Examining the Relationships Between Employment-Contingent Health Insurance, Treatment Decisions, Health Outcomes, & Labor Supply
Cathy J. Bradley, PhD
Professor, Department of Health Administration
Co-leader, Cancer Prevention and Control Massey Cancer Center
Virginia Commonwealth University
What's the problem?
Employers are the principal source of health insurance in the United States, providing
health benefits to about half of non-elderly adults in this country. Some of these adults
are covered by insurance through their own employers (this is called "employer-contingent
health insurance," or ECHI); others are covered by insurance through their spouse's
The source of a person's health insurance coverage can affect a wide range of labor
market decisions, such as where and how much people work and whether they stay with an
employer or change jobs. Changes in a person's health status, such as a cancer diagnosis
and subsequent treatment and recovery, injects a third and complex dynamic into this
health insurance-employment link.
In the past few years, some light has been shed on how these three factors interact and
influence each other, but major gaps in our knowledge still exist.
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How does this research address the problem?
Since 1998, Dr. Cathy Bradley, a health economist, has conducted a series of
ARP-supported studies to explore the health care and decisions about employment and hours
worked that individuals make in response to incentives and disincentives created by a
cancer diagnosis and source of health insurance. Findings from each study have informed
and enriched subsequent work, allowing for a broad and pioneering exploration of these
Dr. Bradley's first study examined labor market outcomes of long-term breast cancer
survivors by comparing samples from the Health and Retirement Survey and NCI's
Surveillance, Epidemiology, and End Results (SEER) program. She found that the survivors
were less likely to work compared to women who had never had cancer. She also found that,
compared to working women without cancer, women who were employed after their diagnosis
worked more hours per week and had higher wages and earnings. Her conclusion was that
breast cancer's effects on labor supply was complicated in that it had both negative
effects (causing some women to stop working) and positive effects (causing women to stay
in the workforce or increase their hours in order to retain health insurance or rebuild
Dr. Bradley and her colleagues then began to focus on the relationship between ECHI,
health, and decisions about work. They first created a model to explain how workers with
ECHI may respond to a health shock, such as a cancer diagnosis. The model indicated that
a health shock will likely reduce the person's labor supply, but that the effect would be
smaller for workers with ECHI than for workers who have insurance through their
The next step was a five-year ARP-funded study, conducted with Dr. David Neumark, an
international expert in labor economics. This study collected and analyzed data over an
18-month period on the labor market decisions of a cohort of women newly diagnosed with
breast cancer, men newly diagnosed with prostate cancer, a control group of people without
cancer, and spouses. The analysis provided compelling evidence that ECHI creates
incentives to remain working following a health shock, such as breast cancer, and that
some women with ECHI may forego radiation or chemotherapy treatment to avoid interruptions
in their ability to meet work demands. In addition, the study found that women with ECHI
are more likely than women with insurance through their spouse to have only poor or fair
health after diagnosis and treatment.
These results were the catalyst for another study of married women newly diagnosed with
breast cancer. This research, currently underway, uses a quasi-experimental design to
compare women with ECHI and women who have health insurance through their spouses on three
different issues: (1) cancer treatment and treatment adherence; (2) changes in health
status at 2 and 9 months following diagnosis; and (3) labor supply responses at 2 and 9
months following diagnosis compared to the time immediately preceding diagnosis. Dr.
Bradley and Dr. Neumark also are examining the labor supply responses of spouses following
their partner's breast cancer diagnosis. Conceivably, ECHI creates similar labor supply
incentives for employed, healthy spouses of women with breast cancer as it does for women
with the disease. Spouses with ECHI may work long hours and thereby forego caregiving
activities so that they can preserve their insurance.
Dr. Bradley is now collaborating on a new study that is replicating her previous
analyses in a population-based cohort of 750 breast, prostate, and colorectal cancer
patients in Ireland. Using data from two telephone surveys, conducted at about 6 and 12
months after diagnosis, Dr. Bradley will investigate rates of work resumption and the
personal, treatment, and job-related factors that influence it. She also will examine the
cancer survivors' experiences after returning to the workplace and the influence of
employers and health care professionals on survivors' decisions about resuming work. The
survivors' employment outcomes will be compared with those of the overall Irish population
and US cancer survivors.
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Significance of the study & results
Because of the emphasis on screening and early detection of cancer, many individuals
must deal with cancer and the consequences of treatment during their working years. For
them, work is financially essential, both for the income it provides and because it
supplies health insurance. A greater understanding of the interactions among ECHI, job
and work decisions, treatment decisions, and health outcomes is vital to a host of health
policy issues, given our nation's continued reliance on employer-sponsored health
Many aspects of these issues have not been explored before, and Dr. Bradley's research
is providing valuable insights that can be used by policy makers, employers, health
insurance plans, and patients. Her insights will help to inform interventions to manage
symptoms and rehabilitation services for patients and also may lead to the development of
workplace policies that help cancer survivors resume and continue to work.
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Recent publications of interest
Bradley CJ, Neumark D, Luo Z, Bednarek HL.
Employment-contingent health insurance, illness, and labor supply of women: evidence from married women with breast cancer.
Health Econ 2007 Jul;16(7):719-37.
Bouknight RR, Bradley CJ, Luo Z.
Correlates of return to work for breast cancer survivors.
J Clin Oncol 2006 Jan 20;24(3):345-53.
Bradley CJ, Neumark D, Luo Z, Bednarek H, Schenk M.
Employment outcomes of men treated for prostate cancer.
J Natl Cancer Inst 2005 Jul 6;97(13):958-65.
Bradley CJ, Neumark D, Bednarek HL, Schenk M.
Short-term effects of breast cancer on labor market attachment: results from a longitudinal study.
J Health Econ 2005 Jan;24(1):137-60.
Steiner JF, Cavender TA, Main DS, Bradley CJ.
Assessing the impact of cancer on work outcomes: what are the research needs?
Cancer 2004 Oct 15;101(8):1703-11. Review.
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