Industrial Injury Hospitalizations Billed to Payers Other Than Workers' Compensation: Characteristics and Trends by State

Abstract

Findings suggest potentially dramatic cost shifting from WC to Medicare. This study adds to limited, but mounting evidence that, in at least some states, the burden on non-WC payers to cover health care for industrial injuries is growing, even while WC-related employer costs are decreasing-an area that warrants further research.

Coverage Gaps and Cost-Shifting for Work-Related Injury and Illness: Who Bears the Financial Burden?

“…Azaroff, Levenstein, and Wegman (2002) described a set of conceptual filters underlying low documentation of occupational injury/illness (e.g., work not identified as the injury/illness cause, workers avoiding retaliation or stigma, providers avoiding the WC system), and some of these filters directly contribute to increased financial burden on workers and their families in the aftermath of occupational injury/illness. There is convincing evidence that underreporting of work-related injury/illness, perhaps the most well-researched driver of WC underutilization, is significant and potentially on the rise (Boden & Ozonoff, 2008; Fan, Bonauto, Foley, & Silverstein, 2006; Friedman & Forst, 2007; Groenewold & Baron, 2013; Morse et al, 2005; Rosenman et al, 2000; Rosenman et al, 2006; Sears et al, 2017; Sears, Bowman, & Hogg-Johnson, 2014; Sears, Bowman, Rotert, Blanar, & Hogg-Johnson, 2016; Shannon & Lowe, 2002; U.S. House of Representatives Committee on Education and Labor, 2008).…”

“…Severe work-related injuries, which may be less likely to go unreported, are not declining to the same degree as minor injuries (Sears et al, 2016). There is also limited but mounting evidence that, in at least some states, the relative burden on non-WC payers is growing, even while direct WC-related costs to employers are decreasing (Groenewold & Baron, 2013; Lipscomb, Dement, Silverstein, Cameron, et al, 2009; Lipscomb, Dement, Silverstein, Kucera, 2009; Sears et al, 2017).…”

“…Department of Labor, 2016). Unfortunately, in recent decades, growing evidence suggests that WC is not meeting its core objectives—workers and their families, social safety net programs, employer-provided or individual-purchased health insurance (HI), health care systems, and other entities are increasingly bearing the costs of occupational injury and illness (Groenewold & Baron, 2013; Lipscomb, Dement, Silverstein, Cameron, & Glazner, 2009; Lipscomb, Dement, Silverstein, Kucera, & Cameron, 2009; Sears, Bowman, Blanar, & Hogg-Johnson, 2017). The national health care and productivity cost for occupational injury/illness has been estimated at $250 billion annually, larger than the $219 billion estimate for cancer (Leigh, 2011).…”

“…No single data source captures all occupational injuries and illnesses (Murphy, Sorock, Courtney, Webster, & Leamon, 1996; National Academies of Sciences, Engineering, and Medicine, 2018; Rosenman et al, 2006; Schulte, 2005; Sears & Bowman, 2016). Multiple payers—including individual workers—can be involved in covering the costs of occupational injury/illness, complicating financial burden estimates (Leigh, 2011; National Academies of Sciences, Engineering, and Medicine, 2018; Schulte et al, 2017; Sears, Bowman, Adams, & Silverstein, 2013; Sears et al, 2017). Furthermore, not all costs are direct financial outlays, and can include foregone wages or caregiving activities.…”

What Types of Treatment Are Provided for Patients With Carpal Tunnel Syndrome? A Retrospective Analysis of Commercial Insurance

“…Workers' compensation claims are not covered within our data set, and their treatment information would be lost. However, some literature suggests that rather than switching to workers' compensation, many illnesses that might be treated as workers' compensation might be seen under private insurance [35]. Sixth, in this study we assumed that people with CTS would continue to receive treatments until their symptoms resolved to their satisfaction.…”