Overall pattern of health care and social welfare use by injured workers in the British Columbia cohort

Transition between social protection systems for workers with long term health problems: A controlled retrospective cohort study

Many nations have established workers' compensation systems as a feature of their social protection system. These systems typically provide time-limited entitlements such as wage replacement benefits and funding for medical treatment. Entitlements may end for workers with long-term health conditions before they have returned to employment. We sought to determine the prevalence of transitions to alternative forms of social protection, specifically social security benefits, among injured workers with long-term disability, when workers' compensation benefits end. We linked Australian workers' compensation and social security data to examine receipt of social security payments one year before and after workers' compensation benefit cessation. Study groups included (1) injured workers whose workers' compensation benefits ceased due to reaching a 260-week limit introduced by legislative reform (N = 2761), (2) a control group of injured workers with at least 104 weeks workers compensation income support (N = 3890), and (3) a matched community control group (N = 10,114). Adjusted binary logistic regression examined the odds of transitions to social security in the injured worker groups relative to the community control group. Within 12 months of workers' compensation benefit cessation, 60% (N = 1669) of the exposed group received social security payments, of which 41% (N = 1120) received the unemployment allowance and 19% (N = 516) the disability pension. Among the work injured control group, 42% (N = 1676) received social security payments after workers compensation benefits ceased. Transitions to social security payments were significantly more common than community levels for both exposed (OR 25.0, 95%CI = 20.7, 30.1) and work injured control groups (OR 4.7, 95%CI = 4.2, 5.3). Many injured workers with long-term health problems transition to social security when their workers' compensation benefits cease. Transitions were more common among workers whose claims ended due to legislative reform which time-limited benefits. Design and implementation of system level policy reform should consider the social and economic impacts of transitions between separate social protection systems.

The impact of long-term workers' compensation benefit cessation on welfare and health service use: protocol for a longitudinal controlled data linkage study

Background

In 2012, the Australian state of New South Wales passed legislation that reformed its workers’ compensation system. Section 39 introduced a five-year limit on income replacement, with the first affected group having their benefits cease in December 2017. There is limited evidence on how this will affect their healthcare service use and where they will go for financial support.

Methods

Multiple data sources will be linked: administrate workers’ compensation claims data from the State Insurance Regulatory Authority (SIRA), universal health insurance data from the Medical Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS), state hospital and emergency department data, and social welfare data from the Department of Social Services’ Data Over Multiple Individual Occurrences (DOMINO). An estimated 4,125 injured workers had their benefits cease due to Section 39. These will form the exposure group who will be compared to 1) a similar group of workers’ compensation claimants who have had at least two years of compensated time off work but whose benefits did not cease due to Section 39; and 2) a community comparison group drawn from state hospital and emergency department records.

An accredited third party will link the data, which will be accessible only via secure virtual machine. Initial analyses will compare the prevalence and incidence of service use across groups in both the year before and year after benefit cessation; the community control will be assigned the median benefit cessation date in lieu of an actual date. To estimate the impact of benefit cessation due to Section 39, we will conduct time series analysis of the prevalence and incidence of service use.

Discussion

This study will provide much-needed evidence on the consequences of long-term benefit cessation, particularly on subsequent healthcare and welfare service use.

The long-term burden of work-related carpal tunnel syndrome relative to upper-extremity fractures and dermatitis in Washington State

BACKGROUND

Carpal tunnel syndrome (CTS) is among the most burdensome of all musculoskeletal disorders as measured by workers' compensation claims costs and lost earnings. But the burden of CTS extends beyond direct claim costs.

METHODS

A survey covering health, social, economic and work-related outcomes was administered to 1,255 injured workers whose Washington State Fund workers' compensation claims had closed 6 years previously. Logistic and linear regression methods were used to model the outcomes of CTS claimants across four separate outcome domains.

RESULTS

Workers diagnosed with CTS suffer substantial deficits across all four outcome domains as compared to the two comparison groups of claimants. Former CTS claimants were almost twice as likely not to be working as compared to the fractures cohort.

CONCLUSIONS

A comprehensive measurement of the burden of CTS shows losses extend beyond direct claims costs to include continuing pain, loss of function, adverse financial impacts and household disruption which extend long after claim closure. Am. J. Ind. Med. 58:1255-1269, 2015. © 2015 Wiley Periodicals, Inc.

Investigating the longer-term health consequences of work-related injuries among youth

PURPOSE

To investigate the longer-term health consequences of work injuries among youth aged 15-24 years using a population-based, longitudinal study (1991-2001) of merged health care and workers' compensation records.

METHODS

A group-based modeling approach was used (1) to identify unique trajectories of health care use defined by general practitioner visits among the study sample stratified by gender, and (2) to determine the injury factors that predict a youth's membership in a trajectory, adjusted for sociodemographic factors.

RESULTS

Four long-term trajectories of health care use were identified among young injured workers, for both males and females. Similar trajectories were observed among a comparison, noninjured sample but the magnitude of health care use was consistently higher among the injured worker cohort, especially for females (attributable to general practitioner [GP] visits for symptoms, signs and ill-defined diagnoses), and a notable "spike" in health care use occurred in the year immediately after a work injury for both males and females that was not observed in the comparison population during the matched year (attributable to GP visits for musculoskeletal and injury diagnoses). For males, the type of work injury mattered with an increased odds of belonging to the higher health care trajectories associated with a musculoskeletal injury (odds ratio [OR] = 1.57, 95% CI = .76, 3.23; and OR = 1.61, 95% CI 1.08, 2.41 for the postinjury trajectories), adjusted for age, occupation, socioeconomic status, and geographic location.

CONCLUSION

Persistent use of health care services may represent a cumulative burden of morbidity over the life course as a result of a work-related injury in general among young women and as a result of musculoskeletal injuries in particular among males.

Social and economic consequences of workplace injury: a population-based study of workers in British Columbia, Canada

BACKGROUND

Existing research suggests that workplace injuries can have significant economic and social consequences for workers; but there are no quantitative studies on complete populations.

METHODS

The British Columbia Linked Health Database (BCLHD) was used to examine 1994 injured workers who lost work time due to the injury (LT) and a group of injured individuals who did not lose time after their injuries (NLT). Three outcomes were explored: (1) residential change, (2) marital instability, and (3) social assistance use. Logistic regression adjusted for several individual and injury characteristics.

RESULTS

LTs were more likely to move and collect income assistance benefits, and less likely to experience a relationship break-up than the NLTs. LTs off work for 12 or more weeks were more likely to receive income assistance than LTs off for less time.

CONCLUSIONS

The increased risk suggests that the long-term economic consequences of disabling work injury may not be fully mitigated by workers compensation benefits.

How many employees receive safety training during their first year of a new job?

OBJECTIVE

To describe the provision of safety training to Canadian employees, specifically those in their first year of employment with a new employer.

DESIGN

Three repeated national Canadian cross-sectional surveys.

SUBJECTS

59 159 respondents from Statistics Canada's Workplace and Employee Surveys (1999, 2001 and 2003), 5671 who were in their first year of employment.

MAIN OUTCOME

Receiving occupational health and safety training, orientation training or office or non-office equipment training in either a classroom or on-the-job in the previous 12 months.

RESULTS

Only 12% of women and 16% of men reported receiving safety training in the previous 12 months. Employees in their first 12 months of employment were more likely to receive safety training than employees with >5 years of job tenure. However, still only one in five new employees had received any safety training while with their current employer. In a fully adjusted regression model, employees who had access to family and support programs, women in medium-sized workplaces and in manufacturing, and men in large workplaces and in part-time employment all had an increased probability of receiving safety training. No increased likelihood of safety training was found in younger workers or those in jobs with higher physical demands, both of which are associated with increased injury risk.

CONCLUSIONS

From our results, it would appear that only one in five Canadian employees in their first year of a new job received safety training. Further, the provision of safety training does not appear to be more prevalent among workers or in occupations with increased risk of injuries.

Health care use associated with work-related musculoskeletal disorders among hospital workers

INTRODUCTION

The purpose of this study was to investigate if work-related musculoskeletal disorders (WMSDs) are associated with increased health care use, over and above workers' compensation health care benefits, in the period prior to and following a workers' compensation claim indicating gradual progression and declining function associated with musculoskeletal morbidity.

METHODS

This study employed secondary analysis of employment data, workers' compensation claim data and provincial (universal) medical services data for a cohort of health care workers; and investigated rates of medical care contacts among injured workers with a WMSD claim (n=549) compared to a matched group of non-claim workers. Predictors of health care contacts were estimated using general linear regression.

RESULTS

WMSD injured workers had significantly higher rates of health care contacts associated with a claim compared to non-injured workers, over and above workers compensation health care benefits. In the final multi-variable model, a WMSD claim among injured workers was associated with an estimated 69% (95% CI, 1.50, 1.91) increase in health care use for the 12-month period immediately after the injury date compared to non injured workers.

CONCLUSION

The pattern of visits for WMSDs suggests that workers visit general practitioners as part of an ongoing pattern of symptoms, resulting in frequent utilization of health services prior to work disability that is also reflected in health care contacts after return-to-work.

Healthcare use before and after a workplace injury in British Columbia, Canada

OBJECTIVES

There is growing evidence that occupational injuries influence workers' emotional and physical wellbeing, extending healthcare use beyond what is covered by the Workers' Compensation Board (WCB).

METHODS

The authors used an administrative database that links individual publicly funded healthcare and WCB data for the population of British Columbia (BC), Canada. They examined change in service use, relative to one year before the injury, for workers who required time off for their injuries (lost time = LT) and compared them to other injured workers (no lost time = NLT) and individuals in the population who were not injured (non-injured = NI).

RESULTS

LT workers increased physician visits (22%), hospital days (50%), and mental healthcare use (43% physician visits; and 70% hospital days) five years after the injury, relative to the year before the injury, at a higher rate than the NI group. For the NLT workers, the level of increased use following the injury was between that of these two groups. These patterns persisted when adjusting for registration in the BC Medical Service Plan (MSP) and several workplace characteristics.

CONCLUSIONS

Although the WCB system is the primary mechanism for processing claims and providing information about workplace injury, it is clear that the consequences of workplace injury extend beyond what is covered by the WCB into the publicly funded healthcare system.

Trial by fire: a multivariate examination of the relation between job tenure and work injuries

AIMS

This study examined the relation between months on the job and lost-time claim rates, with a particular focus on age related differences.

METHODS

Workers' compensation records and labour force survey data were used to compute claim rates per 1000 full time equivalents. To adjust for potential confounding, multivariate analyses included age, sex, occupation, and industry, as well job tenure as predictors of claim rates.

RESULTS

At any age, the claim rates decline as time on the job increases. For example, workers in the first month on the job were over four times more likely to have a lost-time claim than workers with over one year in their current job. The job tenure injury associations were stronger among males, the goods industry, manual occupations, and older adult workers.

CONCLUSIONS

The present results suggest that all worker subgroups examined show increased risk when new on the job. Recommendations for improving this situation include earlier training, starting workers in low hazard conditions, reducing job turnover rates in firms, and improved monitoring of hazard exposures that new workers encounter.

Individual factors and musculoskeletal disorders: a framework for their consideration

Individual factors have been variously defined as non-work, demographic, physiological or psychological factors. They may represent a variety of important constructs at different relevant levels that may not be initially evident in their measurement. These include: work-related factors e.g., job assignment, duration of exposure, work style, anthropometric mismatches, and differential responses to job demands; concomitant external or internal exposures e.g., sports, smoking, and endogenous hormones; and physical, psychological and social vulnerabilities e.g., prior injury, depression, socio-economic status. Such factors operate in different ways in the development, course and response to interventions of musculoskeletal disorders. Newer framings of their contribution to musculoskeletal disorders are providing new insights into the role of such factors as some among many which contribute to the burden of MSK disorders in working age populations. As researchers, practitioners and policy makers, we need to consider them in order to reduce burden, to protect the vulnerable and to match interventions to different groups of people most appropriately.

Age related differences in work injuries and permanent impairment: a comparison of workers' compensation claims among adolescents, young adults, and adults

BACKGROUND

There is growing evidence that adolescent workers are at greater risk for work injury.

AIMS

To investigate the severity of work injuries across age groups.

METHODS

Workers' compensation records were used to examine work related injuries among adolescents (15-19 years old), young adults (20-24 years old), and adults (25+ years old) between 1993 and 2000. The incidence of compensated injuries was calculated for each age group and compared by gender, industry, and type of injury. The presence and degree of permanent impairment in each age group was also examined.

RESULTS

For males, adolescents and young adults had higher claim rates than adults. For females, adults had the highest claim rates and young adults the lowest. Rates of permanent impairment indicated that age was positively associated with severity of injury.

CONCLUSIONS

Indicators of health consequences, in particular presence of permanent impairment, provide preliminary evidence that compensated work injuries sustained by youth are not as serious as injuries sustained by adults. Nevertheless, there was evidence that some young workers sustain injuries that have long term consequences. Documenting the consequences of the injuries that young workers sustain has implications for secondary prevention efforts and health services policy.