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This week, Aaron looks at studies on how health care workers' incomes compare to the rest of the population and to each other. Also, there's a new study out showing to many kids are victims of violence, and King v Burwell has been decided, and nothing is changing with Obamacare.

John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen -- Graphics

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 Introduction


So I'm gonna try and squeeze in three studies today, and that's a lot of information and I don't wanna go too long. So no more intro; this is Healthcare Triage News.

[intro music]

 Story 1


First up, "Understanding Pay Differentials Among Health Professionals, Nonprofessionals, and Their Counterparts in Other Sectors," which was just published in Health Affairs. It talks about how much people working in healthcare make compared to other jobs in the United States.

Every time I write about healthcare spending, I like to remind people that one person's waste is another person's income. Money that's spent on healthcare isn't put into a big pile and burned; it's put into other people's pockets.

These researchers used data from the March Current Population Surveys from 1979 to 2013, and controlled for a lot of factors that could be associated with income. If you're interested in the full methods, I encourage you to go read the paper, as it's well written. But I wanna focus on the results here.

Workers in healthcare are more educated in general than those in other sectors. Nonprofessional healthcare workers averaged between 0.3 and 0.6 years more in schooling than non-healthcare sector employees. Professional healthcare employees, like nurses and physicians, averaged from more than 1 to almost 6 more years of schooling.

And after controlling for other factors like how many years of schooling you've had, workers in healthcare make about 3% more than those of comparable workers in non-healthcare sectors. That's more, but not as much as many might think. And the spread is not even.

Those in the bottom quartile of healthcare employees make about the same as non-healthcare employees, while those in the top quartile make about 4.7% more than their non-healthcare counterparts.

Healthcare professionals, on the other hand, make quite a bit more. Nurses make about 40% more than would be predicted by education, experience, and demographics. Physicians earn 50% more than would be predicted.

The spreads are different, though. Nurses at the lower end of the pay spectrum earn more than their counterparts in the non-healthcare world, compared to those at the higher end of the pay scale. For doctors, the opposite is true--there's more of a difference at the higher end of the spectrum. 

But such professionals comprise a minority of the healthcare workforce, making it unlikely that high salaries in general can be blamed for outsized healthcare spending. Physician compensation is less than 10% of all healthcare spending, and nurses account for less than 7%.

As this paper reports, if tomorrow, somehow policy makers were able to strip all extra pay from healthcare professionals--above what you'd expect they'd make in other sectors--overall healthcare spending would be reduced by only 6%.

Further, given that pay differentials haven't been increasing over recent time, doing so would do nothing to bend the cost curve in the future.

Of course, I'm a doctor. So take all that with a grain of salt.

 Story 2


The second study is from JAMA Pediatrics, and it's "Prevalence of Childhood Exposure to Violence, Crime, and Abuse: Results From the National Survey of Children's Exposure to Violence." 

It used a telephone survey that collected data on 4,000 children 0 to 17 years old. Violence against children is a significant issue, but how often does it occur? This is an attempt to give us some numbers.

More than 37% of youth experienced a physical assault as defined by the researchers in the previous year. More than half had experienced at least one in their lifetime. More than 9% had experienced an assault-related injury in the previous year.

Two percent of girls had experienced a sexual assault or sexual abuse, as did 4.6% of girls 14 to 17 years old. More than 15% were mistreated by a caregiver, and one-third of those were victims of physical abuse. Almost 6% of children had witnessed an assault between parents.

There were only two significant changes in those data from 2011, the last time the survey was done. The first was a decline in exposure to dating violence, and the second was a decline in lifetime exposure to household theft.

Both of those things are good, but the overall numbers show we have a lot of work still to do.

 Story 3


And the final bit of news is that the Supreme Court decided the King v. Burwell case, which you may remember from our show on the same topic. They decided at a 6-3 vote that the law should stand as is, that Congress didn't mean to have subsidies only for those states that set up their exchanges. 

This means that for all intents and purposes, meaning for all of you, nothing has changed. The law will continue to function as it did before, and as it will tomorrow. Everyone will get subsidies, regardless of how their state does their exchange.

The more important legal aspect is that they decided the case in such a way that future administrations will have a hard time tinkering or screwing with the law in the future.

It all seems like a big waste of time. In fact, Harold Pollack over at Politico said, "The greatest trolling exercise in the history of healthcare policy is over."

[outro music]