Low-income earners are interested in helping design employment benefits chosen to meet their needsand paying attention to their choices could improve their health, say authors of a new survey of Washington, D.C.-Baltimore-area workers.


Giving low-income earners an opportunity to design employment benefits is not something that they get very often, says lead author Dr. Marion Danis, of the National Institutes of Health. They were very eager to be able to voice their opinion about that.


The study appears in the September issue of the American Journal of Public Health. The 408 participants had either incomes of less than $35,000 or a total household income of less than three times the national poverty level, based on family size.


Researchers instructed study participants to identify their personal priorities for employment benefits individually.


The top six priorities in descending order were as follows: health care, paid vacation, retirement, disability pay, job flexibility, and training. These benefits are similar to what higher-income earners usually receive, but are much less common for low-income earners.


Study participants then met in groups to discuss their coverage choices. Afterward, they made individual choices and researchers looked for changes in their priorities.


Health care again topped the list of benefits. Next were disability pay, paid vacation, retirement, job flexibility, and family time.


I think it is very interesting how commonly people did pick training after those top dominating benefits, Danis says. One of the things we know is so crucially associated with the health status of low-income folks is the degree of their education.


Benefits directly related to health and health improvementsuch as resources for healthy eating and exercisealso were available, but ranked lower on the workers priority lists.


Study participants said they understood that these issues are important, but felt they could deal with them on their own.


Participants pointed out that they could not put together their own retirement or disability plans in real life.


I think (this study) illustrates that there are painful trade-offs that you have to make, that you have to prepare yourself, and you have to cover yourself for catastrophic costs, says Jon Gabel, senior fellow at the National Opinion Research Center at the University of Chicago.


These findings pertain not only to the U.S. health-coverage system, which is largely based on private insurance, but also to countries such as Canada and the United Kingdom, which offer universal health insurance, Danis says.