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PubMed1999

Evaluation of the Washington State Workers' Compensation Managed Care Pilot Project I: medical outcomes and patient satisfaction.

OBJECTIVES: This study examined the effect of managed care on medical outcomes and patient satisfaction as part of an evaluation of the Washington State Workers' Compensation Managed Care Pilot. METHODS: One hundred twenty firms (7,041 employees) agreed to have their injured workers treated in managed-care plans. Managed care introduced two changes from the fee-for-service (FFS) delivery system currently used by injured workers in Washington State: (1) experience-rated capitation, and (2) a primary occupational-medicine delivery model. The FFS control group included injured workers employed at 392 firms (12,000 employees). A total of 1,313 workers who experienced occupationally related injuries or illnesses between April 1995 and June 1996 were interviewed by telephone at 6 weeks after injury regarding their medical outcomes and satisfaction with care. Workers whose injuries resulted in four or more lost workdays (n = 372) were also interviewed at 6 months after injury on the same topics. The areas surveyed included functional outcomes and satisfaction with care, providers, and access to providers. RESULTS: The measures of functional outcome reflected no consistent differences between the managed care and the FFS conditions. The workers who attended the managed-care system reported lower levels of satisfaction with care, particularly with access to providers. For example, 58% of managed-care patients reported satisfaction with their attending physician as compared with 69% of FFS patients (P<0.01). CONCLUSIONS: Workers treated through managed-care arrangements were less satisfied with their care, but their medical outcomes were similar to those of workers who received traditional FFS care. The current workers' compensation system in Washington State affords injured workers great latitude in choosing providers. If provider choice is substantially restricted by managed care, worker satisfaction is likely to diminish.

Adult↗
PubMed2003

Chemical management and control strategies: experiences from the GTZ pilot project on chemical safety in Indonesian small and medium-sized enterprises.

In 1998 the Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) launched the Convention Project on Chemical Safety in developing countries. The project aims to support developing countries in the implementation of the Rotterdam and Stockholm Conventions, create human resources and institutional capacities and to demonstrate via pilot measures how chemical safety in the partner countries can be improved and sustainably implemented in line with international standards. With this objective the development of a Chemical Management Guide (CM Guide) for small and medium-sized enterprises in developing countries has been initiated. The guide describes a step-by-step approach which is based on identifying 'hot-spots' as a first step, and making a chemical inventory as a second step. The third step is the continuous improvement of chemical management. In total, there are six tools that aim to support the chemical management process: basic concepts for risk assessment; description of control approaches; using material safety data sheets (MSDSs); risk phrases for hazardous substances; safety phrases for hazardous substances; symbols used for labelling hazardous substances. In the course of the test-implementation of the CM Guide in Indonesia, it was found that MSDSs were not available in most of the smaller companies. In contrast, medium-sized and larger companies do have more MSDSs available. It was also found that the way to engage the minds of company owners and managers is with economic arguments related to the loss, waste and expiry of materials, and quality standards expected from importing countries.

Developing Countries↗