Report 3 - Exploring the Link Between Work-Life Conflict and Demands on Canada's Health Care System

1. See for example MacBride-King & Paris, 1989; Duxbury et al., 1991; Higgins et al., 1992; Duxbury & Higgins, 1998; Duxbury et al., 1999; MacBride-King Bachmann, 1999.
2. Duxbury et al., 1991, p. 16.
3. Peter Drucker (1999) coined the term "knowledge worker" to describe highly skilled employees whose work is complex, cyclical in nature, and involves processing and using information to make decisions.
4. From the 1970s through to the early 1990s, researchers studied work-family conflict. In the latter part of the 1990s, the term was changed to "work-life" conflict in recognition of the fact that employees' non-work responsibilities can take many forms, including volunteer pursuits and education, as well as the care of children or elderly dependents.
5. We sometimes use the term work-life balance in this report to mean the opposite of work-life conflict. This reflects the fact that the concept of conflict and balance are frequently viewed as a continuum. Employees with low work-life conflict/high work-life balance are at one end of the continuum while those with high work-life conflict/low work-life balance are at the other.
6. The rest of the respondents (37% of the sample) spent between $1 and $300 per year on medications.
7. A discussion of the assumptions made when calculating the costs associated with high levels of work-life conflict can be found in Appendix E.
8. It should be noted that there is likely to be some overlap of the costs associated with each form of work-life conflict. Total costs/potential savings cannot, therefore, be calcuated as the sum of the costs associated with each type of conflict.
9. Defined in this study as an employee who spends at least one hour a week in child care, elder care or both.
10. A full discussion of these question can be found in CIHI (2003).
11. CIHI (2002, p. 5) provides an excellent table outlining where these studies were done and where the findings can be obtained.
12. Role overload is one of four dimenstions of work-life conflict examined in Duxbury and Higgins (2003) and is used here for illustrative purposes. Similar findings werer observed with respect to ther other three facets of work-life conflict.
13. While these data reflect a significant improvement in physical working conditions and a concomitant decline in the incidence of work-related fatalities and injuries over the past several decades, there is still a substantive amount of work that remains to be done in this area.
14. Triple Bottom Line Reporting, as defined by Bachmann (2002), focuses on three elements of organizational sustainability: (1) economic (wages, benefits, labour productivity, job creating, training and development), (2) environment (impacts of processes, products and services on air, water, land, biodiversity and human health) and (3) social (workplace health and safety, employee retention, labour and management rights, working conditions).
15. With the exception of a brief, modest recovery in the late 1980s.
16. Nine percent find elder care to be a strain several times a week or daily. Another 17% experience such feelings approximately once a week.
17.  A summary of this literature can be found in Higgins & Duxbury (2002).
18. The proportion of Canadians defining their health as "excellent" has not changed since 1985 (Statistics Canada, 1999).
19. Note: The mean level of perceived health for this sample is 3.44 (good to very good) with a standard deviation of 0.99.
20. Analysis of the data (not shown in this report) shows a strong positive correlation between the perception that one's health is fair/poor, total absenteeism and prescription drug use.
21. A full discussion of this phenomenon is found in Higgins and Duxbury (2002).
22. An understanding of the idea of absolute risk is also important to this discussion. Absolute risk takes the prevalence of the risk factor into account when selecting an intervention. Generally, cutting the risk of a very rare adverse event in half will likely have less of an effect on the outcome of interest than a smaller drop in the risk of a common event (CIHI, 2003).
23. Note: the question on physician visits was phrased as follows "In the last six months, have you seen a physician other than for a regular check-up or a maternity-related visit? If yes, how many visits have you made?"
24.  If the ratios reported in Ontario hold nationally (i.e. 65% of patients with mental health issues seek alternative care while 35% visit their physician only), our data probably underestimate the situation by about 35%.
25. An excellent table outlining who is waiting for what and for how long can be found on p. 85 of this CIHI report.
26. According to our data, the percentage of Canadians reporting high role overload incrased by 11% between 1991 and 2001, while the percentage reporting high levels offamily to work interference and caregiver strain doubled.
27. In this report, we are restricting the analysis at the national level to costs borne by the public health care system. In Duxbury and Higgis (2003), we focused on the costs to organizations of increased absenteeism. The socio-economic costs of work stress and work-life conflict are far-reaching, however, and exterd well beyond these segments of society. These effects may include lost opportunities for further education, involuntary early retirement caused by stress, increased taxation to cover the costs of social support, and a decline in the standard of living due to reduced productivity (Cooper et al., 1996). The list is virtually limitless. No attempt was made to explore these very serious, but complex issues in this report.
28. It should be noted that these four forms of work-life conflict are correlated (see Duxbury & Higgins, 2003). This means that there will be some degree of overlap with respect to the costs associated with each form of work-life conflict. As such, we cannot add these four amounts to arrive at a total cost to the health care system of work-life conflict.
29. Note: In the survey, we asked respondents to use the six months prior to the study as their frame of reference when answering questions on use of the health care system, prescription drug use, etc. For the convenience of the reader, the data in the conclusion section are presented as visits or use per year. These estimates were obtained by multiplying the findings for a six-month period by two.
30. The rest of the respondents (37% of the sample) spent between $1 and $300 per year on medications.
31. A full discussion of this phenomena can be found in Duxbury and Higgins (2003).
32. It should be noted that these four forms of work-life conflict are correlated (see Duxbury & Higgins, 2003). This means that there will be some degree of overlapwith respect to the costs associated with each form of work-life conflict. As such, we cannot add these four amounts to arrive at a total cost to the health care system of work-life conflict.
33. Right now, efforts are fragmented by the need to coordinate within government departments, among departments and between different levels of government. emphasize how organizations and Canadian society benefit from healthy workplace practices.
34. While the Compassionate Care Leave benefit is an important first step in the support of elder caregiving, it will not benefit most caregivers who provide long-term care.
35. We would like to acknowledge the assistance of Health Canada and CIHI who spent a lot of time and effort trying to help us track down national data.
36. In this analysis, caregiver strain was broken down into two main groups: those who reported such strain once a week or more and those who experienced it monthly or less. With 9.0% of the population reporting very high levels of caregiver strain (i.e. report strain daily or several times a week), the direct cost of physician visits is estimated to be $207 million per year.
37. In this analysis, caregiver strain was broken down into two main groups: those who reported such strain once a week or more and those who experienced it monthly or less. With 9.0% of the population reporting very high levels of caregiver strain (i.e. report strain daily or several times a week), the direct cost of inpatient hospital stays works out to $1.62 billion.
38. In this analysis, caregiver strain was broken down into two main groups: those who reported such strain once a week or more and those who experienced it monthly or less. With 9.0% of the population reporting very high levels of caregiver strain (i.e. report strain daily or several times a week), the direct cost of emergency visits is estimated at $62.9 million per year.
39. The specific limitations associated with each set of data are given in the text boxes in this appendix.
40. 1999 calculations based on visits made by Canadians aged 15 to 64 years; 2003 calculations based on visits made by all Canadians, regardless of age.