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Workers' compensation cost shifting: an empirical study.

C Zwerling·J Ryan·E J Orav
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Abstract

It has been suggested that health maintenance organizations (HMOs) overdiagnose work-related injuries and illnesses to increase their income. This study compared the Workers' Compensation experience of 2,176 Boston postal employees enrolled in a large HMO with that of 3,473 employees enrolled in a large fee-for-service health insurance plan. It controlled for the potential confounders of age, gender, job classification, type of injury, and duration of employment. It found no difference in the incidence of injuries: 5.93% for HMO enrollees and 6.25% for fee-for-service plan enrollees. Medical costs averaged $475 for HMO enrollees and $838 for fee-for-service plan enrollees (p = 0.018). Total costs averaged (09 for HMO enrollees and $1388 for fee-for-service plan enrollees (p = 0.063). In our cohort, there was no evidence of cost shifting. It appeared that the HMO provided less expensive medical care for injured postal workers.

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BostonCost AllocationHealth Maintenance OrganizationsInsurance, Health, ReimbursementPatientsPostal ServiceWorkers' CompensationJournal Article

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C Zwerling, J Ryan, E J Orav. 1991. Workers' compensation cost shifting: an empirical study.. https://doi.org/10.1002/ajim.4700190306

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