A longitudinal study of piece rate and health: evidence and implications for workers in the US gig economy.

The objective of this study was to evaluate health outcomes for workers subject to piece rate historically to better understand the implications of pay type in the modern-day gig economy. While piece rate occurring in the 1980s and 1990s predates recent platform-based employment, it introduced and normalized patterns of economic precariousness that are instrumental in the current gig economy. Evidence suggests that such pay types may result in poor health outcomes; however, cross-sector evidence of its long-term effects on US workers is lacking. This article represents the first longitudinal cross-sector analysis relating health outcomes to this performance pay type in US workers. This is a longitudinal cohort study. Data from six survey waves of the 1979 National Longitudinal Survey of Youth collected between 1988 and 2000 are used in a random-effects logit model to predict self-reported health limitations related to piece rate, while controlling for worker, work environment, lifestyle, time, and location trends. Pay tied to piece rate in current or prior periods significantly increases the odds of self-reported health limitations compared with salaried work (odds ratio [OR]: 1.4–1.8). These effects are elevated for the subgroups of low-wage (OR: 1.5–1.8), female (OR: 1.8–1.9), and non-white (OR: 2.0–2.1) workers compared with their high-wage, male, and white peers. The results suggest that piece rate pay designed to promote efficiency may have important negative implications for worker health, especially for the most vulnerable members of the US workforce such as women, minority, and low-income workers. Given the growing popularity of performance-based pay to the gig economy, more research is needed to determine if the practice is justified from a public health perspective. • Piece rate significantly increases the odds of self-reported health limitations compared to salaried effort. • Piece rate has the greatest negative effect on health for low-wage, female, and non-white workers. • Pay designed to promote efficiency may have important deleterious impacts on worker health, especially for vulnerable workers. [ABSTRACT FROM AUTHOR]