Financial Status of Low Skilled, Low Wage Workers in Health Care

Introduction: As healthcare systems work toward achieving the goals of the “Triple Aim,” a common approach is to use more assistive personnel, paraprofessionals, and lay workers as part of healthcare teams and healthcare delivery. Much of the job growth in health care over the last decade and projections into the future are at the entry level requiring minimal training. Researchers and policymakers are increasingly aware that many healthcare personnel do not have viable professional development opportunities and are paid very low wages. A critical implication of a financially unstable workforce is high turnover, which may lead to a poorly functioning healthcare team and thus poor patient care.

Objective: This study aims to identify the healthcare jobs in which workers are at highest financial risk and to what extent they rely on federal support such as welfare, food stamps, and Medicaid.

Data and methods:This study uses a pooled cross-sectional sample of nationally representative household survey data from the Current Population Survey, and particularly the Annual Social and Economic Supplement between 2011 and 2013. The study sample is restricted to employed individuals between 18 and 75 years old. Healthcare jobs are defined using the 2009 Standard Occupational Classification system. We define “financial risk” of a worker as whether or not the worker falls into any of the following categories: 1) receipt of an hourly wage rate of less than $15 per hour, 2) having an annual income at or below the federal poverty rate, 3) receipt of cash welfare from the Temporary Assistance of Needy Families (TANF) program, 4) receipt of food subsidies from the Supplemental Nutrition Assistance Program (SNAP), 5) receipt of Medicaid, and 6) being uninsured. We compare how the rates of financial risk compared to an overall employed population. We examine how financial risk varies by rurality, race/ethnicity, marital status, presence of young children in household, and health care setting (i.e., hospital, ambulatory care, and long-term care).

Results: The healthcare jobs at most financial risk are those with below a Bachelors’ degree entry level requirement. Particularly at risk are healthcare jobs that require less than a high school degree: “personal and home care aides” (PCA), and “nursing, psychiatric and home health aides” (NPHH). For example, about 25% of PCAs and 18% of NPHHs receive food subsidies, compared with 7% of the overall employed population. About 20% of PCA and 13% of NPHHs receive Medicaid compared to 5% of the overall employed population. Over one in five PCAs, NPHHs, massage therapists, and phlebotomists are uninsured compared to 17% of the overall employed population. Minorities, single individuals, and persons with young children in the household were also more likely to be at financial risk. Healthcare workers in long-term care fared worse than ambulatory care workers; both fared worse than hospital workers. 

Conclusions: By understanding the financial risk of the healthcare workforce, healthcare systems can better target their recruitment and retention efforts to reduce turnover, enhance the welfare of members of a healthcare team, and improve patient care.