Queue 'Research highlights'
In brief
- Problematic interactions among health-care providers, injured workers and workers’ compensation boards may delay the return to work of injured workers with complicated claims.
- Problems can arise in four domains: access to care, conflicting or imperfect medical knowledge, limited understanding of workers’ compensation system requirements and confusion about decision-making authority.
- These problems can result in frustration, financial difficulties and mental health problems for injured workers.
- Open lines of communication among all parties is the goal.
Why was this analysis done?
Health-care providers (HCPs) play a central role in workers’ compensation systems. They help determine if injuries are related to work, provide information to workers’ compensation boards (WCBs) about the nature and extent of injuries, and assess and make recommendations about workers’ return-to-work capabilities. However, when problems occur among the health-care system, injured workers and WCBs, it can delay the return to work of injured workers with complex claims. This analysis explains why and how this happens.
How was this analysis done?
This analysis builds on a larger Institute for Work & Health study that examined why injured workers with long-term workers’ compensation claims have problems with return to work (see www.iwh.on.ca/highlights/toxic-dose). The qualitative study was based on 34 interviews with injured workers who had long-term and complicated claims, 14 peer helpers and 21 service providers. This latter group included health-care providers (HCPs) such as general practitioners, occupational health physicians, physiotherapists and chiropractors, along with employees of Ontario’s Workplace Safety and Insurance Board and legal representatives.
What did the researchers find?
The researchers identified four domains related to injured workers’ experiences of the health-care system that played key roles in complicating and prolonging compensation claims:
- access (e.g. problems among injured workers accessing the health care needed, often due to geography or their status as injured workers);
- communication and understanding (e.g. health-care providers being unfamiliar with the need of WCBs for timely and detailed information in order to adjudicate claims);
- knowledge (e.g. health-care providers being unable to provide the level of diagnostic and work-relatedness certainty preferred by WCBs in order to adjudicate claims, especially when dealing with “invisible” injuries such as musculoskeletal disorders and chronic pain); and
- decision-making ownership (e.g. confusion among the parties about who has ultimate decision-making authority with respect to workers’ health).
These problems resulted in frustration, financial difficulties and mental health problems for injured workers.
The researchers provided some recommendations to improve the ways that injured workers’ health-care needs are being met and to facilitate a supportive relationship between compensation boards and HCPs. For one, they emphasized the need for more communication among all compensation system parties.
What are some strengths and weaknesses of the study?
Strengths of this study include the synergy between accounts of injured workers and service providers, and among participants across the study locations. Weaknesses include the focus on one jurisdiction (Ontario) and the limitation of the number of injured workers studied.
Authors:
Kosny A,
MacEachen E,
Ferrier S,
Journal:
Journal of Occupational Rehabilitation. 2011; [DOI 10.1007/s10926-011-9307-3]
Title:
The role of health care providers in long term and complicated workers' compensation claims In brief
- Physiotherapy use and costs to treat musculoskeletal disorders (MSDs) among employees at a large Ontario workplace increased substantially over a 10-year period.
- Physiotherapy should be accessible to working-age adults with MSDs. The potential exists for unequal access to physiotherapy services among workers not privately insured or covered by their workplaces.
- The growing dependence on private physiotherapy services for working adults may warrant a closer examination of the services covered under universal health-care schemes.
Why was this study done?
Access to primary care is central to Canada’s universal health-care system. But not all workplaces provide health-care benefits to fund physiotherapy services. In Ontario since 1994, physiotherapy has been considered primary care, but the mix of private and public funding for physiotherapy treatment has been in flux.
Provincial health-care plans increasingly restrict insurance coverage for physiotherapy services. For example, in 2005, the Ontario Health Insurance Plan (OHIP) restricted its funding; publicly funded, community-based physical therapy (PT) services offered through Ontario's network of providers were partially delisted in April 2005. Services remaining include those for the following: seniors; those age 19 and under; residents of long-term care homes; those needing physiotherapy services in their home or after being hospitalized; Ontario Disability Support Program, Family Benefits and Ontario Works recipients.
The potential for unequal access exists for those not privately insured or in workplaces without coverage.
In debates over access to essential or “medically necessary” care, comparatively little attention has been paid to the funding of physiotherapy services. This study sought to provide a clearer picture of physiotherapy use and funding among workers with musculoskeletal disorders (MSDs) in one large workplace.
How was the study done?
The study examined physiotherapy use and funding for MSDs among 2,000 employees of a large, unionized newspaper in Ontario. Researchers retrieved billing information about MSD-related physiotherapy services from three payers: the Workplace Safety and Insurance Board (WSIB), the newspapers’s private health insurance carriers, and the workplace itself. Starting in 1995, the workplace reimbursed employees up to $1,500 a year for MSD treatment. As of 1997, it also provided and paid for on-site physiotherapy. The researchers looked at physiotherapy use and costs by quarter, over the period 1992 to 2002.
What did the researchers find?
The researchers noted a substantial rise in physiotherapy use to treat MSDs in this workplace over the 10-year period. An average of 234 physiotherapy services per quarter during the years 1992 to 1994 increased to 1,281 per quarter in 1999 to 2002.This increase in use was accompanied by a shift in payer, from the WSIB and health insurance carriers to, initially, the workplace fund to reimburse costs and then to the employer-paid on-site service. Average costs per quarter for physiotherapy services also increased, from $4,740 per quarter in 1992 to 1994 to $52,134 per quarter in 1999 to 2002. The researchers speculated that the affordability and accessibility of the workplace-funded physiotherapy, along with an active workplace campaign to promote early reporting and treatment of MSDs, accounted for the increase in use and costs.
Pointing to systematic reviews that confirm the effectiveness of physiotherapy, the researchers concluded that physiotherapy should be accessible to working-age adults with MSDs. However, since provincial health insurance programs have become more restrictive and most workplaces do not provide the level of funding and services offered by the newspaper, the potential exists for unequal access to physiotherapy services among workers not privately insured or covered by their workplaces.
The growing dependence on private physiotherapy services for working adults may warrant a closer examination of the services covered under universal health-care schemes.
What are some strengths and weaknesses of the study?
A major strength is that this study provides an important benchmark for Canadian research on the funding of physiotherapy services. A weakness of the study was its inability to obtain OHIP data, which likely led to an underestimation of the total use of physiotherapy.
Authors:
Journal:
Healthcare Policy, 2011: vol. 6, no. 3, pp. 93-108
Title:
Changes in physiotherapy utilization in one workforce: Implications for accessibility among Canadian working-age adults In brief
- In most developed countries, there has been an increase in the number of employment arrangements that are temporary and insecure. There are concerns that these employment arrangements may have adverse effects on the health of workers.
- In a longitudinal study of a representative sample of Canadian workers, certain work characteristics associated with precarious employment—i.e. low pay, no pay increase, substantial unpaid overtime, no pension and manual work—put workers at increased risk of poor physical health.
Why was this study done?
Globalization, trade competition and rapid technological innovation are changing the nature of work. Job security is giving way to precarious work arrangements. Precarious employment tends to fall short in areas such as certainty about continuing work, control over work, legal protection, adequate income and benefits, job status and job safety.
Although a lot has been written about the rise of precarious employment, less research has been done to determine its effects on worker health. This study explored the health effects of being exposed to several aspects of precarious employment.
How was the study done?
Researchers used data from Statistics Canada’s Survey of Labour and Income Dynamics (SLID) from 1999 to 2004. SLID enrols a sample of people who are followed over time and each year provide information on personal characteristics, job factors and self-reported health. The researchers studied a sample of 4,491 people who met the following criteria: 25 to 54 years of age, not a full-time student, employed at least nine months of the year, not self-employed, not a manager, and in good, very good or excellent health at the beginning of the year.
The researchers then looked at the self-reported health of these people during subsequent years and compared it to those aspects of their work linked to precarious employment. Precarious employment was determined using measures such as level of job permanence, irregular schedule, substantial unpaid overtime, involuntary part-time work, no union coverage, low earnings, no annual pay increase, no pension coverage, no supervisory responsibilities and manual work.
What did the researchers find?
People in part-time or contract work did not report poorer health in subsequent years. However, those exposed to other work characteristics associated with precarious employment did report poorer general health or functional limitations in subsequent years.
The study provides evidence that exposure to precarious employment arrangements could have a negative effect on the health of workers. The researchers call for regulatory initiatives and comprehensive benefits programs to address the potential health effects of the changing labour market.
What are some strengths and weaknesses of the study?
By including only workers who were in good health at the beginning of the study period, the researchers helped ensure the results reflect the effect of precarious employment on health, rather than the possibility that poor health leads people to accept precarious work. Limitations include the inability of the study to measure particular dimensions of precarious work, the effect of precarious work on mental health and prolonged exposures to precarious work.
Authors:
Journal:
Work, 2011: vol. 38, no. 4, pp. 369-382
Title:
The health consequences of precarious employment experiences In brief
- From 1999 to 2007, the lost-time claim rate for young Ontario workers (ages 15 to 24) declined more steeply than the adult rate, so that the two rates are converging.
- The convergence in youth and adult claim rates do not appear to be due to changes over time in the industries in which youth work or changes in their job tenure.
- Ontario’s youth-specific prevention initiatives may have contributed to the steeper decline in youth claim rates.
Why was this study done?
Working is a big part of the lives of Canadian teenagers and young adults. One of the most consistent findings in occupational health and safety research over the last two decades is that younger workers have more non-fatal work injuries (and lost-time claims) than adults. Given this tendency, this study sought to examine trends in young worker and adult lost-time claim rates in Ontario in recent years. This type of information is helpful because it provides policy-makers in occupational health and safety with evidence/information to help them determine the best place to target their prevention efforts.
How was the study done?
Approximately 1.2 million lost-time claims reported to Ontario’s Workplace Safety and Insurance Board (WSIB) from 1991 to 2007 were combined with labour force data to compute lost-time claim rates by age group. To examine the contribution of work-related factors, claim rates were also broken down by industry and job tenure.
What did the researchers find?
Young workers, 15 to 24 years of age, showed a much steeper decline in lost-time claim rates from 1999 to 2007, compared to older adults. This illustrates that elevated work injury risk for young workers is not unchangeable. It may, in fact, vary over time due to labour-market factors and/or prevention initiatives.
The study also found that industry and length of time on the job—two work-related factors known to affect the risk of work injury—did not appear to explain the converging youth and adult rates. Although they do not provide direct evidence, these results leave open the possibility that youth-specific interventions begun in Ontario in 1999/2000 contributed to the steeper decline in rates among young workers. This underscores the need to examine the impact of these kinds of broad-based prevention initiatives.
What are some strengths and weaknesses of the study?
This study is one of the first to show a convergence in youth and adult workers’ compensation claims in a North American jurisdiction. The study sample of a complete provincial population of insured workers is also a strength. One weakness is that lost-time claims may not be representative of all work injuries in Ontario. In addition, differential changes in reporting work injuries may have occurred over time.
Authors:
Journal:
Occupational & Environmental Medicine. 2011. [Online first: DOI: 10.1136/oem.2010.062562]
Title:
Examining the decline in lost-time claim rates across age groups in Ontario between 1991 and 2007 In brief
- A small but important minority (14%) of injured workers who make a claim involving neck pain to Ontario’s Workplace Safety and Insurance Board (WSIB) have multiple episodes off work on benefits. This group is responsible for 40 per cent of all lost-time days due to neck pain in a two-year study period.
- Most injured workers who make claims involving neck pain have a single episode on benefits and they are off work for an average of 11 days. (Of note, the average length of this single episode is shorter than the length of the first episode for those with multiple episodes.)
- Recurrent claims for neck pain represent a significant burden of disability.
Why was this study done?
Neck pain is a common and burdensome disorder in most industrialized countries. The global prevalence of neck pain in workers varies from 27 to 48 per cent in any given year, resulting in work limitations in 11 to 14 per cent of workers. Yet very little is known about the course of work absenteeism related to this type of pain. This study was done to describe the course of lost-time claims involving neck pain in workers compensated by WSIB.
How was the study done?
Researchers identified 5,761 injured workers (18 years of age and above) who had a WSIB lost-time claim involving neck pain in 1997 or 1998, and who had not been on workers’ compensation benefits due to neck pain the year before. Researchers followed what happened to these injured workers in the two years after their initial claim. They measured the total time on lost-time benefits, as well as the number of times on benefits, and the length of time associated with the benefits.
What did the researchers find?
The average total time on benefits for injured workers with neck pain was 13 days during the two years following the initial claim. This time was shorter for men than for women, and for younger workers than for older workers.
Most injured workers who made workers’ compensation claims that involved neck pain only had a single episode on benefits within a two-year period. The average time on benefits for injured workers with a single episode was 11 days. Younger workers were more likely than older workers to have only one episode of work absenteeism, and women and men were equally likely to have only one episode.
However, 14 per cent of claimants with a claim for neck pain had multiple episodes on benefits during the two-year follow-up period. For this group, the average number of absentee days was 19 to 22. Workers experiencing multiple episodes were responsible for 40 per cent of all lost-time days due to neck pain during the study period.
What are some strengths and weaknesses of the study?
The strength of the study is that researchers only followed workers who had not had a claim involving neck pain during the previous year. However, the study does not count actual cases of neck pain, only the number of claims—hence, this study could be capturing the ‘tip of the iceberg.’
Authors:
Journal:
Spine, 2011: vol. 36, no. 12, pp. 977-982
Title:
The course of work absenteeism involving neck pain: A cohort study of Ontario lost-time claimants 