Outsourcing has become increasingly widespread throughout industrialized societies over the past 20 years. Accompanying this has been a renewed growth in home-based work, sometimes using new technologies (telework) but also entailing a re-emergence of old forms, such as clothing outwork, used extensively 100 years ago. A growing body of research indicates that changes to work organization associated with outsourcing adversely affect occupational health and safety (OHS), both for outsourced workers and for those working alongside them. This study assessed the OHS implications of the shift to home-based workers in the Australian clothing industry by systematically comparing the OHS experiences of 100 factory-based workers and 100 outworkers. The level of self-reported injury was over three times higher among outworkers than factory-based workers undertaking similar tasks. The most significant factor explaining this difference was the payment system. All outworkers were paid solely by the piece, whereas factory workers were paid either under a time plus production bonus system or solely on a time basis. While the incidence of injury was far higher among outworkers, factory-based workers paid under an incentive system reported more injuries than those paid solely on a time basis. Increasing injury was correlated with piecework payment systems.