Stressed workers cost health system extra $6B a year


For the first time, study links soaring health costs to mounting workloads


Kathryn May
The Ottawa Citizen

Tuesday, November 09, 2004

The downsizing that swept the country's workplaces during the 1980s and 1990s backfired with so much work piled on employees that billions of dollars have been unnecessarily added to Canada's annual health care costs, says a landmark study.

The federally funded study, to be released today, is the first to link the mounting workloads of Canadians and soaring health care costs. It concludes stress and illness caused by work overload is adding an extra $6 billion a year in health care costs, while the strain of elder care adds another $5 billion a year.

But Linda Duxbury, one of the report's co-authors, insists those extra costs are the "tip of the iceberg," because the study only examined the impact on family doctors, emergency rooms and in-hospital stays.

"It's time we stop pretending that we're going to fix health care by throwing more money at system fixes and start looking at what makes people sick. And what makes people sick is workload and the strain of elder care," said Ms. Duxbury.

"Instead of crying for more dollars for health care, policymakers should recognize we have a finite resource in people and start crying for something to be done about the work environment."

Ms. Duxbury, a professor at Carleton University's Sprott School of Business, co-wrote a series of reports based on a massive survey of 32,000 workers. The study was commissioned by Health Canada to examine how Canadians are coping with the demands of their work and family lives.

The 2001 National Work-Life Conflict Study, conducted by Ms. Duxbury and Chris Higgins of the University of Western Ontario, surveyed workers in 100 major organizations in the public, private and not-for-profit sectors.

The findings are considered accurate within 1.5 percentage points, 19 times out of 20.

Ms. Duxbury calculated rising health costs by examining the impact of four key factors -- role overload, work interference with family responsibilities, family interfering with work and "caregiver strain" --on working Canadians' use of the health care services over the previous six months. Regular checkups and maternity-related appointments were excluded.

The biggest health care pressure is what Ms. Duxbury calls "role overload" -- that frazzled, overwhelming feeling that there's never enough time to get things done. About 60 per cent of working Canadians say they can't balance their jobs and family lives, and this conflict is increasing physician visits by 25 per cent a year, in-patient hospital stays by 17 per cent and use of emergency rooms by 23 per cent.

The key predictor for overload is unpaid overtime. One Canadian in four regularly works 50 or more hours a week compared to a decade ago when only one in 10 put in these kinds of hours. On top, they work at home evenings and weekends, logging another 18 hours a month in unpaid overtime.

But Ms. Duxbury said the most alarming increase in health costs is among workers who face the "physical, mental and emotional" strain of caring for elderly parents -- a trend that will accelerate with aging baby boomers who have fewer children to care for them. These workers report the highest incidence of in-hospital stays.

The study found 66 per cent of working Canadians face elder care duties compared to a decade ago when only one in 12 cared for aging dependents.

"These are the people between 30 and 50 years old who have child care and elder care and work and career advancement and providing for their families and and... It's all those ands that are wearing them down, and that's where work environment makes the biggest difference," said Ms. Duxbury.

Another increased cost is prescription drugs. Employers across the country complain about rising costs of benefits for their workers. At the top of the list are tranquilizers and anti-depressants, followed by medication for cardiovascular and stomach ailments.

But Ms. Duxbury said governments are "misguided" to keep pumping money to add more doctors, equipment and hospital beds without getting a handle on why demand is skyrocketing.

One in five respondents perceive their health as poor or fair. But the study finds striking differences when factors such as gender, type of job, dependents and whether one works in the private or public sector come into play.

Traditionally, women have complained about their health and were the most likely to see doctors. For the first time, the study found men are now as likely as women to complain about poor health, whether they were executives, managers or blue-collar workers.

The big difference is that men don't see a doctor until a problem worsens and then they to go to emergency rooms rather than a family physician.

Good health is typically associated with socioeconomic status, which means professionals and managers generally enjoy better health than lower level employees, but that trend is shifting too. "A manager's job once seemed to offer a lot of protection for health, but it doesn't any more, and that's because the sheer volume of demands on managers has gone up so much that's it's beyond the capacity of many to actually deliver on them without impairing their health," said Ms. Duxbury.

The most surprising finding is that women in pink-collar jobs, such as secretaries and clerks, suffer more ill health than men in blue-collar jobs.

Ms. Duxbury said more work needs to be done on "what makes these jobs so horrible," but she said much of the work is "drudgery" and employees have little control or respect.

Public servants -- at all levels -- are in the poorest health and men in the private sector are in the best health. Both face huge workloads and long hours, which suggests the working environment is making bureaucrats sick. Among public servants, women are the unhealthiest and see physicians more than their counterparts in the private sector. The most stressed, depressed and ailing are female public servants in clerical and administrative jobs.

The one in 10 Canadians who put family first and refuse the extra hours are the lowest users of health services. Only one in three Canadians, however, put work ahead of family.

Ms. Duxbury said employers must bear more responsibility in wrestling health care costs by re-thinking their "outdated" management practices. The first priority is to reduce the work demands on Canadians so that they can do their jobs in a 45-hour week. To do that, she says, employers have to hire more workers, especially managers.

"I'm not saying turn work places into country clubs and issue margaritas at the door, but workloads are out of control," she said. "If hours of work were taken down to 45 hours we could probably free up about 25 per cent of our family physicians' time, which will make a significant difference in wait times."

Ms. Duxbury has long argued employers got a "free ride" for a cost-saving downsizing strategy that has effectively shifted costs to taxpayers who now have to pay more for health care.

"I'm seeing people stressed, burned out, unhappy and I'm not seeing any consequences for the employer. So what if their benefits go up, they give smaller wages. It's all about the employer and it's been all about the employer for years and I'm getting tired of it," she said.

"Canadians should have a say about their work and tax dollars and whether they want to subsidize business with socialized health care."

 The Ottawa Citizen 2004