Large Employers Research Articles

Should There Be Vertical Choice in Health Insurance Markets?

We study the welfare effects of offering choice over financial coverage levels––vertical choice''––in regulated health insurance markets. Though the efficient level of coverage, which trades off the value of risk protection and the social cost from moral hazard, likely varies across consumers, we emphasize that this variation alone is not sufficient to motivate choice. When premiums cannot reflect individual costs, consumers may not select their efficient coverage level. We show that vertical choice is efficient only if consumers with higher willingness to pay for insurance have a higher efficient level of coverage. Using administrative data from a large public employer, we investigate this condition empirically and find that the welfare gains from vertical choice are either zero or economically small. Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.

Regional University as a Social Institution (on the example of the Ingush State University)

The article analyses a regional university as a social institution on the example of the case of the Ingush State University. A general description of the university is given. It is shown that a regional university in modern conditions as a social institution acquires special significance both as a scientific institution, and as the main element of the regional educational space, and as a center of an innovative economy. The Ingush University focuses on continuing professional education, that includes pre-university training, secondary vocational education, higher vocational education at various levels, as well as postgraduate and additional vocational education. Opportunities for obtaining secondary vocational and higher education for socially vulnerable segments of the population are expanding. The university is one of the largest employers in the region, therefore, the article emphasises its role in solving the problem of graduates employment. The university provides opportunities for stable employment for representatives of the highest qualifications, who otherwise would not have been able to find an occupation due to the peculiarities of the structure of the depressed regional economy. In addition, the conditions for the development of small innovative enterprises are being formed at the Ingush State University. The driving force behind this process is the Engineering Center, a supplier of a sorbent with a high sorption capacity to the Russian market. The centre is aimed at a long-term solution of problems in the development of modified sorption materials that are used in a wide range of industries, including medicine and agronomy, to eliminate environmental pollution as a result of oil spills, to purify wastewater from various organic substances. The culture-creating role of the university in the space of regional culture is multifaceted. The university, on the one hand, is part of the world cultural and educational community, on the other hand, it works to preserve, develop and spread the culture of the regional peoples. The article analyses the integrative function of the university in the creation and support of a single educational and cultural space as an important condition for state unity and sustainable development of our multinational country. The role of the rector's personality in solving the problems facing the regional university in modern conditions is emphasized.

Using Payroll Tax Variation to Unpack the Black Box of Firm-Level Production

This paper uses quasi-experimental variation in payroll taxes to estimate their incidence and investigate how firms use their input factors. We find that higher payroll tax rates lead to large employment responses and have no effects on employee earnings. As payroll taxes increase, firms substitute away from low-skilled, routine and manual workers towards more productive workers and also reduce investments. Our results imply that, contrary to the canonical tax incidence model, firm-level production and input factor choices are affected by payroll taxes. Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.

Systemic Discrimination Among Large U.S. Employers

We study the results of a massive nationwide correspondence experiment sending more than 83,000 fictitious applications with randomized characteristics to geographically dispersed jobs posted by 108 of the largest U.S. employers. Distinctively Black names reduce the probability of employer contact by 2.1 percentage points relative to distinctively white names. The magnitude of this racial gap in contact rates differs substantially across firms, exhibiting a between-company standard deviation of 1.9 percentage points. Despite an insignificant average gap in contact rates between male and female applicants, we find a between-company standard deviation in gender contact gaps of 2.7 percentage points, revealing that some firms favor male applicants while others favor women. Company-specific racial contact gaps are temporally and spatially persistent, and negatively correlated with firm profitability, federal contractor status, and a measure of recruiting centralization. Discrimination exhibits little geographical dispersion, but two digit industry explains roughly half of the cross-firm variation in both racial and gender contact gaps. Contact gaps are highly concentrated in particular companies, with firms in the top quintile of racial discrimination responsible for nearly half of lost contacts to Black applicants in the experiment. Controlling false discovery rates to the 5% level, 23 individual companies are found to discriminate against Black applicants. Our findings establish that systemic illegal discrimination is concentrated among a select set of large employers, many of which can be identified with high confidence using large scale inference methods.

Systemic Discrimination Among Large U.S. Employers

We study the results of a massive nationwide correspondence experiment sending more than 83,000 fictitious applications with randomized characteristics to geographically dispersed jobs posted by 108 of the largest U.S. employers. Distinctively Black names reduce the probability of employer contact by 2.1 percentage points relative to distinctively white names. The magnitude of this racial gap in contact rates differs substantially across firms, exhibiting a between-company standard deviation of 1.9 percentage points. Despite an insignificant average gap in contact rates between male and female applicants, we find a between-company standard deviation in gender contact gaps of 2.7 percentage points, revealing that some firms favor male applicants while others favor women. Company-specific racial contact gaps are temporally and spatially persistent, and negatively correlated with firm profitability, federal contractor status, and a measure of recruiting centralization. Discrimination exhibits little geographical dispersion, but two digit industry explains roughly half of the cross-firm variation in both racial and gender contact gaps. Contact gaps are highly concentrated in particular companies, with firms in the top quintile of racial discrimination responsible for nearly half of lost contacts to Black applicants in the experiment. Controlling false discovery rates to the 5% level, 23 individual companies are found to discriminate against Black applicants. Our findings establish that systemic illegal discrimination is concentrated among a select set of large employers, many of which can be identified with high confidence using large scale inference methods.

Spillover Effects from Voluntary Employer Minimum Wages

Low unionization rates, a falling real federal minimum wage, and outsourcing have hampered wage growth in the low-wage sector in the US. In recent years, a number of private employers have opted to institute or raise company-wide minimum wages for their employees, sometimes in response to public pressure. To what extent do wage-setting changes at major employers spill over to other employers, and what are the broader labor market effects of these policies? In this paper, we study recent minimum wages by Amazon, Walmart, Target, CVS, and Costco using data from millions of online job ads and employee surveys. We document that these policies induced wage increases at low-wage jobs at other employers, where the modal response was to match the wage announced by the large retailer. In the case of Amazon’s $15 minimum wage in October 2018, our estimates imply that a 10% increase in Amazon’s advertised hourly wages led to an average increase of 2.3% among other employers in the same commuting zone. Using the CPS, we estimate wage increases in exposed jobs in line with our magnitudes from employee surveys and find that large employer minimum wage policies led to small but precisely estimated declines in employment, with employment elasticities ranging from -0.04 to -0.13. Large employer minimum wage announcements influenced wages more broadly. The magnitude of these wage spillovers cannot easily be explained by standard competitive pressures, suggesting a role for both market power and norms in wage determination.

Czech Kurzarbeit: Evidence from the First Pandemic Wave

We describe the firm-type structure of the use of the main Czech kurzarbeit program (called Antivirus B) during the spring 2020 pandemic wave. Evidence based on the Structure of Earnings Survey shows large participation gaps in favor of large employers, and disproportionately high intensity of use of the program by manufacturing companies, in particular those exhibiting a declining wage bill already prior to the pandemic. Compared to other industries, manufacturing is thus able to ‘cover’ by kurzarbeit support the largest share of the decline in hours worked between the 2nd quarters of 2019 and 2020, with the exception of the hospitality and culture industries, which were directly affected by pandemic measures, such as restaurant closures.

Assessing Labor Market Conditions Using High-Frequency Data

When the COVID-19 pandemic struck in March 2020, the U.S. economy experienced a sharp, unexpected recession with large employment losses. The information on employment available from traditional data sources arrives with a lag and does not promptly reflect sudden changes in labor market conditions. In this article, we discuss how new high-frequency data from Homebase and Ultimate Kronos Group can offer critical information on the state of labor markets in real time. Using these datasets, we construct coincident employment indices to assess employment at a high frequency. Employment during the pandemic reacted to changes in the number of infections and the restrictions imposed by government officials (see, e.g., the discussion in Dvorkin and Bharadwaj, 2020). Our latest data suggest that employment has recently increased and will continue to increase as the pandemic wanes.

Prevalence of chronic hepatitis B in Oro Province, Papua New Guinea.

Chronic hepatitis B (CHB) affects over 250 million people worldwide. In Papua New Guinea, the prevalence of CHB has been estimated to be over 8%, and it is a leading cause of death. To address this problem, an alliance was formed between the government of Oro Province, a large private employer and an Australian nongovernmental organization, which established a CHB test and treatment programme. Between 2014 and 2019, rapid hepatitis B surface antigen testing was performed on 4068 individuals in Oro Province. The crude prevalence rate was 12.98% and was significantly higher in males (15.26%) than females (10.94%) (P < 0.001). The rate was 4.72% among children aged 10 years and under, 12.81% among women of childbearing age (19–35 years) and 18.48% among health-care workers. These results indicate that the rates of vaccination at birth and later among women of childbearing age and health-care workers must be improved to prevent transmission of CHB.

Monetary Economics Overview Includes Monetary Policy Instruments, Functions and Impacts

This study discusses monetary policy, the function and impact of monetary policy as well as the factors that influence the money supply. Monetary policy is a policy or regulation issued by the Central Bank which is used to manage a number of money supplies in a country to be able to create a specific purpose. The functions and impacts of monetary policy include maintaining an investment climate that occurs within the country, increasing the stability of economic growth in a country, overcoming high levels of unemployment and opening up a number of large employment opportunities, increasing the number of the balance of payments, maintaining the stability of value. the existing currency exchange is able to maintain a number of stability of the price of goods on the market. Factors that affect the amount of money circulating in society include the size of state spending, the fast and slow rate of money circulation, the motive for having cash, the transaction motive, the precautionary motive, and the speculative motive.

Changes in Drug List Prices and Amounts Paid by Patients and Insurers

High out-of-pocket drug costs can cause patients to skip treatment and worsen outcomes, and high insurer drug payments could increase premiums. Drug wholesale list prices have doubled in recent years. However, because of manufacturer discounts and rebates, the extent to which increases in wholesale list prices are associated with amounts paid by patients and insurers is poorly characterized. To determine whether increases in wholesale list prices are associated with increases in amounts paid by patients and insurers for branded medications. Cross-sectional retrospective study analyzing pharmacy claims for patients younger than 65 years in the IBM MarketScan Commercial Database and pricing data from SSR Health, LLC, between January 1, 2010, and December 31, 2016. Pharmacy claims analyzed represent claims of employees and dependents participating in employer health benefit programs belonging to large employers. Rebate data were estimated from sales data from publicly traded companies. Analysis focused on the top 5 patent-protected specialty and 9 traditional brand-name medications with the highest total drug expenditures by commercial insurers nationwide in 2014. Data were analyzed from July 2017 to July 2020. Calendar year. Changes in inflation-adjusted amounts paid by patients and insurers for branded medications. In this analysis of 14.4 million pharmacy claims made by 1.8 million patients from 2010-2016, median drug wholesale list price increased by 129% (interquartile range [IQR], 78%-133%), while median insurance payments increased by 64% (IQR, 28%-120%) and out-of-pocket costs increased by 53% (IQR, 42%-82%). The mean percentage of wholesale list price accounted for by discounts increased from 17% in 2010 to 21% in 2016, and the mean percentage of wholesale list price accounted for by rebates increased from 22% in 2010 to 24% in 2016. For specialty medications, median patient out-of-pocket costs increased by 85% (IQR, 73%-88%) from 2010 to 2016 after adjustment for inflation and 42% (IQR, 25%-53%) for nonspecialty medications. During that same period, insurer payments increased by 116% for specialty medications (IQR, 100%-127%) and 28% for nonspecialty medications (IQR, 5%-34%). This study's findings suggest that drug list prices more than doubled over a 7-year study period. Despite rising manufacturer discounts and rebates, these price increases were associated with large increases in patient out-of-pocket costs and insurer payments.

The changing nature of gender selection into employment over the great recession

SUMMARY The Great Recession has strongly influenced employment patterns across skill and gender groups in EU countries. We analyse how these changes in workforce composition might distort comparisons of conventional measures of gender wage gaps via non-random selection of workers into EU labour markets. We document that male selection (traditionally disregarded) has become positive during the recession, particularly in Southern Europe. As for female selection (traditionally positive), our findings are twofold. Following an increase in the labour-force participation of less-skilled women, due to an added-worker effect, these biases declined in some countries where new female entrants were able to find jobs, whereas they went up in other countries which suffered large female employment losses. Finally, we document that most of these changes in selection patterns were reversed during the subsequent recovery phase, confirming their cyclical nature.

Promoting Sustainable Enterprise &amp; Human Resource Development in Rural Kenya: A Cooperative Approach

There is an urgent need to promote sustainable enterprise and human resource development in order to create thriving rural communities and solve some of the problems facing Kenya such as poverty and under-employment. Rural areas face such challenges as resource constraints, lack of needed infrastructure, inability to attract large employers, availability of local talent, among others, that limit the range of economic development strategies available to rural areas. This paper makes suggestions on how to promote cooperative-modelled entrepreneurial structures, building on the existing tradition of relying on self-help groups and cooperatives for job creation and economic empowerment in rural communities.

Testing Annual Increases in Charitable Donations

In this paper, I briefly summarise the findings of a study conducted with a large employer to encourage participants to sign up to annual increases in their donations, rather than a one off increase in their donations. Our results are inconclusive, with qualitative large, but statistically insignificant effects of the ‘menu’ of annual enrolment options on the amounts donated, but more modest effects on donation increases per se.

Does the Implementation of Reference Pricing Result in Reduced Utilization? Evidence From Inpatient and Outpatient Procedures.

Reference pricing (RP) is an insurance design that can be used to incentivize patients to use low-price settings. While RP is not intended to affect overall utilization, it could unintentionally reduce utilization. We examined whether utilization was reduced when a large employer adopted RP for selected elective surgeries, including inpatient joint replacement surgery and outpatient cataract surgery, colonoscopy, and arthroscopic surgery. Data included a treatment group subject to RP implementation and a comparison group that was not. We applied autoregressive integrated moving average analysis as comparison-population interrupted time-series analysis to determine whether there were procedure reductions following RP implementation. We find no evidence of short-term decreases (within 3 months of RP implementation). However, we find very modest declines of approximately 14 (20%) fewer arthroscopic knee surgeries 6 months after RP implementation and 129 (17.2%) fewer colonoscopies 8 months after RP implementation. There were no declines in the other procedures examined.

Work and breast milk feeding: a qualitative exploration of the experience of lactating mothers working in ready made garments factories in urban Bangladesh

BackgroundIn Bangladesh 65% of children under 6 months of age were exclusively breastfed with maternal employment being a risk factor that has jeopardized exclusive breastfeeding. As Ready Made Garment (RMG) factories have been the largest employer of low income women in Bangladesh, the objective of our study was to explore the barriers and facilitators of breastfeeding and perceptions about use of expressed breast milk among mothers who worked in the RMG sector.MethodsThis formative research was conducted during July–September 2015 in two slums of Dhaka among RMG workers who were mothers and the caregivers of 0–12 month old infants. Qualitative data was obtained from purposively selected participants of 8 in-depth interviews and 4 focus group discussions (mothers and caregivers), and 2 key informant (RMG factory official) interviews. Mothers were from multiple RMG factories while factory officials were from a single factory. Thematic analysis was conducted.ResultsThe main themes of qualitative exploration were knowledge and experience of breastfeeding; structural barriers (home and workplace); consequences of inadequate breastfeeding; and perception and experience of using expressed breast milk. Despite knowledge both of the benefits of breast milk and of the importance of breastfeeding for 6 months, most mothers introduced formula as early as 2 months to prepare for their return to work. Barriers such as excessive workload, inadequate crèche facilities at work, and lack of adequate caregivers at home impeded exclusive breastfeeding. Mothers and caregivers had very little knowledge about the use of expressed breast milk and were concerned about contamination.ConclusionAs RMG factories are the largest employer of low-income women in Bangladesh, facilitating RMG factory working mothers’ ability to use breast milk could help to promote infant health and help women remain in the workforce.

An American Disgrace

An American Disgrace

Employment Vulnerability of People With Severe Mental Illness

Using French longitudinal register data, we compare the evolution of employment rates of persons with severe chronic mental illness, before and after the first medico-administrative recognition of the illness by the Statutory Health Insurance (SHI), with that of people without recognised mental illness. The study focuses on persons of working age having a work history before recognition. Our empirical approach relies on a double difference method with coarsened exact matching. Before illness recognition subjects had lower employment rates than those without mental illness but relatively high, reflecting their initial employment attachment. Results indicate that employment rates decrease sharply after recognition. A large employment rate gap between persons with and without severe mental illness develops during the four years following recognition. We examine whether the magnitude of the decrease is sensitive to the macroeconomic context. Findings show that the decline in employment rates was significantly more pronounced during the Great Recession compared with the pre-crisis period, amongst women. As a conclusion, this study points out that implementing coordinated early health and labour policies in the phase of the entry into the chronic-illness insurance scheme of the SHI might play a key role in preventing the detrimental effects of illness on economic and social conditions of persons with severe mental illnesses.

Effect of Patient Financial Incentives on Statin Adherence and Lipid Control

Financial incentives can improve medication adherence and cardiovascular disease risk, but the optimal design to promote sustained adherence after incentives are discontinued is unknown. To determine whether 6-month interventions involving different financial incentives to encourage statin adherence reduce low-density lipoprotein cholesterol (LDL-C) levels from baseline to 12 months. This 4-group, randomized clinical trial was conducted from August 2013 to July 2018 among several large US insurer or employer populations and the University of Pennsylvania Health System. The study population included adults with elevated risk of cardiovascular disease, suboptimal LDL-C control, and evidence of imperfect adherence to statin medication. Data analysis was performed from July 2017 to June 2019. The interventions lasted 6 months during which all participants received daily medication reminders and an electronic pill bottle. Statin adherence was measured by opening the bottle. For participants randomized to the 3 intervention groups, adherence was rewarded with financial incentives. The sweepstakes group involved incentives for daily adherence. In the deadline sweepstakes group, incentives were reduced if participants were adherent only after a reminder. The sweepstakes plus deposit contract group split incentives between daily adherence and a monthly deposit reduced for each day of nonadherence. The primary outcome was change in LDL-C level from baseline to 12 months. Among 805 participants randomized (199 in the simple daily sweepstakes group, 204 in the deadline sweepstakes group, 201 in the sweepstakes plus deposit contract group, and 201 in the control group), the mean (SD) age was 58.5 (10.3) years; 519 participants (64.5%) were women, 514 (63.9%) had diabetes, and 273 (33.9%) had cardiovascular disease. The mean (SD) baseline LDL-C level was 143.2 (42.5) mg/dL. Measured adherence at 6 months (defined as the proportion of 180 days with electronic pill bottle opening) in the control group (0.69; 95% CI, 0.66-0.72) was lower than that in the simple sweepstakes group (0.84; 95% CI, 0.81-0.87), the deadline sweepstakes group (0.86; 95% CI, 0.83-0.89), and the sweepstakes plus deposit contract group (0.87; 95% CI, 0.84-0.90) (P < .001 for each incentive group vs control). LDL-C levels were measured for 636 participants at 12 months. Mean LDL-C level reductions from baseline to 12 months were 33.6 mg/dL (95% CI, 28.4-38.8 mg/dL) in the control group, 32.4 mg/dL (95% CI, 27.3-37.6 mg/dL) in the sweepstakes group, 33.2 mg/dL (95% CI, 28.1-38.3 mg/dL) in the deadline sweepstakes group, and 36.5 mg/dL (95% CI, 31.3-41.7 mg/dL) in the sweepstakes plus deposit contract group (adjusted P > .99 for each incentive group vs control). Compared with the control group, different financial incentives improved measured statin adherence but not LDL-C levels. This result points to the importance of directly measuring health outcomes, rather than simply adherence, in trials aimed at improving health behaviors. ClinicalTrials.gov Identifier: NCT01798784.

Minimum wage policy and the racial earnings gap

Economic Inequality The earnings gap between white and Black workers in the United States fell substantially only once over the past 70 years. Derenoncourt and Montialoux show how this change was driven in large part by the 1967 extension of the federal minimum wage to sectors that employed about 20% of the total U.S. workforce but nearly a third of Black workers, including agriculture, hotels, and schools. This policy extension can explain more than 20% of the decline in the racial earnings gap between 1965 and 1980 and did not have large adverse employment effects on either Black or white workers. The gap between the average wage in the treated industries and the rest of the economy fell, as did the gap between Black and white workers within the treated industries. Q. J. Econ. 10.1093/qje/qjaa031 (2020).