title: The Effects of Job Insecurity on Health Care Utilization: Findings from a Panel of U.S. Workers.
abstract: To examine the impacts of job insecurity during the recession of 2007-2009 on health care utilization among a panel of U.S. employees.
  
  
  
  Linked administrative and claims datasets on a panel of continuously employed, continuously insured individuals at a large multisite manufacturing firm that experienced widespread layoffs (N = 9,486).
  
  
  
  We employed segmented regressions to examine temporal discontinuities in utilization during 2006-2012. To assess the effects of job insecurity, we compared individuals at high- and low-layoff plants. Because the dataset includes multiple observations for each individual, we included individual-level fixed effects.
  
  
  
  We found discontinuous increases in outpatient (3.5 visits/month/10,000 individuals, p = .002) and emergency (0.4 visits/month/10,000 individuals, p = .05) utilization in the panel of all employees. Compared with individuals at low-layoff plants, individuals at high-layoff plants decreased outpatient utilization (-4.0 visits/month/10,000 individuals, p = .008), suggesting foregone preventive care, with a marginally significant increase in emergency utilization (0.4 visits/month/10,000 individuals, p = .08).
  
  
  
  These results suggest changes in health care utilization and potentially adverse impacts on employee health in response to job insecurity during the latest recession. This study contributes to our understanding of the impacts of economic crises on the health of the U.S. working population.
authors.affiliation: Division of General Medical Disciplines, Department of Medicine, Stanford University, Palo Alto, CA.
authors.forename: Rita
authors.identifier: 0000-0003-0730-4077
authors.initials: R
authors.lastname: Hamad
authors.affiliation: Division of General Medical Disciplines, Department of Medicine, Stanford University, Palo Alto, CA.
authors.forename: Sepideh
authors.initials: S
authors.lastname: Modrek
authors.affiliation: Division of General Medical Disciplines, Department of Medicine, Stanford University, Stanford, CA.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Cullen
mesh_terms: D000328:Adult; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D014481:United States
keywords: Health care utilization; job insecurity; mass layoffs; panel study; workplace