Objectives The objective of this study was to determine the strength of evidence on the effectiveness of two policy levers-the experience rating of workers' compensation insurance and the enforcement of occupational health and safety regulation-in creating incentives for firms to focus on health and safety issues.Methods An extensive systematic literature review was undertaken in an effort to capture both published and grey literature studies on the topic. Studies that met specific subject-matter and methods criteria underwent a quality assessment. A qualitative approach to evidence synthesis, known as "best-evidence" synthesis, was used. This method ranks the strength of evidence on a particular topic on the basis of the number, quality, and consistency of studies on the topic.
ResultsThere was moderate evidence that the degree of experience rating reduces injuries, limited to mixed evidence that inspections offer general and specific deterrence and that citations and penalties aid general deterrence, and strong evidence that actual citations and penalties reduce injuries.Conclusions Although experience rating is a key policy lever of those providing workers' compensation insurance, there is much to be learned about its merits. Few studies have concerned the topic, and most have used crude proxy measures or exploited natural experiments. There have been many more studies on the merits of regulation enforcement, even though here too measures were often crude. Nonetheless, this synthesis indicates that general deterrence is less effective in reducing injury incidence and severity, whereas specific deterrence with regard to citations and penalties does indeed have an impact.Key terms citation; experience rating; inspection; occupational health and safety regulation; penalty; workers' compensation. In this article we use the term "injuries" to refer to both injuries and illness unless expressly referring to both in order to make a distinction between the two. There are two broad avenues by which public policy attempts to influence the prevention of injuries 5 in the workplace: experience rating of workers' compensation insurance premiums and enforcement of occupational health and safety (OHS) regulations. The empirical literature on these policy levers is large, and diverse statistical methods, different levels of data aggregation, and samples from various time periods and jurisdictions are used. As a result, it is difficult to compare and contrast the evidence and quality of evidence provided by different studies. Consequently, synthesizing the evidence for the purposes of informing policy is a formidable task.However, the effort is warranted given that it is a highly significant area of research and policy making. To date, Kralj (1), Hyatt & Thomason (2), Mendeloff (3), and Thomason (4), among others, have reviewed parts of this diverse literature, but none have employed systematic review methodology. To our knowledge, this is the first attempt to perform a systematic review of this literature and one of very few...