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Objectives: Examine short-term disability (STD) and workers’ compensation (WC) associated leave and wage replacements, and overall direct healthcare payments, among employees with osteoarthritis (OA) versus other chronically painful conditions; quantifying the impact of opioid use. Methods: Analysis of employees with more than or equal to two STD or WC claims for OA or pre-specified chronically painful conditions (control) in the IBM MarketScan Research Databases (2014 to 2017). Results: The OA cohort (n = 144,355) had an estimated +1.2 STD days, +$152 STD payments, and +$1410 healthcare payments relative to the control cohort (n = 392,639; P

About one in four employees in a cohort of 408,000 US workers took a temporary leave of absence from work because of illness or injury in the period 2008-12. They accounted for nearly 60 percent (about $6.5 billion) of total worker health care and disability payments. This finding underscores the importance of workplace care management, lifestyle management, and health and safety efforts to prevent disability leaves.

Purpose Early interventions can help short-term disability insurance (STDI) claimants return to work following onset of an off-the-job medical condition. Accurately targeting such interventions involves identifying claimants who would, without intervention, exhaust STDI benefits and transition to longer-term support. We identify factors that predict STDI exhaustion and transfer to long-term disability insurance (LTDI). We also explore whether waiting for some claims to resolve without intervention improves targeting efficiency. Methods We use a large database of STDI claims from private employer-sponsored disability insurance programs in the United States to predict which claims will exhaust STDI or transition to LTDI. We use a split sample approach, conducting logistic regressions on half of our data and generating predictions for the other half. We assess predictive accuracy using ROC curve analysis, repeating on successive subsamples, omitting claims that resolve within 2, 4, and 6 weeks. Results Age, primary diagnosis, and employer industry were associated with the two outcomes. Rapid attrition of short-duration claims from the sample means that waiting can substantially increase the efficiency of targeting efforts. Overall accuracy of classification increases from 63.2% at week 0 to 82.9% at week 6 for exhausting STDI benefits, and from 63.7 to 83.0% for LTDI transfer. Conclusions Waiting even a few weeks can substantially increase the accuracy of early intervention targeting by allowing claims that will resolve without further intervention to do so. Predictive modeling further narrows the target population based on claim characteristics, reducing intervention costs. Before adopting a waiting strategy, however, it is important to consider potential trade-offs involved in delaying the start of any intervention.

Debates about the productivity impact of work accommodations typically focus on employment and labor force participation outcomes. This study considers whether accommodations mediate on-the-job productivity losses among employees who report health problems.The study uses ordered logistic regression to predict employees' self-reported productivity losses as a function of health problems and experiences with needed work accommodations.On average, the odds that an employee who did not get a needed accommodation reported higher levels of lost productivity are 5.11 times the odds for an employee who got a needed accommodation.Although health problems make it difficult for many employees to perform well on the job, accommodations could reduce productivity losses in some cases. Nonetheless, more research on the impact of specific kinds of accommodations for different chronic conditions is warranted.

Although the penal system and public assistance programs play significant roles in the lives of disadvantaged populations in the United States, the relationship between the two institutions is not well understood. This is particularly true of publicly financed health care coverage. In this article, the authors study how state-level incarceration rates shape the provision of publicly financed health care and health insurance (Medicaid), using two theoretical frameworks as a guide: a collateral consequences model and a punitive regime model. The authors use state-level panel data to estimate how the size of the incarcerated population is related to Medicaid enrollments across states and within them over time. These analyses suggest that incarceration rates do have a substantial and positive effect on Medicaid rates within states over time. Across states, the relationship is less clear. On average, states with higher incarceration rates had somewhat fewer Medicaid enrollments until the early 1990s. After this point, Medicaid enrollments began to increase with the size of the incarcerated population. These findings suggest that though states’ efforts to control crime and poverty may be linked, whereby states that use incarceration liberally are also stingy with Medicaid, the collateral consequences of mass incarceration undermine these efforts by producing greater demands for social welfare services.

What career information do potential military recruits seek? The Internet increasingly provides a medium for advertising and communication with recruiters and other potential recruits. The authors explored the influence of online information on enlistment decision making. Analysis of recent Army new recruit surveys showed that a sizable proportion of recruits have encountered military advertising or sought recruiting information online. The authors also examined online discussion forums—in which soldiers and prospective soldiers ask questions, trade insights, and vent frustrations—for postings indicating information seeking for enlistment decision making. Potential recruits were most interested in recruiting processes and what to expect from a military lifestyle, seeking opinions and details on job functions, duty stations, and benefits. These findings suggest that potential recruits may seek information online when unable or unwilling to find it from military websites or talking to recruiters.

Studies of nations' military efforts and social well‐being are a staple of sociology, economics, and political science, but have produced ambiguous results. This article argues that the standard measure of military efforts—defense spending—inadequately captures the social and political impact of military preparedness. It instead suggests that military personnel policies impact social welfare efforts to the degree that they alter citizens' relationships to labor markets, directly provide social welfare benefits to military personnel, or create discursive obstacles to other groups seeking benefits. The results indicate that net of military spending, nations with relatively large armed forces make smaller social welfare efforts, while nations with conscription tend to spend more generously.

Observers of the U.S. welfare state often contrast its low levels of social spending with its lavish defense spending. This article dem- onstrates that U.S. military institutions in fact provide a segment of the population with benefits that have characteristics of formal wel- fare state programs and have similar social welfare purposes. It thus conceives of social assistance benefits for military families as comprising a distinct welfare state institution, one that challenges assumptions that the U.S. strategy for achieving social welfare goals fundamentally depends on rewarding market participation and financially supporting families only under conditions of extreme poverty. When U.S. president George W. Bush released his proposal for the federal government's 2006 budget, many observers were quick to contrast the proposed growth in military spending with the reductions in social welfare programs such as Medicaid, food stamps, and public housing. Such concerns about the imbalance between "guns and butter" underscore a long-standing and popular conception of national security and social welfare efforts as separate, and perhaps even antithetical, political priorities. This conception is particularly strong among academic treatments of the American wel- fare state. Analysts often conceive of the United States as a laggard welfare state because it spends comparatively few of its resources on

Since the end of the draft in 1973, African Americans have been overrepresented among volunteers for the US Armed Forces. While many commentators have hailed the military as a uniquely egalitarian avenue for social and economic advancement in a society beset with racial inequities, the high participation rate among blacks has periodically led to concerns that they (and more recently, other ethnic minorities such as Hispanics) would disproportionately suffer from casualties in the event of military hostilities. However, after numerous US military engagements since the 1970s, these fears have not been borne out. In fact, African Americans seem less likely to die in combat than their overall representation in uniform would suggest. Taken at face value, the racial composition of US combat casualties stands in stark contrast to the racial pattern of morbidity and mortality in the larger society, where African Americans as a group fare worse than whites on measures such as death rates, infant mortality, and life expectancy. It would seem that, as a comparatively disadvantaged group, African Americans in the all-volunteer era have reaped the benefits of military service without unduly bearing its ultimate burdens. However, explanations for the unexpectedly low African American casualty rate have not been rigorously examined. Furthermore, assessing the racial equity of military service based on historical casualty patterns assumes that future combat operations will closely resemble those that have occurred since Vietnam-an assumption that in this new century looks increasingly untenable. Extending the work of Martin Binkin and his collaborators, this study argues that the racial composition of combat casualties reflects three factors: the social processes that sort volunteers into various military units and occupational specialties; the mix of units and specialties that participate in military operations; and the battlefield conditions they encounter. Or put another way, given a particular environment within which armed conflict occurs, the probability of any person becoming a casualty is a function of their representation in those units most likely to make hostile contact with enemy forces. Following this, the underrepresentation of African Americans in the units most involved in combat operations since Vietnam may partly explain the disjuncture between their military participation and casualty rates. By extension, the higher propensity of whites to serve in combat capacities could explain their higher-than-expected, post-Vietnam casualty rate. The same may be true of ethnic Hispanics, who are also overrepresented in the combat arms, though their reasons for volunteering for such assignments may differ from those of their non-Hispanic white counterparts. The short duration of post-Vietnam US ground combat engagements such as Panama and Somalia-as well as the prominent roles played by special operations and light-infantry units for which blacks are less likely to volunteer has thus far prevented a rigorous evaluation of such propositions. However, the 2003-2004 conflict in Iraq presents one opportunity to assess the race distribution of US casualties under varying combat conditions. First, compared to other combat engagements since Vietnam, many diverse military units have been operating in Iraq for a relatively long time. Second, the US military experience in Iraq has been, broadly speaking, marked by differing conflict environments. In the relatively brief opening period, coalition ground combat forces (mainly US and British infantry and armor) rapidly penetrated deep into enemy territory and carried out offensive actions primarily against Iraqi military forces. The subsequent-and ongoing-mission involves efforts by combat and noncombat personnel (e.g., intelligence, police, logistical, and civil affairs) to consolidate US control, restore civil order, pacify hostile forces, and administer occupied areas. This study assesses the racial equity of military service by examining the racial distribution of US casualties in Iraq for the first twelve months national dialogue on the equity of military service may shift back to the social process that impels whites-particularly those from the lower socioeconomic strata-into the ranks. However, should US troops resume large-scale offensive campaigns against a number of seerningly growing and increasingly well-organized insurgent threats, casualties among blacks and Hispanics may creep up to a point where the fairness of military sacrifice again becomes an uncomfortable racial issue. On a final note, the findings of this study are not germane only to the military experiences of the United States. As of 2000, several advanced industrial democracies with long histories of conscription had abandoned the practice in favor of voluntary service, or had plans to phase it out by 2004. Some nations with rising immigration rates have experienced increased racial and ethnic diversity in their volunteer militaries, while others (such as Spain and France) actively recruit foreign volunteers. At the same time, conflicts such as Kosovo in 1999 and contemporary operations in Afghanistan and Iraq have subjected the militaries of many nations to their first hostile fire in decades (for example, coalition casualties in Iraq include personnel from Italy, Spain, Poland, Denmark, and Bulgaria). To the degree that ethnic enlistment patterns are similarly structured by socioeconomic factors, debates about military equity and recruitment policies in the US case may presage similar dialogues elsewhere. Language: en

The objective of this study is to examine how much of the relationships between unhealthy body weight, and health and productivity outcomes are attributable to health status, and how much can be ameliorated by weight loss or improvements in health. Cross-sectional and first-difference regressions were conducted of employees' body mass index (BMI) category, illness absences, presenteeism, medical spending, and disability leaves. Employees in the obese BMI category have significantly worse outcomes than employees in the healthy and overweight BMI categories. Controlling for physical and emotional health status mediates much of the observed relationships. Improved health, stress, and psychological distress are associated with reduced illness absence and presenteeism among overweight and obese employees. Obese employees who lost weight experienced reduced presenteeism. The findings suggest that overweight and obese employees can realize improved productivity without weight loss.

OBJECTIVE To determine productivity loss and indirect costs with deep vein thrombosis (DVT) and pulmonary embolism (PE). METHODS Medical and pharmacy claims with short-term disability (STD) and long-term disability (LTD) claims from 2007 to 2010 were analyzed from the Integrated Benefits Institute's Health and Productivity Benchmarking (IBI-HPB) database (STD and LTD claims) and IMS LifeLink™ data (medical and pharmacy claims), which were indirectly linked using a weighting approach matching from IBI-HPB patients' demographic distribution. RESULTS A total of 5442 DVT and 6199 PE claims were identified. Employees with DVT lost 57 STD and 440 LTD days per disability incident. The average per claim productivity loss from STD and LTD was $7414 and $58181, respectively. Employees with PE lost 56 STD and 364 LTD days per disability incident. The average per claim productivity loss from STD and LTD was $7605 and $48,751, respectively. CONCLUSIONS Deep vein thrombosis and PE impose substantial economic burdens.

Objective To better understand presenteeism and absenteeism on the basis of the choices employees make about working when they experience episodes of illness. Methods We examine nationally representative data to describe employees' work responses to episodes of illness and how different leave policies contribute to their decisions. Results Illness episodes typically result in absence from work rather than working a normal or adjusted routine. Employees adjust their routine when ill primarily to save leave or because they have too much work. Paid sick leave and scheduling flexibility influence the likelihood of absence in different ways. Conclusions Although flexibility to adjust work routines can reduce absences, it is not known to what extent productivity suffers when this occurs. Measures of both short- and long-term presenteeism are necessary to understand the full productivity costs of illness in the workforce.

OBJECTIVE To determine the total burden of illness, including direct and indirect costs for employees and their dependents with acute coronary syndrome (ACS). METHODS Medical and pharmacy claims along with short-term disability (STD) and long-term disability (LTD) claims from 2007 to 2010 were analyzed using two data sets: Integrated Benefits Institute's Health and Productivity Benchmarking Database (STD and LTD claims) and IMS LifeLink™ Health Plan Data (medical and pharmacy claims). RESULTS Employees with ACS lost 60.2 ± 0.29 STD and 397.9 ± 8.09 LTD days per disability incident. For employers, the estimated average per claim productivity loss from STD and LTD was $7943 ± 39.7 and $52,473 ± 1114, respectively. Total annual ACS health care costs per employee were $8170 ± 106, with $7545 ± 104 for annual medical costs. Hospitalizations accounted for 75% of total annual ACS health care costs. CONCLUSIONS ACS imposes a substantial economic burden on employees, employers, and society.

Introduction: Though, deep vein thrombosis (DVT) and pulmonary embolism (PE) impose a major burden on US healthcare system, limited data exists on the economic impact of DVT and PE on younger working population. DVT, which occurs in approximately 1 in every 1,000 adults every year, is estimated to cost between $5-8 billion annually or on average $20,000 per treated patient per year. PE occurs in 0.6 million patients annually and results in 50,000 to 200,000 deaths every year. This study examined the total burden of illness, including the direct and indirect healthcare costs to employers and employees with DVT and PE. Methods: Retrospective analyses from 2007-2010 were performed using two datasets: (1) Integrated Benefits Institute’s Health and Productivity Benchmarking Database was used for short-term disability (STD) and long term disability (LTD) claims, and (2) IMS LifeLink data was used for medical and pharmacy claims. Indirect costs analyses included costs of lost work days from STD and LTD claims and wage replacement costs. Direct costs included annual pharmacy and medical claims for newly diagnosed DVT and/or PE individuals. Total healthcare cost estimates between the two datasets were linked by derived age and gender analytic weights. Results: 5,445 (female=54%) and 6,199 (female=50%) disability claims were filed for DVT and PE, respectively. Employees with DVT lost on average 57 (SEM 4.6) STD and 440 (SEM 30.5) LTD days per disability incident. For employers, estimated lost productivity costs per DVT claim were STD=$7,414±625 and LTD= $58,181±4,332. Total annual DVT healthcare costs per employee including out of pocket costs were $2,449 + 106 with $2,160±102 for annual medical and $290 ±20 for total pharmacy costs. Employees with PE lost on average 56 (SEM 3.0) STD and 364 (SEM 26.1) LTD days per disability incident. For employers, the estimated lost productivity costs per PE claim for STD and LTD were $7,605±402 and $48,751±3,615, respectively. Total annual PE healthcare costs per employee including out of pocket costs were $5,040 + 460 with $4,851±457 for annual medical and $190 ±22 for total pharmacy costs. Hospitalizations accounted for 84% of total annual PE health costs. Conclusion: DVT and PE constitute a heavy economic and lost productivity burden for both employers and their employees. Direct and disability costs to employees are substantial. Productivity losses for employers are also significantly high. Appropriate management of DVT and PE may help improve lost days from work, reduce healthcare resource utilization, improve workforce productivity, and reduce total economic burden.

OBJECTIVE Modifiable health risks such as smoking, exercise, and body weight have been linked to illness absence from work. This suggests that employers could improve their productivity if their workers adopted healthier lifestyles, but methodological concerns regarding selection bias and omitted variables remain. METHODS We use a first-difference model of changes in health behaviors and illness- and family-related absence from work among a nationally representative, longitudinal panel of employed individuals. RESULTS Workers who lost weight or increased their frequency of light exercise also saw their illness absences decrease over a 2-year period. Some, but not all, of the relationship is mediated by the change in health status. No such decrease was observed for family-related absences. CONCLUSION The findings are consistent with the proposition that both employers and employees could benefit from efforts to support better health habits.

How do potential recruits decide to enlist in the military? What information do they seek on which to base career decisions? The Internet increasingly provides a medium for advertising and communication with recruiters and other potential recruits. The authors explored the influence of online communication on enlistment decision-making. Analysis of recent Army new recruit surveys showed that a sizeable proportion of recruits have encountered Army advertising or sought recruiting information online. They also examined online discussion forums - in which soldiers and prospective soldiers ask questions, trade insights, and vent frustrations - for postings indicating information seeking for enlistment decision-making. Potential recruits were most interested in recruiting processes and what to expect from a military lifestyle, seeking opinions and details on job functions, duty stations, and benefits. These findings suggest that potential recruits may seek information online when unable or unwilling to find it from military websites or talking to recruiters.

The Los Angeles Police Department is seeking to increase its force to more than 10,000 officers. RAND researchers devised strategies for the city to improve recruiting and increase the efficiency of the hiring process.

This research brief summarizes an assessment of recruiting in the San Diego Police Department, recommending that the department target a wider range of applicants, make applicant screening more efficient, and strengthen recruiting teams.