[Cooperation between employer, physician and insurance company regarding compensation regulations in accidents].
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Accidents↗
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Quality of life and chronic nonmalignant pain.
Chronic nonmalignant pain is a prevalent and costly phenomenon. Chronic pain induces stressors that affect personal and work lives of sufferers. Because of this interference, quality of life is impacted. The purpose of this pilot study was to explore the impact of stressors on the quality of life of adult patients with chronic pain. The framework guiding this study was Neuman's Systems Model based on the concepts of stress and reaction to stress. A descriptive correlational research design was used to compare participants' quality of life according to their health and function; family, psychological, spiritual, and socioeconomic status; and the stressors of age, gender, income, marital and work status, occupation, monthly treatment costs, and type of insurance. Each participant was administered the Ferrans and Powers Quality-of-Life Index and a demographic survey. Results revealed that a higher quality of life was associated with participants who were older, female, and employed, whereas a lower quality of life was associated with participants with a low income, higher treatment costs, and a lack of workmen's compensation insurance. Based on Neuman's model, the implications of chronic pain sufferers' resistance to the negative impact of various stressors are discussed.
Adaptation, Psychological↗
The occupational health status of hired farm workers.
The U.S. hired farm work force presently is two-thirds foreign-born: mostly young Mexican men with low educational attainment who neither read nor write English. Sixty percent earn so little that they and their families live in poverty. Four of ten migrate to find work, 33% are not authorized to work in the U.S., and 25% work for a labor market intermediary, usually a labor contractor. Few hired farm workers have health insurance of any kind and, despite low incomes, relatively few seek or receive government benefits. Government regulation of the workplace exempts agricultural employers from numerous provisions that apply to other industries; for example, agriculture is exempt from portions of the Fair Labor Standards Act, allowing children as young as age 12 to work in the fields, and employers with 10 or fewer employees are exempt from OSHA regulation. Only 12 states require farm employers to carry workers' compensation insurance. While hired farm workers face significant safety and health risks, there are major gaps in existing research covering this occupational group. An ad hoc task force convened by NIOSH developed a prioritized agenda for occupational safety research in this population: musculoskeletal disorders, pesticide-related conditions, traumatic injuries, respiratory conditions, dermatitis, infectious diseases, cancer, eye conditions, and mental health.
Adolescent↗
Methodologic issues in the use of workers' compensation databases for the study of work injuries with days away from work. I. Sensitivity of case ascertainment.
BACKGROUND: Case ascertainment costs vary substantially between primary and secondary data sources. This review summarizes information on the sensitivity of state administrative databases in workers' compensation systems for the ascertainment of days-away-from-work (DAFW) work injuries for use in modeling studies. METHODS: Review of the literature supplemented by data from governmental or organizational reports or produced for this report. RESULTS: Employers currently appear to provide workers' compensation insurance coverage for 98.9% of wage and salary workers. Wage and salary jobs account for approximately 90% of jobs in the United States. In industries such as manufacturing, the fraction of covered jobs is probably closer to 98%. In Minnesota, the number of DAFW cases ascertained by the Bureau of Labor Statistics' annual survey of occupational injuries and illnesses is approximately 92-97% concordant with the number of wage compensation claims for injuries producing DAFW over the period 1992-2000, once adjustments are made to permit direct comparisons of the numbers. The workers' compensation databases provide information for more than 95% of the total DAFW resulting from work injuries. Covariate estimates are unaffected by this less than 5% loss because effects appear dependent on time from injury. CONCLUSIONS: Statewide workers' compensation administrative databases can have substantial utility for epidemiologic study of work injuries with DAFW because of their size, using high sensitivity for case ascertainment as the evaluative criterion.
Databases as Topic↗
Preparing the company physician to testify at legal proceedings.
Company physicians are frequently required to testify as to their findings and opinions in cases where employees' health jeopardizes their work status. The company physician may face conflicting ethical obligations in weighing the physician-patient relationship against the needs of the employer. If the employee seeks outside health care assistance, the company physician may have to testify against other health care professionals. The three most common forums in which the company physician may be asked to submit medical reports and/or testify are arbitration hearings, workers' claims for Social Security disability, and workers' compensation insurance benefits. Company physicians should be aware of the nature of each type of proceeding and they should be prepared to render persuasive expert testimony.
Ethics, Medical↗
Comparison of disability duration of lumbar intervertebral disc disorders among types of insurance in Korea.
The incidence of work-related musculoskeletal disorder including low back pain sharply increased since 2000 in Korea. The objectives of the present study are to compare disability duration of lumbar intervertebral disc displacement among types of insurances, and to obtain its appropriate duration. The medical records of all patients whose final diagnosis in discharge summary of chart was lumber specified intervertebral disc displacement (LIVD) in 6 large general hospitals in Korea were reviewed to compare the length of admission and disability among different types of insurances. The information on age, gender, the length of admission, the length of follow-up for LIVD, occupation, operation, combined musculoskeletal diseases, and type of insurance was investigated. 552 cases were selected and analyzed to calculate arithmetic mean, median, mode, and geometric mean of disability duration. There was a significant difference in the length of admission and disability among types of insurance after controlling covariates such as age and combined diseases by the analysis of covariance. The length of admission in cases of IACI and AI was much longer than that of HI, and the length of disability in cases of IACI was much longer than that of HI. Prolonged duration of admission and disability was not assumed due to combined diseases, complication or other unexplainable personal factors in cases of those with industrial accidents compensation insurance and automobile insurance. This means that proper management of evidence-based disability duration guidelines is urgently needed in Korea.
Adult↗
The industrial orthopedic rehabilitation market: a niche opportunity.
The industrial orthopedic rehabilitation market is an opportunity for hospitals of all sizes to provide a needed service with significant revenue potential. For a 250-bed community hospital, an industrial orthopedic rehabilitation program can generate $3.5 to $4 million in revenue. Based on the authors' experience, contribution margins from the programs, if designed properly, can range from 30% to 40%. A well-designed industrial orthopedic rehabilitation program adds to a strong orthopedics product line by providing continuity of care and the "extras" that make a program successful. For a hospital that is developing an orthopedics product line and trying to build a presence in the marketplace, an industrial orthopedic rehabilitation program can introduce your services to local employers, opening the door for their use of other "high tech" orthopedic services that you provide. Industrial rehabilitation is synonymous with what is often referred to in health care as the outpatient "workers' compensation" or "injured workers"' market. Essentially, this market consists of employees whose on-the-job injuries or job-related chronic conditions require medical care. These injuries may or may not involve lost workdays during which injured employees are unable to perform job functions. Since the orthopedic segment of the industrial rehabilitation market represents the bulk of the injuries and costs, developing the services and programs that can produce return to work (or case settled) outcomes for these workers represents a sound opportunity for health care providers. However, since workers' compensation insurance is liability (not health care) insurance, understanding the rules and regulations specific to this insurance segment in your state, along with the needs of all the key players in the system, is the key to developing programmatic elements critical to long-term success.
Hospitals, Community↗
Evaluation of safety balls and faceguards for prevention of injuries in youth baseball.
CONTEXT: Safety balls and faceguards are widely used in youth baseball, but their effectiveness in reducing injury is unknown. OBJECTIVE: To evaluate the association of the use of faceguards and safety balls and injuries in youth baseball. DESIGN, SETTING, AND PARTICIPANTS: Ecological study using a national database of compensated insurance claims maintained by Little League Baseball Incorporated, combined with data on the number of participants in Little League and data from a census of protective equipment usage for youth aged 5 to 18 years participating in Little League Baseball in the United States during 1997-1999. MAIN OUTCOME MEASURES: Rate of injury and injury rate ratio comparing users with nonusers of protective equipment. RESULTS: A total of 6 744 240 player-seasons of follow-up and 4233 compensated injury claims were available for analysis. The absolute incidence of compensated injury per 100 000 player-seasons was 28.02 (95% confidence interval [CI], 26.76-29.29) for ball-related injury and 2.71 (95% CI, 2.32-3.11) for facial injury. Overall, use of safety balls was associated with a reduced risk of ball-related injury (adjusted rate ratio, 0.77; 95% CI, 0.64-0.93). This reduction was essentially due to 1 type of safety ball, known as the reduced-impact ball (adjusted rate ratio, 0.72; 95% CI, 0.57-0.91). Use of faceguards reduced the risk of facial injury (adjusted rate ratio, 0.65; 95% CI, 0.43-0.98). Metal and plastic guards appeared to be equally effective. Safety balls appeared to be more effective in the minor division (ages 7-12 years) than in the regular division (ages 9-12 years). CONCLUSIONS: Reduced-impact balls and faceguards were associated with a reduced risk of injury in youth baseball. These findings support increased usage of these items; however, it should be noted that the absolute incidence of injury in youth baseball is low and that these equipment items do not prevent all injuries.
Adolescent↗
Anterior intramuscular transposition of the ulnar nerve for cubital tunnel syndrome.
Forty-five sequential cubital tunnel releases with anterior transposition of the ulnar nerve in an intramuscular fashion were performed over a 4-year period. All patients had a positive Tinel's sign at the cubital tunnel and reported numbness and tingling in the ring and small finger of the affected arm. Thirty-three cases had preoperative electrodiagnostic studies performed. Twenty-three cases had positive electromyographic and nerve conduction velocity findings for cubital tunnel syndrome, whereas 10 cases had normal electromyographic and nerve conduction velocity studies. Twenty-four cases were covered by Workers' Compensation insurance. The average age of the patients was 40 years, with an average duration of symptoms of 22 weeks. Average follow-up examination was 15 months, with all patients being reexamined and completing a symptom outcome questionnaire. No significant differences between preoperative electrodiagnostic status could be demonstrated with regard to final symptom outcome. Patients with improved results from a symptom status were younger and had cubital tunnel syndrome of shorter duration. A trend toward poor results in patients with Workers' Compensation was noted, although this was not statistically significant. Overall, 87% of the patients had resolved or improved symptoms after cubital tunnel release with the anterior intramuscular transposition technique.
Adolescent↗
Wounding the messenger: the new economy makes occupational health indicators too good to be true.
The U.S. Bureau of Labor Statistics and workers' compensation insurers reported dramatic drops in rates of occupational injuries and illnesses during the 1990s. The authors argue that far-reaching changes in the 1980s and 1990s, including the rise of precarious employment, falling wages and opportunities, and the creation of a super-vulnerable population of immigrant workers, probably helped create this apparent trend by preventing employees from reporting some injuries and illnesses. Changes in the health care system, including loss of access to health care for growing numbers of workers and increased obstacles to the use of workers' compensation, compounded these effects by preventing the diagnosis and documentation of some occupational injuries and illnesses. Researchers should examine these forces more closely to better understand trends in occupational health.
Data Collection↗
The effect of safety initiatives on safety performance: a longitudinal study.
Construction industry is one of the most dangerous industries, not only in the USA, but worldwide. In this longitudinal study we examined the effects of safety initiatives on the safety performance of construction companies. One of the measures commonly used in the USA to track a company's safety performance is the experience modification rate (EMR). The EMR is based on the company's safety records (injury claims) from the past three full years and is used to calculate the workers' compensation insurance premiums. In a longitudinal study, we studied the effects of safety efforts and initiatives on the EMR. The results show that safety initiatives and money spent on safety do improve safety performance, but only over time.
Accident Prevention↗
The medical detection of simulated occupational injuries: a historical and social analysis.
Occupational malingering is often thought to involve the deliberate feigning of disease by workers seeking undeserved financial gain. Concern about this form of malingering grew in the late 19th century as a result of the emergence of the new industrial economy and the institution of workers' compensation insurance. Medical judgments about the simulation of work injuries have placed physicians in a crossfire between the interests of employers and workers in numerous medicolegal debates. Because of uncertainty about the true cause of many occupational disorders and the highly charged social environment in which medical opinions are rendered, physicians' views about malingering are often swayed by cultural, political, and economic forces. The historical record shows that a medical diagnosis of occupational malingering can reflect deep-seated cultural and social biases toward women, Jews, immigrants, and other groups representing a potential threat to the privileged social class. Current efforts to eliminate fraudulent workers' compensation claims must be sensitive to the inherent ambiguities in the medical determination of work-relatedness and the potential for judgments about simulated work injuries to conceal deep-seated social biases and class prejudices.
Accidents, Occupational↗
Occupational health practice in New Zealand.
On the basis of the national un-funded liability for work injuries and illnesses, and comparisons of health outcome and cost data to a benchmark, it can be concluded that occupational health practice in New Zealand is deficient. This deficiency persists despite recent legislative reforms and is due to a combination of Accident Rehabilitation and Compensation Insurance Corporation, health professional and industrial factors. It is clear that a comprehensive corrective strategy is needed to attend to: the up-skilling of health case managers and the medical profession in concert; and, to encouraging employers to introduce comprehensive occupational health programmes.
Benchmarking↗
Productivity costs measurement through quality of life? A response to the recommendation of the Washington Panel.
This paper comments on the recently published guidelines of the Washington Panel on incorporation of indirect non-medical costs, or productivity costs, in economic evaluations of health care. Traditionally the human capital or more recently the friction cost method is used to measure these costs. The Panel, however, recommends incorporating productivity costs as health effects in the denominator of the C/E ratio. This paper argues that incorporation of productivity costs in cost-effectiveness analysis expressed as health effects is not correct. Only direct health related effects on quality of life that cannot be meaningfully monetarized should be considered as health effects. Furthermore, measuring productivity costs in terms of quality of life may lead to misrepresentation of these costs from a societal viewpoint. This misrepresentation occurs because of the existence of social security systems and private insurance compensating for income reductions from disease. Furthermore, the patient's viewpoint is useful for quality of life measurement, but not for measuring productivity costs from a societal perspective. Finally, alternative recommendations are formulated for incorporating societal productivity costs in economic evaluations of health care.
Absenteeism↗
Injury and illness in the American workplace: a comparison of data sources.
Setting priorities for workplace health and safety research depends upon accurate and reliable injury and illness data. All occupational health databases have limitations when used to summarize the national scope of workplace hazards. The comparison of data from multiple sources may produce more credible estimates of the leading occupational injuries and illnesses. The purpose of this paper is to describe the strengths and weaknesses of six data collection systems that record occupational injuries and illnesses on a national level and to compare the leading estimates from these systems for 1990. The six systems are: 1) National Traumatic Occupational Fatalities database, 2) the Bureau of Labor Statistics Census of Fatal Occupational Injuries, 3) The Bureau of Labor Statistics Annual Survey data, 4) a large workers' compensation database, 5) the National Council on Compensation Insurance data, and 6) The National Electronic Injury Surveillance System. Occupational injuries, as defined herein, predominate over illnesses in terms of the number of cases and the overall costs. Databases that provide information on the antecedents of injuries suggest how these injuries may be prevented and warrant more attention and refinement.
Accidents, Occupational↗
Controlling workers' compensation costs for prescribed medication.
The rise in prescription drug costs in workers' compensation cases has become alarming. According to the National Council on Compensation Insurance (NCCI), the prescription drug share of total medical costs by accident year increased from 6.5% in 1997 to 9.6% in 2001. Today, 10 cents of every dollar spent on medical care for workers' comp is spent on prescription drugs. Why the increase? The reasons vary; however, whatever the reason, it is critical to determine whether a prescribed drug is treating a work-related injury or another ailment unrelated to the injury. Knowing what questions to ask and where to go for additional information can help keep prescription medication costs under control.
Cost Control↗
Devastating injuries in healthcare workers: description of the crisis and legislative solution to the epidemic of back injury from patient lifting.
The purpose of this report is to describe a crisis in healthcare, disabling back injuries in US healthcare workers. In addition, outlined is the proven solution of safe, mechanized, patient lifting, which has been shown to prevent these injuries. A "Safe Patient Handling--No Manual Lift" policy must be immediately instituted throughout this country. Such a policy is essential to halt hazardous manual patient lifting, which promotes needless disability and loss of healthcare workers, pain and risk of severe injury to patients, and tremendous waste of financial resources to employers and workers' compensation insurance carriers. Healthcare workers consistently rank among top occupations with disabling back injuries, primarily from manually lifting patients. Back injury may be the single largest contributor to the nursing shortage. Reported injuries to certified nursing assistants are three to four times that of registered nurses. A national healthcare policy for "Safe Patient Handling--No Manual Lift" is urgently needed to address this crisis. Body mechanics training is ineffective in prevention of back injury with patient lifting. Mandated use of mechanical patient lift equipment has proven to prevent most back injury to nursing personnel and reduce pain and injury to patients associated with manual lifting. With the national epidemic of morbid obesity in our country, innovative devices are available for use in emergency medical systems and hospitals for patient lifting and transfer without injury to hospital personnel. The US healthcare industry has not voluntarily taken measures necessary to reduce patient handling injury by use of mechanical lift devices. US healthcare workers who suffer disabling work-related back injuries are limited to the fixed, and often inadequate, relief which they may obtain from workers' compensation. Under workers' compensation law, healthcare workers injured lifting patients may not sue their employer for not providing mechanical lift equipment. Discarding healthcare workers disabled by preventable back injuries is an abuse which legislators must remedy. In addition, Medicare reimbursement policies must also be updated to allow the disabled community to purchase electrically operated overhead ceiling lifts. The US lags far behind countries with legislated manual handling regulations and "No Lifting" nursing policies. England and Australia have had "No Lifting" nursing policies in place since 1996 and 1998, respectively. The National Occupational Research Agenda (NORA) recognized a model in 2003 for reduction of back injuries to nursing staff in US healthcare facilities. Also in 2003, the American Nurses Association called for elimination of manual patient handling because it is unsafe and causes musculoskeletal injuries to nurses. The first state legislation for safe patient handling passed both houses in California but was vetoed by the Governor in September 2004. California and other states are preparing to (re)introduce legislation in January 2005. A national, industry-specific policy is essential to quell the outflow of nursing personnel to disability from manual patient lifting.
Adult↗
Costs of occupational injuries and illnesses in California.
OBJECTIVES: The purpose of this study was to estimate the annual incidence, the mortality, and the direct and indirect costs associated with occupational injuries and illnesses in California in 1992. To achieve this, we performed aggregation and analysis of national and California data sets collected by the U.S. Bureau of Labor Statistics, California Workers' Compensation Insurance Rating Bureau, California Division of Industrial Relations, the National Center for Health Statistics, and the U.S. Health Care Financing Administration. METHODS: To assess incidence of and mortality from occupational injuries and illnesses, we reviewed data from state and national surveys and applied an attributable risk proportion method. To assess costs, we used the cost-of-illness, human capital, method that decomposes costs into direct categories such as medical expenses and insurance administration expenses as well as indirect categories such as lost earnings, lost home production, and lost fringe benefits. Some cost estimates were drawn from California data, whereas others were drawn from a national study but were adjusted to reflect California's differences. Cost estimates for injuries were calculated by multiplying average costs by the number of injuries. For the majority of diseases, cost estimates relied on the attributable risk proportion method. RESULTS: Approximately 660 job-related deaths from injury, 1.645 million nonfatal injuries, 7,079 deaths from diseases, and 0.133 million illnesses are estimated to occur annually in the civilian California workforce. The direct ($7.04 billion, 34%) plus indirect ($13.62 billion, 66%) costs were estimated to be $20.7 billion. Injuries cost $17.8 billion (86%) and illnesses $2.9 billion (14%). These estimates are likely to be low because: (1) they ignore costs associated with pain and suffering, (2) they ignore home care provided by family members, and (3) the numbers of occupational injuries and illnesses are likely to be undercounted. CONCLUSION: Occupational injuries and illnesses are a major contributor to the total cost of health care and lost productivity in California. These costs are on a par with those of all cancers combined and only slightly less than the cost of heart disease and stroke in California. Workers' compensation covers less than one-half of the costs of occupational injury and illness.
California↗