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Workers' compensation managed care: Preliminary findings

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Abstract

The cost of providing care that is effective to return injured workers to the workplace has risen in recent years in a manner that appears to be out of control in the workers' compensation system. In turn, medical care costs are an important component of the rapidly increasing costs of workers' compensation insurance. A model of health care delivery that emphasizes early intervention and return to work is presented. This model focuses on providing aggressive treatment of injuries that historically have been reported to be extraordinarily expensive. This paper is a case study of a managed care treatment model and presents costs of treatment in the first year of utilization. Medical care costs of 295 cases are compared with state and national figures and are found to be substantially better, especially with regard to soft tissue injuries and injuries that involve days lost from work.

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References

  1. Department of Commerce Bureau of the Census. Statistical Abstract of the United States: 1993 (113th Ed.). Table 599, Washington, DC, 1993, p. 379.

    Google Scholar 

  2. Webster BS, Snook SH. The cost of 1989 Workers' Compensation low back pain claims. Spine 1994; 19(10): 1111–1116.

    Article  CAS  PubMed  Google Scholar 

  3. National Council on Compensation Insurance. Media Release. National Safety Council Research & Statistical Services: 1–4, Itasca, IL, 1993.

    Google Scholar 

  4. Kovar MG, LaCroix AZ. Aging in the Eighties, Ability to Perform Work-Related Activities, Data from the Supplement on Aging to the National Health Interview Survey, United States, 1984. Advance Data from 14tal and Health Statistics, No. 136, DHHS Pub. No. (PHS) 87-1250, Public Health Service, National Center for Health Statistics, Hyattsville, MD, May 8, 1987.

    Google Scholar 

  5. Pope MH, Frymoyer JW, Andersson, G, eds. Occupational low backpain. New York: Praeger, 1984.

    Google Scholar 

  6. Deyo RA, Bass JE. Lifestyle and low-back pain: The influence of smoking and obesity. Spine 1989; 14(5): 501–506.

    Article  CAS  PubMed  Google Scholar 

  7. Antonakes JA. Claims costs of back pain. Best's Review. September 1981.

    Google Scholar 

  8. Leavitt SS, Johnston TL, Beyer RD. The process of recovery: Patterns in industrial back injury. Part I: Costs and other quantitative measures of effort. Indust Med Surg 1971; 40(8): 7–14.

    Google Scholar 

  9. Klein BP, Jensen RC, Sanderson LM. Assessment of workers' compensation claims for back strains/sprains. J Occup Med 1984; 26: 443–448.

    Article  CAS  PubMed  Google Scholar 

  10. Spengler DM, Bigos SJ, Martin NA, Zeh J, Fisher L, Nachemson A. Back injuries in industry: A retrospective study. I. Overview and cost analysis. Spine 1986; 11(3): 241–245.

    Article  CAS  PubMed  Google Scholar 

  11. Snook SH, Wébster BS. The cost of disability. Clin Orthop Rel Res 1987; 221: 77–84.

    Google Scholar 

  12. Jette AM, Smith K, Haley SM, Davis KD. Physical therapy episodes of care for patients with low back pain. Phys Ther 1994; 74(2): 101–115.

    CAS  PubMed  Google Scholar 

  13. California Workers' Compensation Institute Bulletin (92-16), September 14, 1992.

  14. Swedlow A, Johnson G, Smithline N, Milstein A. Increased costs and rates of use in the California Workers' Compensation System as a result of self-referral by physicians. N Engl J Med 1992; 327(21): 1502–1506.

    Article  CAS  PubMed  Google Scholar 

  15. Gervais S, Dupuis G, Veronnean F, Bergeron Y, Millette D, Avard J. Predictive model to determine cost/benefit of early detection and intervention in occupational low back pain. J Occup Rehab 1991; 1(2): 113–131.

    Article  CAS  Google Scholar 

  16. Moffroid MT, Aja D, Haugh LD, Henry S. Efficacy of a part-time work hardening program for persons with low-back pain. Work Summer 1993; 3(3): 14–20.

    Google Scholar 

  17. National Council on Compensation Insurance. Workers' Compensation Claim Characteristics, 1991.

  18. Wheaton C. Crawford results vs NCCI results in workers' compensation: A study in benchmarking. Crawford Risk Rev 1993; 9(4): 2–9.

    Google Scholar 

  19. California Workers' Compensation Institute. Workers' compensation litigation costs, 1990, CWCI Research Notes, September 1991.

  20. California Workers' Compensation Institute Bulletin (93-8). May 14, 1993.

  21. California Workers' Compensation Institute Bulletin (93-9). May 21, 1993.

  22. California Workers' Compensation Institute Bulletin (93-17). December 7, 1993.

  23. California Workers' Compensation Institute Bulletin (93-18). December 13, 1993.

  24. Scofea LA. The development and growth of employer-provided health insurance. Monthly Labor Rev 1994; 117(3): 3–10.

    CAS  Google Scholar 

  25. Lamb E. Growth rate slows down in consumer prices, 1994. Monthly Labor Rev May 1994; 5.

    Google Scholar 

  26. Spitzer WO, LeBlanc FE, Depuis M. Scientific approach to the assessment and management of activity-related spinal disorders. Spine 1987; 12(7S).

    Google Scholar 

  27. Wood GA, Morrison DL, Macdonald S. Factors influencing the cost of workers' compensation claims: The effects of settlement method, injury characteristics, and demographics. J Occup Rehab 1993; 3(4): 201–211.

    Article  CAS  Google Scholar 

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Matheson, L.N., Brophy, R.G., Vaughan, K.D. et al. Workers' compensation managed care: Preliminary findings. J Occup Rehab 5, 27–36 (1995). https://doi.org/10.1007/BF02117818

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