Is compensation "bad for health"? A systematic meta-review.

Australian Centre for Economic Research on Health, The University of Queensland, Level 3 Mayne Medical School, Herston Road, Herston, Queensland, Australia 4006.
Injury (Impact Factor: 2.46). 01/2011; 42(1):15-24. DOI: 10.1016/j.injury.2009.12.009
Source: PubMed

ABSTRACT There is a common perception that injury compensation has a negative impact on health status, and systematic reviews supporting this thesis have been used to influence policy and practice decisions. This study evaluates the quality of the empirical evidence of a negative correlation between injury compensation and health outcomes, based on systematic reviews involving both verifiable and non-verifiable injuries.
Systematic meta-review (a "review of reviews").
PubMED, CINAHL, EMBASE, PEDro, PsycInfo, EconLit, Lexis, ABI/INFORM, The Cochrane Library, and the AHRQ EPC were searched from the date of their inception to August 2008, and hand searches were conducted.
Selection criteria were established a priori. Included systematic reviews examined the impact of compensation on health, involved adults, were published in English and used a range of outcome measures. Two investigators independently applied standard instruments to evaluate the methodological quality of the included reviews. Data on compensation scheme design (i.e., the intervention) and outcome measures were also extracted.
Eleven systematic reviews involving verifiable and non-verifiable injuries met the inclusion criteria. Nine reviews reported an association between compensation and poor health outcomes. All of them were affected by the generally low quality of the primary (observational) research in this field, the heterogeneous nature of compensation laws (schemes) and legal processes for seeking compensation, and the difficulties in measuring compensation in relation to health.
Notwithstanding the limitations of the research in this field, one higher quality review examining a single compensation process and relying on primary studies using health outcome (rather than proxy) measures found strong evidence of no association between litigation and poor health following whiplash, challenging the general belief that legal processes have a negative impact on health status. Moves to alter scheme design and limit access to compensation on the basis that it is "bad for health" are therefore premature, as evidence of such an association is unclear.

1 Bookmark
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction Healthcare providers (HCPs) are influential in the injured worker's recovery process and fulfil many roles in the delivery of health services. Interactions between HCPs and insurers can also affect injured workers' engagement in rehabilitation and subsequently their recovery and return to work. Consideration of the injured workers' perceptions and experiences as consumers of medical and compensation services can provide vital information about the quality, efficacy and impact of such systems. The aim of this systematic review was to identify and synthesize published qualitative research that focused on the interactions between injured workers, HCPs and insurers in workers' compensation systems in order to identify processes or interactions which impact injured worker recovery. Method A search of six electronic databases for literature published between 1985 and 2012 revealed 1,006 articles. Screening for relevance identified 27 studies which were assessed for quality against set criteria. A final 13 articles of medium and high quality were retained for data extraction. Results Findings were synthesized using a meta-ethnographic approach. Injured workers reported that HCPs could play both healing and harming roles in their recovery. Supportive patient-centred interaction with HCPs is important for injured workers. Difficult interactions between HCPs and insurers were highlighted in themes of adversarial relations and organisational pressures. Insurer and compensation system processes exerted an influence on the therapeutic relationship. Recommendations to improve relationships included streamlining administrative demands and increasing education and communication between the parties. Conclusion Injured workers with long term complex injuries experience difficulties with healthcare in the workers' compensation context. Changes in insurer administrative demands and compensation processes could increase HCP participation and job satisfaction. This in turn may improve injured worker recovery. Further research into experiences of distinct healthcare professions with workers' compensation systems is warranted.
    Journal of Occupational Rehabilitation 05/2014; · 2.80 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To compare health status, effect on family, occupational consequences, and quality of life (QOL) 1 year after an accident between patients with whiplash versus other mild injuries, and to explore the relationship between initial injury (whiplash vs other) and QOL. This was a prospective cohort study. The study used data from the ESPARR cohort (a representative cohort of road accident victims) and included 173 individuals with "pure" whiplash and 207 with other mild injuries. QOL at 1-year followup was assessed on the World Health Organization Quality of Life questionnaire. Correlations between explanatory variables and QOL were explored by Poisson regression to provide adjusted relative risks, with ANOVA for the various QOL scores explored. One year post-accident, more patients who had whiplash than other casualties complained of nonrecovery of health status (56% vs 43%) and of the occupational effect of pain (31% vs 23%). QOL and posttraumatic stress disorder (PTSD) were similar in the 2 groups. Impaired QOL did not correlate with whiplash when models were adjusted on sociodemographic variables and history of psychological distress. Whatever the initial lesion, PTSD was a determining factor for poorer QOL. Sociodemographic factors, preaccident psychological history prior to the accident, and PTSD were the main factors influencing QOL, rather than whether the injury was whiplash. PTSD may also be related to pain.
    The Journal of Rheumatology 12/2013; 41(3). · 3.17 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to examine differences in pre-, peri-, and post-collision clinical variables across litigating motor vehicle collision (MVC) patients who were classified as dysfunctional (DYS), interpersonally distressed (ID), or adaptive copers (AC) based on Multidimensional Pain Inventory (MPI) profile classifications. A sample of 240 MVC patients who sustained serious physical injuries and experienced MVC-related chronic pain completed the MPI and provided responses to a semi-structured psycholegal interview designed to elicit injury- and pain-related symptoms and treatments, determine the presence and impact of pre-collision experiences, and render psychiatric diagnoses and ratings of psychological disability. A significant multivariate effect of MPI profile group on post-collision variables was revealed, with the DYS and ID groups reporting more pain sites than the AC group and the DYS group receiving more recommendations for treatment than the AC group. Larger proportions of the DYS and ID groups were diagnosed as experiencing major depressive disorder than the AC group. A rating of total psychological disability was applied most often to members of the ID group, with partial psychological disability applied most often to members of the DYS group, and no psychological disability applied most often to members of the AC group. This study extends the MPI literature by establishing the usefulness of the measure in determining those reports of MVC-related pain and emotional distress that are most likely to be associated with post-collision psychological disability. The current study supports the usefulness of MPI profile classifications in identifying MVC patients who are likely to require and benefit from intensive psychological and other rehabilitative interventions.
    The Clinical journal of pain 11/2013; · 2.70 Impact Factor

Full-text (2 Sources)

Available from
Jun 5, 2014