Journal of Occupational Health Psychology1996, Vol. 1. No. 1,100-109

Copyright 1996 by the Educational Publishing Foundation1076-8998/96/$3.00

Occupational Stress and Health Care Use

Michael R. ManningNew Mexico State University

Conrad N. JacksonUniversity of Alabama in Huntsville

Marcelline R. FusilierNorthwestern State University

This study investigated the relationship between health care use and (a) stressful work events; (b)strain; (c) social support; (d) type of job and industry; and (e) the individual characteristics ofcontrol, commitment, and length of time in position. A sample of 260 individuals (95 men, 165women) from two different industries was used. Correlational analyses suggested that health careclaims and costs were positively related to stressful work events and strain and negatively relatedto employees' length of time in position. Industry type also played a role in predicting the healthcare variables. Multivariate analyses suggested that environmental, stressor, and strain variablesaccounted for up to 16% of the variance in health care costs and 21.5% of the variance in numberof health care claims.

The research literature on occupational stress hasemphasized its effects on health (Cooper & Marshall,1976; Ganster & Schaubroeck, 1991; Greenberg,1977; Kasl, 1984; Quick, Horn, & Quick, 1986);health-related physiological variables such as choles-terol levels, blood pressure, and psychological states(Caplan, Cobb, French, Harrison, & Pinneau, 1975;Fox, Dwyer, & Ganster, 1993; Ivancevich, Matteson,& Preston, 1982; Manning, Ismael, & Sherwood,1981); absenteeism, sick days,' and turnover (Cooper& Bramwell, 1992; Gupta & Beehr, 1979; Jamal,1984; Manning & Osland, 1989); job performance(Motowidlo, Packard, & Manning, 1986; Spector,Dwyer, & Jex, 1988); and job-related perceptions andfeelings such as job tension, job satisfaction, commit-ment, etcetera (Kate & Kahn, 1978). This extensiveliterature has enriched researchers' understanding ofoccupational stress and its impact on many importantwork variables.

In this article, we extend research in this area byexamining the heretofore empirically unexplored

Michael R. Manning, Department of Management, NewMexico State University; Conrad N. Jackson, Department ofAdministrative Science, University of Alabama in Hunts-ville; Marcelline R. Fusilier, Department of Business,Northwestern State University.

This research was supported by grants from the W. K.Kellogg Foundation and Blue Cross and Blue Shield ofOhio.

Correspondence concerning this article should be ad-dressed to Michael R. Manning, Department of Manage-ment, College of Business Administration and Economics,New Mexico State University, Las Cruces, New Mexico88003-0001. Electronic mail may be sent via Internet tommanning@nmsu.edu.

relationship between occupational stress and theeconomic variable of health care costs. These costsinclude not only the direct costs of medical treatmentbut also indirect costs associated with the frequencyof receiving health care services. In particular, we areinterested in how health care use is related toindividual characteristics, social support, type of joband industry, stressful work events, and job strain.

Conceptual Framework

The term stress still lacks a clear consensus on itsdefinition and continues to be used with a great dealof conceptual confusion and divergence of opinion(Motowidlo et al., 1986). Many researchers havereviewed the various definitions of stress and thetheoretical differences in how this term is used(Allusi, 1982; Appley & Trumbull, 1967; Beehr &Newman, 1978; Cofer & Appley, 1980; Hogan &Hogan, 1982; Janis & Leventhal, 1968; McGrath,1976; Schuler, 1980). We do not join this debate butdo examine concurrent and longitudinal relationshipsbetween stress and health as identified in Figure 1.

Motowidlo et al. (1986), Lazarus (1966), and Janisand Leventhal (1968) posit that stress is associatedwith certain environmental factors and has variousstrain consequences. Stress is an unpleasant emo-tional experience associated with feelings of tension,irritation, annoyance, dread, anxiety, etcetera. We areconcerned with perceptions of stress that result fromand are associated with one's work that willspecifically predict the number of individual healthcare claims filed and their direct costs.

100

OCCUPATIONAL STRESS AND HEALTH CARE USE

Time 1 Time?

Individual Variables: Individual Variables:

101

Job typeIndustryTime in positionControl

Social support

Stressful work events

Strain

(C)

Health care use

Job typeIndustryTune in positionControl

Social support

Stressful work events

Strain

(D)

Health care use

Figure 1. Model of occupational stress and its consequences for health care use.

Stress, Strain, and Health Care Use

Although much of the literature on occupationalstress posits its effects on health, there is conflictingevidence supporting a correlation between occupa-tional stress and individual health. In part, thesequestions arise because of methodological weak-nesses of prior research. Many studies supporting arelationship between occupational stress and healthuse self-report measures of stress as well asself-perceptions of job tension or mental health,rather than physical health. Kasl (1986) pointed outthat use of these measures raises serious alternativeexplanations such as methods variance and concep-tual overlap. Methodological problems aside, ob-served correlations between stress and physiologicalhealth variables are inconsistent (Jenkins, 1971;Schmitt & Colligan, 1984).

Stressful Events

Most stress research has conceptualized anteced-ents of occupational stress as role stressors (e.g.,ambiguity, conflict, and overload). This has beenproblematic because developing measures of percep-tions of job stress and perceptions of role stressorsthat are clearly independent constructs is verydifficult. In contrast, our model assumes that there arespecific work events that are associated with theexperience of stress. This approach is consistent with

the psychosomatic literature (e.g., Holmes & Rahe,1967) and the job stress literature (Gray-Toft &Anderson, 1981; Koch, Tung, Gmelch, & Swent,1982; Motowidlo et al., 1986; Naismith, 1975), whichassumes that stress is attributed to the frequency inwhich stressful events are experienced by an indi-vidual.

Type of Job, Industry, Social Support,and Individual Characteristics

To more accurately account for variation in stressand strain, we included certain environmental andindividual variables in the analysis. These variableswere chosen on the basis of their identification in theprevious literature as having an impact on perceptionsand reactions regarding work stress. Specificallyincluded in the present study are type of job(supervisor or nonsupervisor), industry, social sup-port, and the individual characteristics of control,commitment, and time in position. These have beenfound to be related to health in the context of stressfulwork events.

Inconsistent findings regarding health outcomesacross occupations and industry were noted in theGanster and Schaubroeck (1991) review. Moreover,these results did not address the question of whetherwork events or selection effects are responsible forany health differences found. Although the present

102 MANNING, JACKSON, AND FUSILIER

study examines data over only a 2-year span, it ispossible to compare health prediction of subsequentjob type as well as job type prediction of subsequenthealth.

The literature on social support has found thatmeasures of support consistently have direct effectson the experience of occupational stress (Fusilier,Ganster, & Mayes, 1986, 1987). The size andadequacy of one's social support network as well asthe particular sources of support may directly influencethe occurrence and frequency of stressful work eventsthat may result in the use of health care services.

We are also interested in understanding whether theindividual characteristics of control and commitmentare related to health care use in the context of stressfulwork events. Ganster and Fusilier (1989) and Sauter,Hurrell, and Cooper (1989) have identified employeecontrol in the workplace as an important variablerelated to occupational stress. Manning, Williams,and Wolfe (1988) have found that commitment andcontrol are negatively related to stressful work events.They explained that committed individuals find life ingeneral, and work in particular, meaningful andengaging. Because these individuals value them-selves and what they are doing, they are willing toexercise influence in personal and social situations.Hence, a committed person is active and curious, notpassive nor alienated, and will influence the fre-quency of stressful work events in their workenvironment. Manning et al. (1988) also explainedthat people with control have a sense of influence andmastery over their life. These individuals believe andact as if they can influence the events around themand therefore directly shape the frequency of stressfulwork events that they experience.

In addition, we are interested in how the length oftime an individual is employed in his or her currentworking position affects health care use. Motowidloet al. (1986) found that nurses who had more years ofnursing experience had lower levels of stress (asmeasured by levels of anxiety, hostility, and depres-sion) than nurses with fewer years of experience. It islikely that individuals with more time in their presentjob will have more influence and control over theirwork thereby mitigating the frequency in whichstressful work events occur. Additionally, more seniorindividuals may also have acquired better job skillsthat will allow them to thwart off potential stressfulwork events before they occur.

Research Purpose

The purpose of the research reported here is toexamine relationships between health care use and

our measures of stress (type of job: supervisory ornonsupervisory responsibility; type of industry: manu-facturing or insurance; social support; individualcharacteristics: control, commitment, and time incurrent position; stressful work events; and jobstrain). Both concurrent and longitudinal relation-ships are investigated.

Method

Participants and Procedures

The participants were recruited from a small manufactur-ing division of a large multinational chemical corporationand a large health insurance company. Participation wasvoluntary and part of a larger research project that evaluatedthe effectiveness of health promotion programs in worksettings. Self-report variables were obtained from surveysadministered at the job site during working hours. Thesurveys were administered twice, approximately 12 monthsapart.

Health care use data were obtained directly from archivalrecords held by the health insurer. The health care use datawere gathered for the 12 months before the first surveyadministration in each company and for 12 monthsafterward, as the claims were filed.

The participants consisted of 260 individuals (95 men and165 women) and included all hierarchical levels of the twoorganizations. There were 143 individuals from the healthinsurance company and 117 individuals from the manufactur-ing company who completed the two surveys and hadcomplete health care information and survey data during thestudy period. The sample included 128 managers and 132individuals with no supervisory responsibility. The meanage was 36.8 years (ranging from 21 to 64 years, SD = 9.9).

Measures

Type of job. The self-report questionnaire asked partici-pants to check whether they did or did not have supervisoryresponsibility. This measure was then treated as a dichoto-mous variable: No supervisory responsibility was coded 0and supervisory responsibility was coded 1.

Social support. At Time 1 social support was measuredwith the Social Support Questionnaire (SSQ) developed bySarason, Levine, Basham, and Sarason (1983). The SSQyields two scores for (a) perceived number of social supportsand (b) satisfaction with social support that is available.Internal consistency estimates of reliability for these twoscales were .93 and .91, respectively. Social support wasoperationalized at Time 2 with a self-report measuredeveloped by Caplan et al. (1975) that distinguished threesources of social support (supervisor, coworkers, and spousesupport). Each of these subscales consists of four items with5-point response formats (1 = don't have any such person; 2through 5 ranged from not at all to very much). Internalconsistency reliabilities were as follows: supervisor support,.83; coworkers support, .73; and spouse support, .81.

Individual characteristics. The self-report question-naire measured control, commitment, and time in position.Control and commitment were measured only at Time 1.Because both variables were conceptualized as disposi-

OCCUPATIONAL STRESS AND HEALTH CARE USE 103

tional, they were assumed to be relatively stable over thetime period measured. The control and commitmentmeasures used subscales of the Hardiness Index (Kobasa,Maddi, & Courington, 1981; Kobasa, Maddi, & Kahn,1982). The control scale uses items from the External Locusof Control Scale (Rotter, Seeman, & Liverant, 1962) and thepowerlessness scale of the Alienation Test (Maddi, Kobasa,& Hoover, 1979). The alienation from self and alienationfrom work scales of the Alienation Test (Maddi et al., 1979)were used to operationalize commitment. According toprocedures developed by Kobasa et al. (1981, 1982), theseitems were composed to develop the control and commit-ment scales. Both measures were scored in a positivedirection with the following internal consistency reliabili-ties: control, .73 and commitment, .76.

Time in curent working position was also self-reported inthe survey questionnaire in number of years.

Stressful work events. Stressful work events wereassessed using the Organizational Readjustment RatingScale (Naismith, 1975). Respondents indicated which of 30stressful job events had occurred in the previous 12 months.Representative examples of such events were "cancellationof a project you were involved in and considered important,""got a new boss," "transferred against your will to a newposition or assignment," "experienced a major reorganiza-tion of work," "major relocation of your work place (moveto a new office or building)." Similar to the scoringprocedures used by Weiss, Ilgen, and Sharbaugh (1982), astressful work events score was computed by summing thenumber of events checked.

Strain composite index. The strain composite index wasa combination of scores on the following measures:job-related tensions, job satisfaction, negative affect, andsomatic complaints. The composite was created because (a)these measures are conceptually related in that they allmeasure different potential aspects of strain, and (b) theirscores evidenced high intercorrelations on the basis of afactor analyses. Results of the factor analysis appear in theResults section of this article.

Specifically, the Job-Related Tension Index (Kahn, Wolfe,Quinn, Snoek, & Rosenthal, 1964) consists of 18 itemsscored on a 7-point scale ranging from 1 (never) to 7 (nearlyall the time). Job satisfaction was operationalized by havingparticipants rate 10 items on a 7-point scale ranging from 1(dissatisfied) to 7 (satisfied; Manring, 1979). The items arerepresentative of specific aspects of the job such as thenature of the task, the quality of supervision, relations withpeople, and freedom to use personal judgement andinitiative. The negative affect subscale from the AffectRating Scale (Sipprelle, Gilbert, & Ascough, 1976) was usedto operationalize this construct. This scale consists of eightitems anchored on a 7-point rating scale ranging from 1 (notat alt) to 7 (very much). Respondents were asked todetermine how well eight words (e.g., fearful, angry, bitter,etc.) described their general feelings. Somatic complaintswere operationalized with five items forming this subscaleof a larger strain index developed by Adams (1981).Representative items that were rated on a 5-point responseformat (rarely to never to quite frequently) are: "upsetstomach or intestinal problems," "sweaty and/or tremblinghands," and "feel dizzy or light-headed."

These four scales were standardized and then summed tocreate a strain composite index for each survey. Thereliability estimate for this Index was .81 for Time 1 and .79for Time 2.

Health care use. Health care use is conceptualized as (a)the actual dollar costs for individual health care servicesrendered and (b) the frequency of contact an individual haswith health care providers. This was operationalized as thetotal number of health insurance claims submitted by anindividual for all sources of health care. These variables areindexes of illness behavior.

The use data were obtained from archival health insurancerecords and included all forms of health care typicallycovered by health insurance programs (physician officevisits, hospital outpatient and inpatient episodes, prescrip-tion drugs used, as well as other forms of health care usesuch as laboratory tests, ambulatory services, home healthcare, etc.). All study participants were insured with atraditional insurance policy in which premiums were paid bytheir respective employer.

Because both health care costs and the number of claimsfiled were not normally distributed, we log transformedthese variables to attempt to normalize the data.

Results

Strain Composite Index

The job strain variables were subjected to aprincipal components factor analysis. We did this todetermine whether the strains should be combinedinto a single index. Although arguments can be madefor treating each strain separately, the present study isnot specifically aimed at looking for individualeffects but rather at examining general effects ofstress and strain on health. The factor analyses wereconducted separately for Time 1 and for Time 2 dataconcerning somatic complaints, negative affect, jobsatisfaction, and job-related tensions. For both timeperiods, all four variables loaded on one factor. Theeigenvalue for Time 1 was 2.55, accounting for63.7% of the variance, and for Time 2, it was 2.48,accounting for 62.1% of the variance. Thus, a jobstrain composite was computed by summing thestandardized scores on the four variables for Time 1and Time 2 separately.

Health Care Use Index

Table 1 displays the correlations of the health caremeasures. The intercorrelation between health carecosts and health care claims at both time periods (.54and .59) is expected and suggests that a separateanalysis for number of claims and costs is warrantedbecause these measures are not simply redundant.

Stress and Health Care Use Zero-OrderCorrelations

Table 2 presents the correlations among theself-report variables and industry type (manufactur-

104 MANNING, JACKSON, AND FUSILIER

Table 1Means and Correlations Between Health Care Measures

Measure

*p<.05. **p<.01.

M SD \

Time 11. Health care costs2. Health care claims

Time 23. Health care costs4. Health care claims

583.804.00

664.884.48

1,881.286.28

1,546.688.20

—.54**

.16*

.16*

—

.34**

.59**—

.52**

ing coded 2 vs. insurance coded 1). Table 3 presentsthe correlations among self-report variables andhealth care use. The data in Table 3 clearly indicatesthat health care use consistently correlates with timein position, stressful work events, industry, and thecomposite strain measure. These results indicate thatstress-related events and strain covary with theeconomic costs of health care claims. It is alsoimportant to note that these results are free ofcorrelated method variance.

Multiple Regression Results

We conducted eight hierarchical regressions toaddress the relationships outlined in Figure 1. Resultsare presented in Tables 4, 5, 6, and 7. Tables 4 and 5concern across-time regressions. Specifically, Table 4uses Time 2 environmental, stressor, and strainvariables to predict Time 1 health care costs(R2 = .IU) and claims (R2 = .160). The sameprocedure was conducted again in Table 5 only thistime relating Time 1 predictors to Time 2 health carecosts (R2 = .160) and claims frequency (R2 = .215).

Tables 6 and 7 pertain to cross-sectional within-time data. As can be seen from the tables, bothcoefficients account for statistically significant propor-tions of variance in health care costs (R2 = .159 and.082, respectively) and claims (R2 = .206 and .146,respectively). Differences in these R2s may beexplained by the use of different social supportmeasures at Time 1 and Time 2.

Regarding the partial regression coefficients, timein position and industry were consistently related tohealth care costs. This suggests that employees in theinsurance company tended to incur more health carecharges than those in the manufacturing company.Furthermore, as hypothesized, the longer an em-ployee tended to hold a position, the lower were thehealth care costs. Results were similar for industry onhealth care claims, yet partial regression coefficientsfor time in position were only significant for Path C(see Table 7). The only other significant partial

regression coefficient was for the strain measure withhealth care costs in Path C.

Discussion

Our results clearly indicate that work stress andstrain are related to health care use concurrently andacross a 1-year time span. The significant correlationsbetween health care costs and industry (—.21 forTime 1 and -.36 for Time 2) and claims (-.32 forTime 1 and — .42 for Time 2) may at first appear to beproblematic, raising questions about whether theparticipants from these two organizations can belegitimately combined into one sample. Indeed, if thestrain index and the stressful work events measurewere not significantly correlated with health care use,and industry alone correlated with health use, thispattern would make the combination of our twosubsample organizations improper. However, in asmuch as significant correlations appear between thestress and strain indexes and health care use, thecombination of these two subsamples is not inappro-priate. The fact that one organization has higher levelsof stress and strain simply results in an expansion ofthe range of variation on the predictor variables, thusobviating the attenuation of stress and use that couldhave resulted from a restriction of range in eithersubsample.

The findings suggest that the insurance companyemployees had higher levels of health care use thandid the manufacturing employees. The industrydifference might be explained in any of several ways.First, work in insurance might have an inherentlygreater health impact than that in manufacturing.Second, the insurance company employees may havehad greater familiarity with filing health claims due tothe nature of their work. This familiarity may havecreated a greater awareness of opportunities for filingclaims as well as greater ease in doing so as comparedwith the manufacturing company employees whomay have had less familiarity with insurance claims.

A third explanation for the industry finding is that

OCCUPATIONAL STRESS AND HEALTH CARE USE 105

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106 MANNING, JACKSON, AND FUSILIER

Table 3Correlations Between Self-Report Variables, Industry, and Health Care Use

Health care use

Variable

Supervisory roleTime in position

Time 1Time 2

Stressful work eventsTime 1Time 2

ControlCommitmentNumber of social supports, Time 1Satisfaction with social support, Time 2Supervisory support, Time 2Coworker support, Time 2Spouse support, Time 2Strain index

Time 1Time 2

Industry

Time

Costs

.02

-.14**-.17**

.12*

.24**-.00

.00

.01-.03-.08-.07-.10*

.13*

.18**-.21**

1

Claims

-.04

-.14**-.13*

.19**

.25**-.01-.03-.03-.08-.08-.07-.10*

.17**

.24**-.32**

Time 2

Costs

-.05

-.13*-.14**

20**.20**

-.03-.03-.12*-.06-.08

.01-.09

.15**

.18**-.36**

Claims

-.07

-.12*-.12*

.24**

.24**-.03-.05-.13*-.05-.05

.04-.04

.16**

.20**-.42**

*p<.05. ** />< . 01.

during the 2 years when the data were collected, theinsurance company underwent a merger. This organi-zational change may have contributed to greaterlevels of stress and strain and consequently morehealth problems than were found in the more stablemanufacturing environment. The suggestion that theinsurance company was under higher levels of stressand strain is consistent with the data as well as ourclinical observations. The / tests comparing means

across companies on the stressful work events andstrain variables were significantly different at bothtime periods. The ambiguity in fully explaining thisfinding is consistent with the previous literatureconcerning stress-related occupational differences.Although differences across occupations have beendocumented, the reasons for them are not yet fullyexplained.

Table 4Across-Time Regression for Path B (Figure 1)

Independent variable(Time 2)

Step 1Spouse supportCoworker supportSupervisor supportJob typeIndustryTime in positionCommitmentControl

Step 2Stressful work events

Step 3Strain composite index

Costs Claims

B

-.06-.06

.00

.24-.70*-.09*

.03

.06

.07

.06

R2 B

-.01-.02

.00

.02

.28**-.02

.00.089** .02

.108** .01

.111** .03

R2

.101**

.150**

.160**

Note. The dependent variable was Time 1 health care costsand claims.*p<.Q5. **p<.01.

Table 5Across-Time Regression for Path A (Figure 1)

Independent variable(Time 1)

Step 1Satisfaction with social

supportNumber of social

supportsJob typeIndustryTime in positionCommitmentControl

Step 2Stressful work events

Step 3Strain composite index

Costs

B R2

-.02

-.10.03

-1.62**-.09*

.04

.00 .151**

.00 .152**

.09 .160**

Claims

B R''

-.00

-.03-.02-.54**-.02

.00

.00 .204

.00 .207

.03 .215

(

#*

**

**

Note. The dependent variable was Time 2 health care costsand claims.* /><X>5. **p<.01.

OCCUPATIONAL STRESS AND HEALTH CARE USE 107

Table 6Within-Time Regression for Path D (Figure 1)

Independent variable(Time 2)

Costs Claims

B R2 B R2

SteplSpouse supportCoworker supportSupervisor supportJob typeIndustryTime in positionCommitmentControl

Step 2Stressful work events

Step 3Strain composite index .06 .159** .09 .206**

-.08-.05-.02

.00-1.60**-.08*

.02

-.00-.01

.00-.02-.53**-.02

.00.00 .155** .00 .196**

.01 .156** .02 .202**

Note. The dependent variable was Time 2 health care costsand claims.*/><.05. **p<.01.

One methodological impediment to the clearinterpretation of the present data is the possibility thatautocorrelation may account for some substantial partof observed relationships. To further the examinationof this important dynamic, future research mustendeavor to use methodologies that offer potential forcontrol of autocorrelation (Miller, 1985).

What might organizations do to reduce health carecosts and use? Our results suggest at least threeplausible strategies: (a) increasing levels of theenvironmental and individual difference variables ofcontrol, employee commitment, social support, and

Table 7Within-Time Regression for Path C (Figure 1)

Independent variable(Time 1) B

Costs Claims

R2 B R2

SteplSatisfaction with social

support .02 -.05Number of social

supports .03 .00Job type .28 .00Industry -1.01** -.34**Time in position -.09* -.02*Commitment .05 .00Control .02 .066** .00 .126**

Step 2Stressful work events -.02 .066** -.02 .128**

Step 3Strain composite index .12* .082** .15* .146**

Note. The dependent variable was Time 1 health care costsand claims.*/><.05. **p<.01.

position tenure; (b) reducing stressful work events;and (c) monitoring the strains that employeesexperience. Of these independent variables, only timein position and the industry variable had statisticallysignificant partial regression coefficients. Althoughonly these two individual effects were detected asdenoted by the partial regression coefficients, theother variables in the analysis contributed to thestatistically significant value of the multiple correla-tion coefficient. Perhaps because the variables are tosome extent interrelated, they are all predictivetogether, and none stand out as being more so in thepresence of the others. Examination of the zero-ordercorrelations reveals that stressful work events and thecomposite strain index are consistently related tohealth over time even though they did not contributeto statistically significant changes in the multiplecorrelation.

The finding that time in position and industry hadsubstantial partial regression coefficients on healthcare costs and use raises a question of why stress andstrain explain so little variance. One possibleconclusion is that where one works and how long onehas worked there may be crucial to understandinghealth care useage in this sample. However, thepresent data do not explain how "where you work"and "how long you have worked there" themselvescontributed to the experience of stress and strain. Itseems likely that future research that uses bothlongitudinal data and numerous organizational sub-samples is needed to better understand these relation-ships.

In their recommended research agenda regardingorganizational stress, Ganster and Schaubroeck (1991)suggested that studies should (a) focus on a fewobjective stressors, (b) use longitudinal designs, and(c) obtain "hard" outcome measures. The presentstudy addresses each of these points. A few stressorsare examined along with personal characteristics thatmight influence individuals' perceptions and reac-tions to these stressors. A 2-year longitudinal designis used. Health care costs and frequency are hardoutcome measures in that they are verifiable andobjective. In addition to continuing the use of thesemethodologies, we suggest that future research alsoimplement longitudinal designs that could explore thedynamic ongoing cycle of stressors —* health —>stressors over numerous cycles. This would addressthe question of whether chronic exposures add up toalter perceptions of stress, or to exacerbate healthoutcomes, or both.

Consistent with previous literature, the differencesin stress levels between the two companies included

108 MANNING, JACKSON, AND FUSILIER

in our sample suggests that some companies orindustries may prove to be considerably more proneto stress than others, with associated costs to society,individuals, and organizations. Thus, there may be aneed to examine potential causal and moderatingfactors that could ameliorate or eliminate these costsand other adverse impacts.

Grasping the dynamics of stress effects on healthcare use is also critical for estimating and taking stepsto control costs of this nature. Ivancevich andMatteson (1980) estimated that stress costs the U.S.economy $50 to $90 billion annually. This figureapproached 10% of the 1980 gross national product.Stress is held accountable for 15% of all occupationaldisease claims for workers' compensation (DeCarlo,1989). The average payment is $15,000. The presentstudy's data allows more specific estimates. Ourfindings show that within the 2 years that health careclaims were collected, the cost of health care onaverage was $1,248.68 per person ($277.96 fordoctors office visits, $641.32 for hospital inpatientcharges, $128.24 for hospital outpatient charges,$34.40 for prescription drugs, and $166.76 for othermedical charges). Admittedly, the employer cannotexert control over all of the variables examined here.But given the costs involved, it may be worthwhile toinvest in efforts to increase employee job tenure aswell as reducing experienced stressors and strains.

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Received June 15,1994Revision received September 6,1994

Accepted January 3,1995 •