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	doctor and patient, man helping woman in wheelchair

Input: Economic Factors

Across the Sector
Terrorism, Natural Disaster, and New and Emerging Health Threats

The demand for services is increased exponentially when a disaster, such as a hurricane, flood, tornado, or a terrorist event occurs. The existing workforce may be overextended during a prolonged period, which may result in higher numbers of injuries and illnesses.


A unique feature of the HCSA sector is the important role of public financing through Medicare and Medicaid and the imperative to provide charity care to those without other means of support. Under-reimbursement results in cost shifting to other payers, but this mechanism for recovering costs is limited. Tight funding is an important consideration for health care and social services providers.

Healthcare Subsector

The healthcare subsector consists of the following industries: hospitals, nursing and residential care facilities, offices of other health practitioners, outpatient care centers, other ambulatory health care services (e.g., transport services, blood and organ banks), medical and diagnostic laboratories.

In 2009, the Healthcare subsector had the largest employment of any NAICS two-digit industrial sector and had 9 of the top 20 projected fastest growing occupations from 2008-2018. The industry is rapidly changing due to pressure to contain costs as well as the introduction of technological and clinical advances for the diagnosis and treatment of illnesses and injuries.

Labor Force Issues
  • Difficulties in recruiting and retaining qualified workers, coupled with an increasing demand for services, place additional occupational safety and health risks on workers.
  • Inadequate staffing and chronic understaffing are exerting additional mental and physical stress on the existing providers.
  • The average age of employed nurses is 45.5 years and is increasing at more than twice the rate of all other occupations in the U.S. workforce. This aging workforce, employed in a physically and psychologically demanding environment, may result in more injury and illness incidents with longer recovery periods, resulting in increased workers' compensation payments and lost productivity.
  • Shift work and long work hours (including mandatory overtime) may have an impact on the safety and health of the worker, as well as the quality of care for the patient.
  • Reductions in hospital stays have resulted in greater than average patient acuity and increased complexity of care, placing increased demands on workers.
  • The importation of health care providers, particularly nurses, creates language and cultural differences which may impede training efforts and basic understanding of occupational safety and health requirements.
Industry Structure
  • The healthcare subsector varies substantially in size of establishment, organizational structure, and staffing patterns.
  • A large proportion of the healthcare subsector is composed of very small establishments that may not be able to take advantage of safer technologies, which may require high start-up and operating costs.
Social Assistance Subsector

The social assistance subsector consists of the following industries: individual and family services, community food and housing, emergency and other relief services, vocational rehabilitation services, and child day care services. Child day day services employs over half of the workers in social assistance.

Some of the fastest growing occupations in the nation (e.g., home care aides, child care workers) are concentrated in the social assistance subsector. A large number of the jobs in social assistance are part-time and low-paying service jobs.

  • High job turnover, part-time workers, and the projected rapid employment growth in this subsector impacts the ability of the organization to provide sufficient and appropriate safety and health training to workers.
  • A substantial amount of the worker's time is spent in local travel, increasing the risk of motor vehicle incidents.
  • Workers in this subsector provide services to populations at risk-mentally ill, physically disabled, and families in crisis-which may contribute to additional mental stress and physical demands on the worker.
  • As in the healthcare subsector, social assistance workers are somewhat older than workers in other industries.
  • Non-traditional worksites (homes as opposed to institutions) may not provide adequate safety and health protection.
  • Non-traditional work schedules, such as 24-hour-long operation, evening, weekend and holiday work requirements, may contribute to higher injury and illness incidents.


Bureau of Labor Statistics: Industry at a Glance: NAICS 61 & 62: Education and Health and Social Services

American Association of Colleges of Nursing: Hallmarks of the Professional Nursing Practice Environment

Career Guide to Industries: Healthcare

Career Guide to Industries: Social Assistance, Except Child Day Care

Career Guide to Industries: Child Day Care Services