Labour Markets & Health

Einleitung / Introduction

Given the lasting positive effects of prenatal and infancy home visiting in the United States on disadvantaged mothers and children at school age, we analyzed the follow-up effects of a German home visiting program (ProKind). We analyse effects in 3 domains at child age 7 years: (1) maternal mental health, (2) maternal employment and welfare receipt, (3) child preferences.

Methode / Method

We conducted a randomized controlled trial of home visiting, enrolling 755 pregnant, low-income women with no previous live births. The intervention comprised 32.7 home visits by family midwives and/or social pedagogues until child age 2 years. Assessments were completed on 533 7-year-old firstborn offspring. Additionally, administrative data about maternal welfare receipt and employment is available for 680 mothers. Mechanisms of the results are analyzed by dynamic mediation analyses.

Ergebnisse / Results

Mothers in the intervention group show fewer clinical mental health problems. However, they are less employed and receive more welfare payments. Children show higher egalitarian preferences.

Zusammenfassung / Conclusion

The results suggest that in a western European welfare state, home visiting targeting disadvantaged mothers has lasting effects in important outcome domains. Although the effects on maternal employment and welfare receipt are ambiguous. Nevertheless, home visits also appear to be an effective and efficient public health intervention in European settings.

AutorInnen

Gabriella Conti, University College London

Anica Kramer, Institut für Arbeitsmarkt und Berufsforschung (IAB)

Sören Kliem, FH Jena

Malte Sandner, Institut für Arbeitsmarkt und Berufsforschung (IAB)

Einleitung / Introduction

Health shocks can impair individuals' ability to participate on the labor market and thus present a major risk to household welfare and a challenge to the public social security system. Based on sick days and hospitalizations, we operationalize the concept of a severe impairment by introducing two novel health shock indicators: one for transitory and one for persistent shocks. We show how these two shock types affect labor market outcomes, such as employment, yearly hours, and labor earnings, but also spousal labor earnings and household net income.

Methode / Method

We classify transitory and persistent health shocks based on a a two-step clustering procedure of sick days and hospital nights. First, we cluster sick days using k-means and distinguish 3 groups, i.e. the healthy/control group, and those potentially having experienced either a transitory or a persistent shock. Second, we cluster based on non-zero hospital nights using k-medians and recover 2 groups, those who experienced either a transitory or a persistent health shock. The clustering procedure defines the location of the borders between the three groups in a data-driven fashion. Our empirical strategy then relies on the comparison of individuals who experience a transitory or a persistent health shock (treatment groups) with individuals who have not and will not experience a shock (never-treated/control group). We go through a two-step process to facilitate the analysis: First, we match control units to treatment units one relative period prior to the shock based on a set of socio-demographic characteristics and other variables possibly affecting trend evolution. Second, based on these matched groups, we perform event-study analyses by running OLS regressions with individual and year fixed effects as well as a set of dummies for the pre- and post-shock relative periods and their interactions with the treatment dummy. The post-shock interaction dummies measure the average treatment effect on the treated of a health shock.

Ergebnisse / Results

We find large employment effects of persistent shocks, particularly for older individuals, whose employment rate drops by 25 percentage points. Transitory shocks have no long-lasting effects on employment. Conditional on remaining employed, both shocks cause gross labor income to decline in the year of the shock, but to a larger degree for persistent shocks. Among individuals under 50, a persistent shock causes a parallel, downward shift of yearly gross income relative to the control group of 2800 Euro. Transitory shocks have no long-term consequences for gross income. For older individuals effects on income are statistically insignificant because a large fraction exits the labor market.

AutorInnen

Mattis Beckmannshagen, Freie Universität Berlin

Johannes König, DIW Berlin

Einleitung / Introduction

As in many countries, nursing and midwife shortage has been a critical issue for many years in Germany. The problem amplified during the Covid-19 pandemic. A well-established literature shows that intention to leave the job is the main predictor of turnover rates among nurses, which affect quality of care and health care costs. Hardly known are the factors that influence the intention to leave among nurses, and especially midwifes, during the Covid-19 pandemic.

Methode / Method

Based on a cross-sectional survey of n=4315 nurses and midwifes conducted by a large German trade union in March to June 2021, we estimated a logistical regression model to identify the role of various job-related factors on intention to leave.

Ergebnisse / Results

We found that sense of coherence, i.e., unmet personal standards for one´s work (odds ratios [OR]=2.2-6.8, p<0.001), staffing perception (OR=1.8-9.6, p<0.001), perceived quality of care (OR=1.6-3.4, p<0.01) and safety perception during the pandemic (OR=1.1-1.7, p<0.05) are most strongly associated with the intention to leave. Other factors (e.g., time for patients’ demands, time for breaks and disruptions of work processes) were only relevant for those nurses and midwifes who assessed those factors very poorly.

Zusammenfassung / Conclusion

Understanding the predictors of nurses´ and midwifes´ intention to leave allows generating measures for reducing turnover rates and health care costs as well as increasing quality of care. Politics and health clinics should aim at increasing safety and quality of care perception, staffing and sense of coherence.

AutorInnen

Maren M. Michaelsen, Universität Witten/Herdecke

Tobias Esch, Universität Witten/Herdecke