Adjusting Rehabilitation Costs and Benefits for Health Capital: The Case of Low Back Occupational Injuries
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Introduction Case-mix adjustments for treatment/rehabilitation costs and benefits of non-traumatic injuries, such as occupational back pain, are much more difficult than adjustments for traumatic injuries. We present a new method for adjusting for severity differences in the costs and benefits of treating occupational low back injuries. Methods Using initial post-injury differences in the health capital of prospective sample of 1,831 occupational related back pain patients, we combine survey data with workers’ compensation claim files and medical billing information to adjust the costs and benefits of treatment using multivariate techniques. Results We find that large differences in the net benefits of treatment between the three lowest cost provider groups virtually disappear once adjustments are made for worker’s health capital (injury severity) at entry into treatment. Conclusions Once adjustments are made for initial health capital immediately after injury, the net benefits of treating occupational low back pain are virtually identical for physician only care, physician plus physical therapy care, and chiropractic care. Net benefits of care are lower for combined physician/chiropractic care, and lowest for all other forms of care (principally, treatment by orthopedic surgeons). Our method is readily adapted for comparisons among individual health care/occupational rehabilitation professionals or among group practices and other health care organizations.
KeywordsHealth capital Cost/benefit analysis Low back pain Provider type Survival curve analysis
This research has been approved by the IRB of Arizona State University and East Carolina University. There are no financial conflicts involved in this research.
- 7.Johnson WG, Baldwin ML, Marcus S. The impact of workers’ compensation networks on medical costs and disability benefits. Cambridge: Workers’ Compensation Research Institute; 1999.Google Scholar
- 9.Grossman M. The demand for health: a theoretical and empirical investigation. Columbia: Columbia University for NBER; 1972.Google Scholar
- 12.Carey TS, Garrett J, Jackman A, McLaughlin C, Fryer J, Smucker DR. The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. The North Carolina back pain project. N Engl J Med. 1995;333(14):913–7.CrossRefPubMedGoogle Scholar
- 17.Ebrall PS. Mechanical low-back pain: a comparison of medical and chiropractic management within the Victorian workplace scheme. Chiroprac J Aus. 1992;22:47–53.Google Scholar
- 20.Hurwitz EL. The relative impact of chiropractic vs. medical management of low back pain on health status in a multispecialty group practice. J Manipulat Physiol Ther. 1994;17:74–82.Google Scholar
- 21.Gold MR, editor. Cost-effectiveness in health and medicine. New York: Oxford University Press; 1996.Google Scholar
- 23.Kolata G. With costs rising, treating back pain often seems futile. The New York Times, February 9, 2004. Late Edition.Google Scholar
- 24.Bigos SJ. United States Agency for Health Care Policy and Research. Acute low back problems in adults. USA: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research; 1994.Google Scholar