Do Long Work Hours Impede Workers' Ability to Obtain Health Services

Background: Currently, Americans receive only about half of the recommended health care. The Patient Protection and Affordable Care Act expands health insurance coverage to nearly everyone and eliminates patient cost-sharing for many preventive services. However, individuals may still face difficulties in obtaining needed care (e.g., language and cultural issues, lack of qualified practitioners, and having no usual source of care). Individuals may also forgo obtaining health care because they are busy with other competing activities and commitments, such as working in jobs having especially long work hours.;Purpose: My dissertation aims at ascertaining whether working long hours diminishes workers' ability to obtain needed health services. This dissertation contains three studies. Study 1 aims at assessing whether long work hours impede workers' access to preventive health services. A secondary aim is to examine whether this relationship varies among occupations or industries. Study 2 aims at assessing for workers with diabetes, whether working long hours impedes their ability to obtain needed diabetes and preventive health services. Study 2 also examines whether that relationship varies by gender. A third aim is to assess if the relationship between long work hours and access to preventive health services varies according to whether the workers have diabetes or not. Study 3 focuses on dual-earner couples who both work full time, and examines the effects of the combined work hours of a couple on access to preventive health services. Secondary aims of Study 3 include whether the relationship varies by family type (e.g., couples with no child, one child, two or more children) and by gender.;Methods: Data from the 2002-2010 Medical Expenditure Panel Survey (MEPS) were used to measure employees' work hours and their use of selected health services. Multivariate logistic regression analyses were performed to test the association between long hours and service utilization among full-time workers with private health insurance.;Results: Employees working over 60 hours per week were significantly more likely to fail to obtain dental check-ups at least twice a year or a biennial mammogram. Among workers with diabetes, working long hours had no impact on access to diabetes services, but significantly impeded their access to regular preventive health services. Long work hours also have a much larger adverse impact on access to preventive health services for workers with diabetes compared to those without diabetes. Long combined work hours of a dual-earner couple create barriers for individual workers to obtain flu vaccinations. The effect is especially evident among women with at least one young child and among women with two or more children.;Conclusions: The study found that long work hours might create barriers to accessing particular preventive health services. Certain sub-populations of full-time workers, such as workers with diabetes and dual-earner couples with children, are especially at high risk of not receiving care owing to the need to work long hours. Employer programs should be considered that help reduce the need for excessively long work hours and help facilitate access to recommended preventive services.