UCLA

Objective: This dissertation describes the complex relationships between health-related employer support, pain, future medical expenditures and productivity at work by answering three research questions: (1) to what extent is health-related employer support associated with productivity at work and future medical expenditures controlling for factors other than pain, (2) to what extent does pain mediate the relationships between health-related employer support and productivity at work and between health-related employer support and future medical expenditures, and (3) to what extent does health-related employer support moderate the relationship between pain and productivity at work and between pain and future medical expenditures. Data: The main analysis used a restricted survey dataset for a pooled sample of employees from 14 U.S. employers (N=34,359) from 2010 (for one employer, 2008). For five employers, two years of data (2010 and 2011) were available, and for one employer, health insurance claims were also available (N=1,590). Methods: Multiple imputations corrected missing data problems. Regression analyses, including multiple linear regression, multiple logistic regression, and two-part models were used to analyze the relationships. Results: Health-related employer support was not found to be significantly related to future medical expenditures or sick days, regardless of whether the regression controlled for pain. In contrast to the hypothesized direction, lack of health-related employer support was significantly associated with higher self-rated relative productivity, while pain was not significantly associated with self-rated relative productivity. Lack of emotional health-related employer support was significantly associated with increased chance of pain. Pain was significantly associated with increased sick days and increased future medical expenditures. No evidence that health-related employer support moderated the relationship between pain and productivity at work or future medical expenditures was found. Although health-related employer support does not seem to directly affect sick days and medical expenditures, it is related to pain, which in turn is associated with sick days and expenditures. Implications: Pain reduction should improve employers' bottom lines, all else equal, because it would likely lead to lower medical expenditures and decrease the number of sick days taken by employees. Health-related employer support is one potential mechanism under employers' control that is associated with pain.