The Economics of Occupational Safety and Health

AN extended series of economic studies has failed to find any statistically significant impact on national injury rates due to the Occupational Safety and Health Administration, or OSHA.' Two distinct explanations for this apparent failure of OSHA have been put forward in these studies. The first is that, because of limited statutory and budgetary authority from Congress, OSHA is unable to compel industrial compliance with its own standards. Advocates of this position point to the pitifully small level of OSHA fines and to the small number of firms that will actually be inspected. For example, in 1975, the average fine per violation amounted to only $26, while the average number of inspections per firm was only .02,

Economic evaluations in occupational health: what brings the best bang for the buck?

PurposeThe purpose of this paper is to note that the current discussion about employer behaviors appears to be more concerned with how these affect the physical world than the consequences of the adoption of new management practices and organizational changes for the physical and psychological wellbeing of their employees.Design/methodology/approachKeynote speech (review of the literature).FindingsThis paper argues that the overlap between health and personnel economics is a new, fruitful area of research that can fill this void. Recent research in health economics has taught us that the life cycle perspective is key, and accordingly, the importance of childhood conditions have become increasingly better understood. However, the determinants of adult health, and the role of work life and working conditions and changes therein, are less well understood.Originality/valueThe paper discusses what economists can contribute to this area of research, and then selectively reviews some previous studies, including an investigation of the relationship between job design and health in Europe. Finally, some thoughts are given regarding promising areas for further research and a brief discussion of the major challenges involved.

A short history of occupational fitness and health promotion

Research in community and occupational medicine field has grown rapidly in the last decade. In European countries such as Netherland, the contribution of authors in occupational health journal has even doubles in the past five years.1 Knowledge of community and occupational health medicine; which includes community, and occupational health and medicine, epidemiology, community nutrition, and health economics, is constantly growing, hence increase the need of journal submissions and reference searches. In this digital era, the role of web has greatly reduced the barriers for publishing and communicating scientific and research works outcome.2 Journals online in open access (OA) platform is one of many strategic methods with high impact and relevancy. With peer-reviewed method prior of publication, this model of publishing can be freely accessed.3
 In Indonesia, there are still only few of open accessed journal publications in the field of community and occupational medicine. We understand the urge and importance of providing publication platform in this field, therefore The Association of Alumni of Occupational Medicine Magister Faculty of Medicine Universitas Indonesia (ILUNI MKK FKUI) launches The Indonesian Journal of Community and Occupational Medicine (IJCOM) as an open access journal for the expansion of community and occupational medicine-related knowledge and acts as a media for authors to publish their researches.
 IJCOM is the peer-reviewed, world scale scientific journal of community, occupational clinical, and epidemiology, community nutrition, and health economics. As the official journal of ILUNI MKK FKUI we committed to facilitate authors, academicians, students and health care professionals to share their science work in community and occupational medicine, as well as other related field includes epidemiology, community nutrition, family medicine, health economics and other public health research works. This Journal also act as the platform to provide learnings and recommendations in community and occupational medicine and related data for the development of good health practice for Indonesian community and the world.
 We do realize that this first issue is a baby step for a greater future. We will definitely put our utmost effort and energy to develop and grow this journal to meet all the requirements of national accredited journal and ultimately a reputable international journal standard.

Introduction Periodic health examinations (PHE) have been a fundamental part of occupational health and safety (OHS) practice for decades. Nonetheless, PHE have not received a great deal of attention in health economics and ethics literature, which poses many interesting challenges from an efficiency and an equity perspective. Methods We performed electronic searches in databases as EMBASE, PUBMED and Cochrane Library from September 2007. Search terms included MeSH, EMTREE and free text terms related to economic evaluation, occupational health intervention and productivity. We independently included all studies based on three criteria: the analysis was a full or partial economic evaluation (cost analyses); included OHS interventions targeted at an employed population; and were written in English, French, or Dutch. Results The best available evidence assessing benefits of OSH interventions consisted of 156 economic evaluations. A broad range of intervention types was studied in the literature, most frequently health promotion (27%), or multiple intervention types within one study (31%). However, none of these studies specifically focussed on PHE. Studies mainly came from Europe (39%) and North-America (51%), and originated in diverse sectors and industries, most frequently health care (15%). Conclusions Determining the value of OHS proved a theoretically complex endeavour and there are hardly data available on the value of PHE. While the majority of OHS interventions had positive conclusions, most studies were conducted in similar settings and showed substantial methodological deficiencies. Consequently, we need to be cautious to transfer results across settings or countries. Nonetheless, we rendered valuable insight into the potential cost-effectiveness of PHE and key-elements to design a high-quality study. We have now set up a study in Belgium comparing short-, medium- and long-term outcomes in employees undergoing PHE, with a group without an intervention.

Sweden, like other European countries in the 1990s introduced internal market reforms in the delivery of health care. Specifically, in Stockholm county, the Stockholm model was introduced to strengthen the position of patients in their choice of care. Other reform measures introduced included the family doctor's legislation, care guarantee and the adel reform. This paper reports interviews with Swedish physicians, politicians and health economists seven years after the introduction of these reforms. The broader goals of this paper are to explore the extent to which these changes have overtime affected the views of physicians as they reflect on their working conditions and experiences with the use of the diagnostic-related groups (DRG) system. Data was obtained from in-depth interviews of 15 primary care physicians, 4 heads of hospital departments (surgery), 5 county council members and 4 health economists (N = 28). A content analysis was performed on major themes on the interview transcripts. The majority of our respondents reported that the financial incentives introduced through performance-based reimbursements do exist in Stockholm county and that productivity and efficiency have increased over the period of investigation. Primary physicians voiced support for the privatization process in health care delivery. Most physicians reported that they were generally satisfied with their work. Over half of the general physicians complained about their working conditions but felt they have a unique way to play as 'gatekeepers' in the overall Swedish health care delivery system. Our findings suggest that physicians are generally satisfied with their working conditions. Over 90% of our respondents support the use of a diagnostic-related group. What is clear though is that the primary care physician's role due to its potential benefit as an agent of cost control is important, but it is not clear that the primary care physicians have made a major contribution to the Swedish health care delivery system as they should be.

Health and wellbeing are the ultimate goals in life. Expenses, whether governmental or non- governmental, are often directed towards health and development. More efforts and costs are essential for sustainability and its three pillars; environment, society and economy. Cultural, political and technological factors are intermingled with these pillars. The balance between these three pillars is crucial in the nations’ goal to maintain resources for the present and future generations. Work represents a risk as well as a benefit at the same time. The aims of the modern policies and strategies of the Occupational Health and Safety (OHS) programmes are workers’ protection and profit earning as well as sustainability, considering the effectiveness, utility and benefits of those policies. The situation in big firms is rather acceptable but small and medium sized enterprises and informal sector need more effort. Globally, around 4% of GDP is lost due to the costs of work related injuries and illness with global financial losses exceeding $1250 billion. This cost is high compared with that of cancer or AIDS. The burden of occupational injuries and illness is also high when calculating Disability-Adjusted Life Years lost, or healthy years of life lost either from disability or premature death. This will hinder economic development and sustainability. So, all should be motivated towards cost effectiveness OHS programmes as a priority in their agenda. Occupational health literacy, unemployment, workers’ behaviour, high risk group workers (children, women, and elderly and immigrants workers), inequity and inequality should be considered in OHS programmes. Society, workers, payers, and providers’ perspectives must be investigated in facing challenges towards OHS and sustainability. Reallocation of resources, controlling of externalities, enforcement of regulations and encouraging of innovation are crucial elements for sustainable development and economic growth.

One of the objectives of a recently held workshop in Amsterdam, the Netherlands, was to advance methods for the economic evaluation of occupational safety and health (OSH) interventions at the corporate and societal level. Drawing from that workshop, we discuss issues to consider when developing guidelines for good practice (ie, a reference case). The Economics of Occupational Safety and Health (ECOSH) workshop was held in conjunction with the Repository of Occupational Well-being Economic Research (ROWER) initiative in the fall of 2009 and brought together researchers, employers, unions, policymakers, and other stakeholders. Through presentations, break-out sessions, and group discussions, efforts were made to develop a consensus on key elements for good practice. This manuscript integrates these efforts along with earlier contributions in this area. We propose some framework principles and a set of recommendations to serve as the foundations for developing a reference case. We argue that a reference case can be invaluable for the OSH field because it encourages sound principles to be consistently applied in studies. Furthermore, it can ensure that studies are more readily comparable regardless of the intervention type, jurisdiction, or sector. Developing guidelines for good practice in the economic evaluation of OSH interventions that meet the needs of all stakeholders requires discussion as well as time. The ECOSH/ROWER initiative has served as a good starting point for this objective.

Informal recycling is widespread in developing countries and involves the collection, sorting, and selling of recyclable materials. Workers are exposed to hazards including the risk of cuts and musculoskeletal injury, infection, exposure to medical waste, and respiratory conditions like bronchitis, pneumonia, and sinusitis and often use insufficient personal protective equipment. Assess the occupational and environmental health hazards faced by informal recyclers working at a landfill in Asunción, Paraguay. We surveyed 102 informal recyclers and 12 formal recyclers about occupational health, workplace safety, general health, and household economics. Personal air samples were used to assess respirable dust and nobel metal exposure on 18 workers. Exposures to hazards such as syringes, medical waste, and broken glass as well as risk factors such as eating food found in the trash, lack of personal protective equipment (PPE), and inadequate sanitation were frequent among informal recyclers. Minors under 18 years of age constituted 13% of the workforce and experienced equal or greater exposure to these hazards. Formal recyclers had better access to water, sanitation, PPE, and experienced fewer cuts, injuries, and illnesses than formal recyclers. Informal recyclers were exposed to respirable dust that were considerably higher than they would have been exposed to at home or doing other work in their neighborhood. Better regulation of sharps and medical waste and the provision of adequate sanitation and personal protective equipment would address the most pressing occupational health issues in this high risk group.

The 9 (th) Revision of German Medical Licensing Regulations for Physicians has come into effect on October 1 (st) 2003. Social medicine was separated into the fields ""occupational health, social medicine" and the various cross-sectional modules: epidemiology, biometry, medical computer science; health economics, health-care system, public health; prevention, health promotion; rehabilitation, physical medicine, naturopathic treatment. This paper studies the realisation of teaching in the field social medicine at German medical faculties. The survey was conducted in collaboration with the German Association for Social Medicine and Prevention (DGSMP). A survey was conducted at 38 institutes of 36 German medical faculties. The written questionnaire contained mostly selection items in which chances and barriers of the field were queried with supply items. Information about time scale, general conditions and resources was aked for. On the basis of the guidelines of the DGSMP, the topics to be taught were evaluated concerning their relevance and integration into education. The response rate was 68% (n=26). Social insurance, basic principles, responsibility in the Social Security Code and the different providers were judged as the most important topics. There was a strong demand for lecturing material. 82% (n=18) of the faculties wished to have specific material, for example e-learning, examples, lesson plans, curricula and also textbooks. 91% (n=19) of the faculties requested an exchange of information between the faculties concerning educational contents, motivation of students and e-learning. The realisation of teaching is different between the faculties concerning the number of hours, teaching methods and number of students per year. The motivation of the students is one of the problems, but also the lack of acceptance within the clinic. Specific resources and exchange between the faculties are necessary concerning e-learning, which is offered at only few faculties so far, but interest for a more intensive usage exists. Potentials of social medicine are the promotion of awareness among the students and the "identification of basics for medical acts in the social security system". Social medicine offers the possibility to connect the theoretical institutes with the clinic.

BackgroundIn 2013 RheinMain University launched its bachelor’s degree program Health Care Economics requiring each student to participate in a mandatory two-month nursing internship. A preliminary risk assessment revealed serious risks for both students and patients and had to be addressed by appropriate measures such as mandatory systematic safety training for each student.MethodsA short-term educational intervention named “Survival-Day” was designed to minimize risks related to nursing internships of students. This intervention consists of six 45-min-units with theoretical input (2 units) and hands-on training (4 units) imparting basic knowledge and skills in CPR, hand hygiene and handling of masks and protective gowns, prevention of needle stick injuries, fire protection and firefighting. Performance of CPR was assessed using computerized manikins. Acceptance, necessity and usability were assessed anonymously by standardized written questionnaires after completion of nursing internships.Results462 students have completed the Survival-Day until January 2019. CPR performance showed acceptable adherence rates to guideline recommendations (mean 78.8%, SD ±22.6%). The majority of students performed aseptic health care activities (66%), treated patients with multi-resistant pathogens (62%) and disposed sharp instruments such as blood-contaminated needles (76%). According to students’ self-reports about these hazardous activities, less than 50% of these students received adequate safety training at nursing facilities. However, no sentinel events such as needle stick injuries or students becoming second victim have been reported.ConclusionOur study reveals severe discrepancies between legal obligation of nursing facilities to ensure safety instructions for nursing interns and initial training as perceived by this group. Mandatory initial training before conduction of hazardous tasks was mainly covered by our short-term educational intervention (Survival-Day). Regarding responsibility for their students a preliminary safety instruction program like the Survival-Day should be considered for all educational institutions sending students to nursing internships unless mandatory and sufficient safety trainings for nursing interns can be guaranteed by nursing facilities.

Rapid COVID-19 vaccine rollout: immense success but challenges ahead

Based on the assumption of most health expert, paramedics, health economist, reformists and labor/safety proponents is that, the healthcare and safety services can only be available to common man when the process is partially or fully mixed (public-private). That is to them, the private sector participation in healthcare and safety sect oral service provision is eminent. In the payment for healthcare and safety services it was concluded that, the relative efficiency of payments through private insurance scheme or its impacts on the efficiency of public sector is not debatable. It is also postulated that the private/public mix may evolve the possibility of reduction in administrative bottle necks, improve access at an affordable price, and ensure equity through the use of government control mechanisms. The target respondents were medical doctors, nurses, paramedics, human resource personnel and healthcare and safety beneficiaries in Nigeria and Malaysian higher institution as well as both public and private clinics. A random sampling technique was used. A log-linear and chi-square test was used for the analysis of the750 sample respondents in both Nigeria and Malaysia. The study revealed the following results/relationship between Nigeria and Malaysian National Healthcare Scheme and Safety under reform which show r=0.257 with p=0.000 which is less than 0.05, therefore significant, relationship between public control health and healthcare service delivery for safety under reform revealed r=0.164 and p=0.008 and 0.005 which is significant, so also as reform ensures efficiency in healthcare delivery services to employees it in turn ensures equity and safety of employees with r=201, p=0.006 and 0.005 therefore significant and finally control mechanism instituted by the government ensures access and equity improvement in healthcare and safety services to employees under reform.

Industrial disharmony is a state of unrest, a situation where there is an inability among the participating parties to reach a peaceful agreement as it affects job rules and conditions of work. It presents itself as disputes between employers and employees, or between trade unions and employer organizations. Certain factors can be attributed to causing industrial disharmony, these include; inter professional rivalry amongst workforce, perception of preferential and favoured treatment to one group over another, inefficient and ineffective management style strained relationship between the management and labor unions. Highlight were made of the impact of industrial disharmony on the Nigerian healthcare sector, aimed to enlighten policymakers that policies that enhance harmony in the health sector are required, and if they are already in place, then their full implementation is urgently required. Three thematic areas of interest in the discourse on industrial disharmony amongst healthcare professionals in Nigeria were expatiated to include; industrial harmony; employees’ productivity and job satisfaction and last but not the least clients’ satisfaction of service delivery. The numerous negative impact of the ongoing disharmony within the Nigerian Healthcare sector as typified by the different professional associations and unions, whom hardly agree on modes of remuneration, career recognition and headship appointments in the healthcare institutions, has continuously made the health care indices of the country to be at abysmally low ratings. The way forward would be to canvass for the appointment of Health administrators with expertise in Health Economics and Administration to oversee the smooth and unbiased running of public health institutions in Nigeria. Also, all healthcare professionals should be given equal and fair recognition based on the value additions they provide to efficient and effective patient management. Lastly, the realisation by all healthcare professi