Coverage of work-related problems by workers’ compensation in primary care

Alex Collie1,2, Joan Henderson3, Helena Britt3 & Ying Pan3.

1.Institute for Safety Compensation and Recovery Research, Melbourne, Australia2.Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia3.University of Sydney, Sydney, Australia

Presentation to the Canadian Association of Research on Work and HealthVancouver, 2nd June 2012

Outline

• Treatment of work-related problems in General Practice

• Australian workers’ compensation arrangements

• The BEACH study

• Coverage of work-related problems by GPs in Australia

• Discussion and Conclusions

Work-related problems in General Practice

• GP treated injuries in Australia:

• 74% musculoskeletal

• 11% wounds

• 8% crush/burn

• 5% eye

• 2% other

• GP treated diseases in Australia:

• 49% musculoskeletal

• 14% psychological

• 10% skin

• 6% neurological

• 2% respiratory

Driscoll T, Hendrie AL. Aust NZ J Pub Health, 2002: 26(4); 346-351.

Work-related problems in General Practice

•3-5% of all work-related injures result in hospitalisation (Allard E Dembe et al,

(2003) 44 Am J Ind Med 331.)

•In Victoria, Australia during the period 2000 to 2010:

• 34% of injured workers see a GP on the day of the accident.

• 76% of workers compensation clients in Victoria visited a GP.

• Of those, the mean number of GP visits during the course of a claim was 17.4 (SD 30.1).

• The workers compensation regulator spent $1.76 billion on GP services (Collie A, unpublished data)

General Practitioners have a critical role in treatment and rehabilitation of injured workers.

Australian workers’ compensation jurisdictions

•12 workers compensation jurisdictions• 6 states, 2 territories, Comcare, Seacare, Dept of

Veterans’ Affairs, Dept of Defence

•Regulatory differences between jurisdictions• Eligibility• Entitlements

•Societal differences between jurisdictions• Industry mix • Access to healthcare services (geography)

Aims

• To compare the proportion and nature of GP treated occupational health problems in Australia that are claimed through workers’ compensation with those not claimed.

• To determine the coverage of GP treated occupational health conditions by workers’ compensation schemes between jurisdictions.

The Bettering the Evaluation And Care of Health (BEACH) study

• Continuous national study of GP clinical activity, began 1998

• Random sample of 1000 GPs across Australia per annum

• Each GP records details of 100 consecutive patient encounters

• Data recorded:• Reasons for encounter• Problems managed• Referrals / prescriptions• Funding source (workers compensation, medicare, private etc..)• Work-related

Britt H, Miller GC, Charles J, Henderson J, Bayram C, Pan Y: General practice activity in Australia, 2008-09. Canberra: Australian Institute of Health and Welfare; 2009. (AIHW Cat. No. GEP 25.)

Method - overview

Work-related encountersN=12,580 (2.6%)

All GP encounters on BEACHApr 2004 to Mar 2009

N=486,400

Other encountersN=473,820 (97.4%)

Claimed on workers compensation

N=9,743 (77.4%)

Claimed on workers compensation

N=2,837 (22.6%)

Between groups analysis of problems managed.

Analysis of geographic distribution of encounters.

excluded

Top 10 problem categories

RankClaimed on workers compensation Not claimed on workers compensation

Problem Rate per 100 GP encounters Problem Rate per 100

GP encounters

1 Musculoskeletal 69.0 (67.8-70.2) Musculoskeletal 46.4 (43.9-48.9)

2 Skin 12.2 (11.4-13.0) Psychological 21.7 (19.2-24.2)

3 Psychological 8.3 (7.4-9.1) General & unspecified 10.6 (9.2-12.0)

4 General & unspecified 5.9 (5.3-6.4) Skin 10.1 (8.9-11.4)

5 Neurological 3.9 (3.5-4.3) Neurological 3.3 (2.7-4.0)6 Eye 1.4 (1.1-1.7) Respiratory 2.7 (2.0-3.5)7 Digestive 0.9 (0.7-1.1) Eye 2.0 (1.5-2.6)8 Circulatory 0.7 (0.6-0.9) Circulatory 1.7 (1.2-2.2)

9 Respiratory 0.4 (0.3-0.5) Digestive 1.6 (1.1-2.0)

10 Endocrine & metabolic 0.3 (0.2-0.4) Social 1.2 (0.8-1.6)

Subtotal 103 Subtotal 101.3

Top 10 problems managed

RankClaimed on workers’ compensation Not claimed on workers’ compensation

Problem Rate per 100 encounters Problem Rate per 100

encounters1 Back complaint 17.5 (16.6-18.4) Back complaint 12.8 (11.4-14.1)

2 Sprain/Strain 12.8 (11.9-13.6) Acute stress reaction 7.1 (5.9-8.3)

3 Musculoskeletal NOS 10.5 (9.7-11.3) Depression 6.4 (5.2-7.6)

4 Injury skin, other 4.5 (4.1-5.0) Sprain/Strain 6.2 (5.1-7.4)

5 Fracture 4.1 (3.7-4.6) Musculoskeletal NOS 5.0 (4.2-5.9)

6 Laceration / cut 3.7 (3.3-4.1) Anxiety 4.7 (3.7-5.6)7 Depression 3.7 (3.2-4.1) Fracture 2.6 (2.0-3.3)8 Shoulder syndrome 2.9 (2.6-3.3) Osteoarthritis 2.3 (1.8-2.9)

9 Bursitis/tendonitis/synovitis NOS 2.8 (2.5-3.2) Bursitis/tendonitis/

synovitis NOS 2.2 (1.6-2.7)

10 Acute internal damage knee 2.5 (2.2-2.9) Injury skin, other 2.1 (1.6-2.7)

Subtotal 65.2 Subtotal 51.5

Percentage of encounters not claimed by state/territory

Percentage of encounters not claimed by geographic region

Nearly a quarter of work-related problems managed by GPs are not claimed

• In Australia, 22.4% of problems managed by GPs are not claimed on workers’ compensation.

• Consistent with prior studies:

• 57% of work-related fatalities were included in workers’ compensation datasets (Driscoll T, et al. OEM 2003, 60; 195-201)

• 62% of surveyed Australians with work-related injury did not apply for workers’ compensation (SafeWork Australia, 2009)

• Up to 40% of work-related injury and disease appearing on health datasets do not arise on workers’ compensation datasets. (Driscoll T, et al. OEM

2003, 60; 195-201; Boufous A, Williamson A. Aust NZ J Pub Health 2003; 27: 352-356)

“Invisible” problems are less likely to be claimed on workers compensation

• Encounters at which physically evident problems are managed are more likely to be claimed on workers compensation.So-called “invisible” problems are less likely to be claimed.

• Possible reasons• Perceived negative impact of claiming • Eligibility restrictions• Awareness of eligibility

• Australian Work-Related Injury Survey (WRIS) 2005-06:• Reasons for not applying for workers compensation:

• 8% - identified potential negative impact on current or future employment • 5% - stated they were not covered by workers compensation (e.g., sole traders)• 9% - did not think condition was eligible

There are jurisdictional and geographic variations in claiming behaviour

• Significant differences between states and geographic regions.• Queensland and the Northern Territory had the highest percent of unclaimed

encounters / Tasmania the lowest.• Regional and remote workers less likely to claim.

• Possible reasons:• Eligibility differences between jurisdictions• Access to compensation systems in remote areas

• Paradox?• “Risky” industries (e.g., forestry, agriculture, mining) are concentrated in regional /

remote areas yet GP encounters in these areas are less likely to result in a workers compensation claim.

Conclusions

• GPs are an important ‘gatekeeper’ in workers compensation cases.

• Nearly a quarter of GP treated work-related problems do not result in a workers compensation claim.

• “Invisible” problems managed by GPs are less likely to be claimed on workers’ compensation.

• Jurisdictional and geographic differences have an impact on claiming behaviour.

For more information

Dr Alex Collie

Chief Research Officer,

Institute for Safety Compensation and Recovery Research

Monash University

Email - alex.collie@monash.edu

Phone - (03) 9097 0604

Web – www.iscrr.com.au