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During the first eight years of the National Vaccine Injury Compensation Program (NVICP), 786 contested claims were resolved through published judicial opinions. The likelihood of compensation dependent in part on the closeness of the match between the described injury and a specified list of acknowledged untoward vaccine side effects. In addition, the chances of applicant success were influenced by the applicant's choice of attorney and expert witnesses, by the assignment of the Special Master to decide the case, and increasingly over time, by the applicant's ability to comply with procedural requirements. The majority of contested claims arose from pertussis immunizations. For pertussis claims, the goal of insulating manufacturers from product liability suits has been achieved by granting compensation to applicants whose injuries are not scientifically recognized effects of the vaccine. In spite of (or because of) this jarring contradiction between the legal and medical understanding of causation, vaccine availability and childhood immunization rates improved during the early years of the plan. The apparent success of the program may encourage the substitution of no-fault compensation plans for tort-based consumer protection for other products, both medical and nonmedical.
The current system of compensation for the medical costs of occupational illnesses and injuries, a component of health insurance coverage for most workers in the United States, has recently come under scrutiny in the national health care reform debate. The cost of treatment of these conditions is significant, and there exist numerous disincentives for physicians and patients to use the workers' compensation system. Physicians who treat workers with occupationally related diseases may find compensation for a condition is disputed at the same time that it is excluded from payment by third party insurance coverage, leaving the patient selectively uninsured for at least some medical care services. In addition, most workers' compensation programs have been designed in a way that discourages efficient resource use by providers and claimants. We propose allowing health care providers to bill third party health insurers for all care, including work-related diseases and injuries. Insurers, in turn, would bill workers' compensation programs for associated treatment costs. The potential advantages of such a system include reductions in inefficiency and unfair burdens placed on providers and patients, in reporting bias, and in administrative costs balanced against the risks of insurers excluding workers in high risk occupations from obtaining low cost health insurance and shifting away from employers the administrative burden for workers' compensation.
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