Explaining employees' health care costs: a prospective examination of stressful job demands, personal control, and physiological reactivity.

The authors tested the ability of stressful demands and personal control in the workplace to predict employees' subsequent health care costs in a sample of 105 full-time nurses. Both subjective and objective measures of workload demands interacted with personal control perceptions in predicting the cumulative health care costs over the ensuing 5-year period. Tonic elevations in salivary cortisol, moreover, mediated the effects of demands and control on health care costs. Neither the job demands variables nor physiological reactivity measures, however, explained subsequent mental health. The results support findings from the epidemiological literature that demonstrate an important role for employees' control in explaining occupational inequalities in coronary heart disease and mortality. The authors argue that the results also encourage control-enhancing job design interventions by suggesting that their outcomes can benefit both organizations and their members.