Organisational Change, Absenteeism and Welfare Dependency

In this report the authors show that recent attempts to reorganise and cut costs in the Norwegian health care and social services sectors have had the unintended side effects of raising the level of sickness absence and disability among the employees, and that these effects have persisted several years after completion of the reorganisation processes. Since a substantial proportion of the resulting costs are external to the decision-makers, we suspect that the pace of change may have been excessively high. Changes that were efficient from each service provider’s point of view may have been inefficient from a social and a public-finance point of view.Absenteeism; hazard rate model; NPMLE

Informal Care and Labor Supply

Based on Norwegian register data we show that having a lone parent in the terminal phase of life significantly affects the offspring's labor market activity. The employment propensity declines by around 1 percentage point among sons and 2 percentage points among daughters during the years just prior to the parent's death, ceteris paribus. Long-term sickness absence increases sharply. The probability of being a long-term social security claimant (defined as being a claimant for at least three months during a year) rises with as much as 4 percentage points for sons and 2 percentage points for daughters. After the parent's demise, earnings tend to rise for those still in employment while the employment propensity continues to decline. The higher rate of social security dependency persists for several years.elderly care, labor supply, ageing, inheritance

Disability in the Welfare State: An Unemployment Problem in Disguise?

Economies with low unemployment often have high disability rates. In Norway, the permanent disability insurance rolls outnumber registered unemployment by four to one. Based on administrative register data matched with firms' financial statements and closure data collected from bankruptcy proceedings, we show that a large fraction of Norwegian disability insurance claims can be directly attributed to job displacement and other adverse shocks to employment opportunities. For men, we estimate that job loss more than doubles the risk of entry to permanent disability and that displacements account for fully 28 percent of all new disability insurance claims. We conclude that unemployment and disability insurance are close substitutes.disability, displacement, social insurance, employment opportunities

A model for supply of informal care to elderly parents

This paper presents a model of informal care to parents. We assume that the child participates in the labour market and gains in utility from consumption and leisure. In addition it has altruistic motivation to give informal care to its elderly parent. We show how the labour income, labour supply and informal caregiving are affected by exogenous factors such as the education level, wage rate, other supply of care, travel distance and inheritance.informal care for elderly; labour market; elderly parent

The Sick Pay Trap

In most countries, employers are financially responsible for sick pay during an initial period of a worker's absence spell, after which the public insurance system covers the bill. Based on a quasi-natural experiment in Norway, where pay liability was removed for pregnancy-related absences, we show that firms' absence costs significantly affect employees' absence behavior. However, by restricting pay liability to the initial period of the absence spell, firms are discouraged from letting long-term sick workers back into work, since they then face the financial risk associated with subsequent relapses. We show that this disincentive effect is statistically and economically significant.absenteeism, social insurance, experience rating, multivariate hazard rate models

Informal Care and Labor Supply

Based on Norwegian register data we show that having a lone parent in the terminal phase of life significantly affects the offspring’s labor market activity. The employment propen-sity declines by around 1 percentage point among sons and 2 percentage points among daughters during the years just prior to the parent’s death, ceteris paribus. Long-term sickness absence increases sharply. The probability of being a long-term social security claimant (defined as being a claimant for at least three months during a year) rises with as much as 4 percentage points for sons and 2 percentage points for daughters. After the par-ent’s demise, earnings tend to rise for those still in employment while the employment propensity continues to decline. The higher rate of social security dependency persists for several years.Elderly care; labor supply; ageing; inheritance

Temporary Disability and Economic Incentives

We investigate the impacts of economic incentives on the duration and outcome of temporary disability insurance (TDI) spells. The analysis is based on a large quasi‐experiment taking place in Norway, involving a complete overhaul of the TDI benefit system. Our findings show that the labour supply of TDI claimants does respond to both the benefit level and the level of local labour demand. The estimated elasticity of the transition rate to employment with respect to the benefit level is −0.33. We also find that the TDI benefit level significantly affects the transition rate to alternative social insurance programmes.acceptedVersio

De syke pleierne En analyse av sykefravær blant sykepleiere og hjelpepleiere

Rapporten omhandler langtidssykefravær blant sykepleiere og hjelpepleiere som jobber på sykehjem, sykehus, psykiatriske institusjoner og i hjemmetjenesten. Data fra årene 1993 til 2000 viser at hjelpepleiere er betydelig mer utsatt for sykefravær enn sykepleierne. Blant sykepleierne skiller spesialsykepleiere og administrerende sykepleiere seg ut med noe mindre fravær enn "vanlige" sykepleiere. Pleiere på sykehjem og i hjemmetjenesten har betydelig mer fravær enn pleiere som jobber på sykehus og i psykiatriske institusjoner. En forklaring på de store forskjellene mellom pleiergruppene og mellom arbeidsstedene kan være forskjeller i arbeidsmiljø. I hjemmetjenesten og på sykehjem er arbeidet preget av mye fysisk tungt arbeid, med mange tunge løft og arbeid i ubekevemme stillinger. Dette vil øke risikoen for belastningsskader og senere sykefravær. Ser man på hjelpepleiere spesielt, vil de ofte få det aller tyngste pleiearbeidet, noe som gjør denne gruppen særlig utsatt for fravær knyttet til muskel- og skjelettlidelse. Når det gjelder utviklingen over tid har andelen langtidssykemeldinger økt med 50 prosent i den aktuelle perioden (fra 5,8 prosent i 1993 til 8,6 prosent i 2000). I 2000 var sykefraværet blant "vanlige" sykepleiere 7,3%, mens hjelpepleiere hadde et sykefravær på hele 10,3%. Sannsynligvis er det mye som kan gjøres for å få ned sykefraværet både blant sykepleiere og hjelpepleiere. Ulike tiltak for å bedre arbeidsmiljøet vil antakelig kunne redusere fraværet både på kort og lang sikt, noe som gjør at institusjonene og samfunnet blir spart for store kostnader.Langtidssykefravær; hjelpepleiere; sykepleiere; sykehjem; sykehus

A systematic review and meta-analysis comparing mortality in pre-hospital tracheal intubation to emergency department intubation in trauma patients

Background Pre-hospital endotracheal intubation is frequently used for trauma patients in many emergency medical systems. Despite a wide range of publications in the field, it is debated whether the intervention is associated with a favourable outcome, when compared to more conservative airway measures. Methods A systematic literature search was conducted to identify interventional and observational studies where the mortality rates of adult trauma patients undergoing pre-hospital endotracheal intubation were compared to those undergoing emergency department intubation. Results Twenty-one studies examining 35,838 patients were included. The median mortality rate in patients undergoing pre-hospital intubation was 48% (range 8–94%), compared to 29% (range 6–67%) in patients undergoing intubation in the emergency department. Odds ratios were in favour of emergency department intubation both in crude and adjusted mortality, with 2.56 (95% CI: 2.06, 3.18) and 2.59 (95% CI: 1.97, 3.39), respectively. The overall quality of evidence is very low. Twelve of the twenty-one studies found a significantly higher mortality rate after pre-hospital intubation, seven found no significant differences, one found a positive effect, and for one study an analysis of the mortality rate was beyond the scope of the article. Conclusions The rationale for wide and unspecific indications for pre-hospital intubation seems to lack support in the literature, despite several publications involving a relatively large number of patients. Pre-hospital intubation is a complex intervention where guidelines and research findings should be approached cautiously. The association between pre-hospital intubation and a higher mortality rate does not necessarily contradict the importance of the intervention, but it does call for a thorough investigation by clinicians and researchers into possible causes for this finding.publishedVersio