Unemployed Sons and Fathers: Implications for Disease Management and the Patient Centered Medical Home

Writing in the New York Times, David Brooks points out that we're entering the lean years with 8% unemployment extending out to the horizon. It's men that are turning out to be the victims of our Great Recession, with a close to 20% umployment rate for those between the ages of 25 and 54 years. For the first time, a majority of the U.S. workforce will be made up by women.

For the chronically unemployed, there are issues that go beyond the impact on health status. On a long term economic basis, there could be less upward mobility and stunted wage growth. At a more significant level, the cultural American ideal of masculinity itself may have to be redefined.

While this megatrend continues to unfold, the Disease Management Care Blog thinks there are some more immediate implications for the disease and care management industries:

While pregnancy care appropriately focuses on the mothers (for example), how will the pre and perinatal 'dyad' care be impacted (think HEDIS first trimester care) by mothers who also happen to the sole family breadwinner? What's the role of fathers in assuring timely follow-up for their newborns? When disease management and medical home care managers call the child's residence to see how things are going, will they be prepared to deal with a male voice?

At the other end of the age spectrum, until now it's been up to the daughters to deal with most of the work involved with being in the sandwich generation. The DMCB has seen them at clinic appointments and in hospital hallways. As more men assume greater responsibility for their struggling parents, how will gender issues that surround coping skills play any role in the support systems for our nation's elders? How will the disease management industry respond? Will care managers in patient centered medical homes adjust appropriately?

And finally, in the absence of a one-size-fits-all insurance mandate, there are implications for the families that primarily depend on an employed female breadwinner. The DMCB thinks women employees are not only more vulnerable to being underpaid, but being in pay-grades with more minimalist insurance or being forced to chose skinnier insurance options with a smaller pay check deduction. Navigating a family though high deductables, co-pays, co-insurance and benefit limits will be more important than ever in care management.

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