Loss Reduction Through Worker Satisfaction: The Case of Workers’ Compensation

A prospective study of occupational low back pain (LBP) indicates loss reduction efforts in workers’ compensation that improve workers satisfaction with the treatment of their claim significantly improves levels of recovery (reduces losses) and lowers workers’ compensation insurance costs. The improved outcomes associated with greater worker satisfaction with the firm's treatment of their injury claim, as well as with the treatment from their health care provider, are robust to five alternative measures of back problems, including leg pain and back pain scales, measures of functional limitation, and quality of life scales. Satisfaction with effectiveness of the health care is more important in recovery than satisfaction with the provider's bedside manner. While satisfaction with health care provider significantly improves back pain and functionality at 6 months, satisfaction with the employer's treatment of the claim is equally important at 6 months and grows in quantitative importance at 1 year. Overall, higher satisfaction with claim treatment reduces the likelihood that an injury becomes an indemnity claim and results in almost a 30 percent reduction in claim costs.     

Medical Labour Supply and the Production of Healthcare

Medical labour markets are important because of their size and the importance of medical labour in the production of healthcare and in subsequent patient outcomes. We present a summary of important trends in the UK medical labour market, and we review the latest research on factors that determine medical labour supply and the impact of labour on patient outcomes. The topics examined include: the responsiveness of labour supply to changes in wages, regulation and other incentives; factors that determine the wide variation in physician practice and style; and the effect of teams and management quality on patient outcomes. This literature reveals that while labour supply is relatively unresponsive to changes in wages, medical personnel do react strongly to other incentives, even in the short run. This is likely to have consequences for the quality of care provided to patients. We set out a series of unanswered questions in the UK setting, including: the importance of non‐financial incentives in recruiting and retaining medical staff; how individuals can be incentivised to work in particular specialties and regions; and how medical teams can be best organised to improve care.     

The case for case management

An effective case management program can help healthcare organizations: Position the organization for changes under healthcare reform with coordination of care across the healthcare continuum. Enhance quality of care with an interdisciplinary team focus on the progression of the plan of care. Increase payment and decrease costs by expediting patient discharge. Improve the revenue cycle process by ensuring accurate coding for prompt billing, reducing denials, and improving contracting terms with managed care payers. Proactively prepare for Recovery Audit Contractor audits and protect against unfavorable results.     

Medicare Secondary Payer--liability of alleged tortfeasors. Mason v. American tobacco company

The Medicare Secondary Payer (MSP) statute does not provide individuals whose medical costs have been paid for by Medicare with a right of recovery against alleged tortfeasors (wrongdoers). Tobacco companies are not self-insured primary plans under the MSP statute because they have no existing contractual obligation to pay the health care costs of those injured by smoking.     

Membranoproliferative glomerulonephritis

Glomerulonephritis (GN) encompasses a wide variety of primary and secondary diseases that cause injury to the functioning unit of the kidney, the glomerulus. The many classifications of GN sometimes lead to confusion. This case study describes an individual with membranoproliferative GN and includes discussion of classification, treatment, and prognosis of this disease.     

Evolve and integrate: a new imperative for ambulatory care

A highly evolved ambulatory care delivery system possesses four key attributes: high-quality care, exceptional levels of access, outstanding patient and staff satisfaction, and cost-effective delivery of care. Such a system seeks to ease management of the patient care continuum by delivering as many services as possible under one umbrella. High-quality, cost-effective care is achieved through improved care coordination and cost management, resulting from a tight connection between physicians and hospitals and between inpatient and outpatient settings. Improved access is an important means to improving patient satisfaction.     

How to solve the cost crisis in health care

U.S. health care costs currently exceed 17% of GDP and continue to rise. One fundamental reason that providers are unable to reverse the trend is that they don't understand what it costs to deliver patient care or how those costs compare with outcomes. To put it bluntly, few health care providers measure the actual costs for treating a given patient with a given medical condition over a full cycle of care, or compare the costs they incur with the outcomes they achieve. What isn't measured cannot be managed or improved, and this is all too true in health care, where poor costing systems mean that effective and efficient providers go unrewarded, and inefficient ones have little incentive to improve. But all this can be remedied by exploring the concept of value in health care and carefully measuring costs. This article describes a new way to analyze costs that uses patients and their conditions--not organizational units or narrow diagnostic treatment groups--as the fundamental unit of analysis for measuring costs and outcomes. The new approach, called time-driven activity-cased costing, is currently being implemented in pilots at the Head and Neck Center at MD Anderson, the Cleft Lip and Palate Program at Children's Hospital in Boston, and units performing knee replacements at Sch?n Klinik in Germany and Brigham & Women's Hospital in Boston. As providers and payors better understand costs, they will be positioned to achieve a true "bending of the cost curve" from within the system, not in response to top-down mandates. Accurate costing also unlocks a whole cascade of opportunities, such as process improvement, better organization of care, and new reimbursement approaches that will accelerate the pace of innovation and value creation.     

Confronting the fear factor: the coverage/access disparity in universal health care

Since their introduction following World War II, single-payer health care systems and universally mandated health care systems have stumbled, but in their pratfalls are many lessons that apply to the universal health care proposals currently on the table in the United States. The critical and often-over-looked point is that universal coverage does not guarantee that individuals will receive needed care--In many cases guaranteed access to care is a false promise or available only on a delayed timetable. A more feasible alternative lies in providing a safety net for citizens who truly need care and financial support with an appropriate system of checks and balances--without disrupting the economic and actuarial fundamental principles of supply and demand and risk classification.     

An examination of market efficiency: Information order effects in a laboratory market

A series of laboratory double auction experiments is conducted to examine whether the order of information releases affects market prices. Behavioral research on belief revision has shown that individuals are influenced by the order in which a series of information items is presented. The experiments are designed to provide a controlled investigation of whether order effects as displayed by individuals also can influence prices in a market setting where outcomes are not a simple aggregation of individual behavior. Significant evidence is found of a recency effect in the experimental asset markets.     

Designing a guideline-based utilization management program

Many public and private organizations are developing and publishing clinical guidelines to assist health care providers and patients in making appropriate medical decisions. Unless clinical guidelines are part of a well-designed managed care program, they have little effect on physician practice styles. This article explores integral components of an effective guideline-based utilization management program. Initial evaluation of this program suggests that, as part of a well-designed utilization management program, clinical guidelines can inform patients and physicians, and create appropriate incentives for effective health care delivery.     

The cost of treating injured workers: the changing workers' compensation landscape

To better understand the impact of changing health care delivery on the workers' compensation system and the cost of treating injured workers, the author examines the program within the context of recent environmental changes--including the likely impact of managed care.     

When You Know Your Neighbour Pays Taxes: Information,Peer Effects and Tax Compliance

In this paper, we suggest that individuals’ tax compliance behaviours are affected by the behaviour of their ‘neighbours’, or those about whom they may have information, whom they may know, or with whom they may interact on a regular basis. Individuals are more likely to file and to report their taxes when they believe that other individuals are also filing and reporting their taxes; conversely, when individuals believe that others are cheating on their taxes, they may well become cheaters themselves. We use experimental methods to test the role of such information about peer effects on compliance behaviour. In one treatment setting, we inform individuals about the frequency that their neighbours submit a tax return. In a second treatment setting, we inform them about the number of their neighbours who are audited, together with the penalties that they pay. In both cases, we examine the impact of information on filing behaviour and also on subsequent reporting behaviour. We find that providing information on whether one's neighbours are filing returns and/or reporting income has a statistically significant and economically large impact on individual filing and reporting decisions. However, this ‘neighbour’ information does not always improve compliance, depending on the exact content of the information.     

Fraud Classification Using Principal Component Analysis of RIDITs

This article introduces to the statistical and insurance literature a mathematical technique for an a priori classification of objects when no training sample exists for which the exact correct group membership is known. The article also provides an example of the empirical application of the methodology to fraud detection for bodily injury claims in automobile insurance. With this technique, principal component analysis of RIDIT scores (PRIDIT), an insurance fraud detector can reduce uncertainty and increase the chances of targeting the appropriate claims so that an organization will be more likely to allocate investigative resources efficiently to uncover insurance fraud. In addition, other (exogenous) empirical models can be validated relative to the PRIDIT‐derived weights for optimal ranking of fraud/nonfraud claims and/or profiling. The technique at once gives measures of the individual fraud indicator variables’ worth and a measure of individual claim file suspicion level for the entire claim file that can be used to cogently direct further fraud investigation resources. Moreover, the technique does so at a lower cost than utilizing human insurance investigators, or insurance adjusters, but with similar outcomes. More generally, this technique is applicable to other commonly encountered managerial settings in which a large number of assignment decisions are made subjectively based on ‘‘clues,‘’ which may change dramatically over time. This article explores the application of these techniques to injury insurance claims for automobile bodily injury in detail.     

Comparative mortality of adults with traumatic brain injury in California, 1988--97

We studied mortality rates of people with traumatic brain injury using the extensive California Department of Developmental Services database. The data provide mortality rates by age, gender, severity, cause, and associated conditions on 2629 subjects older than 15 years during 1988--97. Increased mortality was observed, particularly among patients with diminished mobility.     

Managed Care and Health Care Utilization: Specification of Bivariate Models Using Copulas

This article studies the effect of managed care on health care utilization compared to traditional fee-for-service plans in private health insurance market. To construct our hypothesis, we build a game-theoretic model to study health care utilization under a two-sided moral hazard: of patients and providers. In econometric modeling, we employ a copula regression to jointly examine individuals’ health plan choice and their utilization of medical care services, because of the endogeneity of insurance choice. The dependence parameter in the copula reflects the relation between the two outcomes, based on which the average treatment effects are further derived. We apply the methodology to a survey data set of the U.S. population and consider three types of curative care and three types of preventive care for the measurement of medical care utilization. We find that managed care is in general associated with higher care utilization. Evidence is also found on the underlying incentives of both patients and medical providers.     

Von der „railway spine“ zum Schleudertrauma — Geschichte und aktuelle Bedeutung seelischer Störungen nach entschädigungspflichtigen Ereignissen

Although post traumatic stress disorder was only recently admitted into the international classification systems, psychological reactions to traumatic incidents have been frequently described for far more than 100 years. The article describes the mental reactions to a trauma in different historical situations. Included are the ?railway spine“ injuries of the 19. century, victims of accidents where third party liability could be claimed and the psychological consequences of the catastrophes which characterized the 20. century; World War One, the rule of National Socialism, World War Two, the expulsion and persecution of political opponents. In the last part the article deals with the whiplash injury. The analysis suggests that different reactions don’t describe an identical disorder. It seems that reactions to injuries are mainly influenced by the historical and social background and the fact of being insured.     

Health information technology and patient outcomes: the role of information and labor coordination

Health information technology (IT) adoption, it is argued, will dramatically improve patient care. We study the impact of hospital IT adoption on patient outcomes focusing on the role of patient and organizational heterogeneity. We link detailed hospital discharge data on all Medicare fee‐for‐service admissions from 2002–2007 to detailed hospital‐level IT adoption information. For all IT‐sensitive conditions, we find that health IT adoption reduces mortality for the most complex patients but does not affect outcomes for the median patient. Benefits from health IT are primarily experienced by patients whose diagnoses require cross‐specialty care coordination and extensive clinical information management.     

Perspectives Articles: Exploring Stakeholder Perspectives on What Is Affordable Health Care

Health care expenditures have accounted for increasing proportions of the U.S. gross domestic product, and the rate of growth of health care expenditures has increased over the past two decades. These two measures of assessing whether the level of health care expenditures is affordable may be appropriate in the aggregate for the United States but are not appropriate to assess whether individual stakeholder groups can afford their particular level of spending on health care. Health care is an economic good that differs from other economic goods, as it involves life and death issues, and invokes a call for a moral authority. This article explores definitions of what is affordable health care from the perspective of different stakeholders and suggests that other measures are needed to assess whether or not health care is affordable for stakeholders as one definition is not appropriate for all stakeholders.