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It seems to me like some of the people at work are taking advantage of the Workers' Compensation system. Since they don't have to pay for the care they receive, it's like a paid vacation. Where's the incentive to get better?
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There is some suspicion (and proof) that patients on Workers' Compensation with injuries incur more costs in the course of their treatment. Are they taking advantage of the system? Or is the system the problem?
Studies that seem to verify the increased utilization of health care services and thus increased costs associated with Workers' Compensation usually include all types of medical problems. That approach can skew results and generate conclusions that might not fit all circumstances.
In a recent study, the authors looked at patients with just one type of problem: upper extremity disorders (shoulder, arm, and hand). They chose this particular area of work-related injuries because it is the most common Workers' Compensation claim. They compared various aspects of patient care (diagnostic testing, treatment, wait between diagnosis and surgery, number of doctor visits) between patients on Workers' Compensation and patients covered by standard health insurance.
It turned out that the way in which patients were treated in the Workers' Comp group had more to do with the system than the patient. What do we mean by that?
Well, patients in the standard insurance group could have surgery right away when it was recommended by the surgeon. Workers' Compensation patients had to wait until all the paperwork was completed. This included letters of request and justification being filed and accepted. Often a second opinion was required adding to the total cost and delaying recommended treatment.
As a result, patients in the Workers' Compensation group also had a higher number of doctor visits at a higher total cost. The fact that patients on Workers' Compensation are in effect "on paid leave" has been suggested in the past as an explanation for why they take longer to recover from injuries and accidents.
This concept is referred to as a moral hazard -- they are paid to stay in the sick role and they don't have to pay for their care so there is no incentive to get better.
Some experts suggest that moral hazard is the reason Workers' Compensation patients have more doctor visits, higher rates of surgery, and longer waits between diagnosis and treatment. But, at least from this study on individual clinical data, the authors suggest it's more a result of how the system is run than how the patient uses the system.
Besides the additional paperwork required, they pointed out that it's the surgeon who decides what tests to order. And some of those tests are probably ordered because the surgeon knows Workers' Compensation requires them for reimbursement. So Workers' Comp patients can't really be faulted for the longer time it takes to get treated and get well.
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