be completed by a sick employee?
Bus driver vs. lawyer
2. Frequency of the friction periods
3. Economic cost of lost productionCost per day ($) x length of friction period(s)
Laura Pizzi, PharmD, MPHJefferson Medical College
Slide # 18
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?
Laura Pizzi, PharmD, MPHJefferson Medical College
Slide # 19
Question:What about the social impact of disease on work productivity?
Laura Pizzi, PharmD, MPHJefferson Medical College
Slide # 20
How do we research HRWP?
Productivity InstrumentsDatabases
Laura Pizzi, PharmD, MPHJefferson Medical College
Slide # 21
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
Laura Pizzi, PharmD, MPHJefferson Medical College
Slide # 22
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
Laura Pizzi, PharmD, MPHJefferson Medical College
Slide # 23
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
Laura Pizzi, PharmD, MPHJefferson Medical College
Slide # 24
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”?
Laura Pizzi, PharmD, MPHJefferson Medical College
Slide # 25
Examples of Productivity Databases
Medstat Inc.MarketScan Health and Productivity Management
Ingenix
Medical Expenditure Survey (MEPS)
Others– mostly employer and/or health plan-specific
Laura Pizzi, PharmD, MPHJefferson Medical College
Slide # 26
Questions?