Who Is Paying the Bills? Health Care Costs for Musculoskeletal Back Disorders, Washington State Union Carpenters, 1989–2003

Department of Community and Family Medicine, Division of Occupational and Environmental Medicine, Duke University Medical Center, Durham, NC 27710, USA.
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine (Impact Factor: 1.63). 09/2009; 51(10):1185-92. DOI: 10.1097/JOM.0b013e3181b68d0a
Source: PubMed


Factors associated with private health insurance payment rates for musculoskeletal back disorders were examined among a 15-year cohort of union carpenters. Payment patterns were contrasted with work-related back injury rates over time.
Negative binomial regression was used to assess payment rates; generalized estimated equations accounted for multiple observations per person and cost correlation within subjects.
Payment rates increased after work-related injury and with the number of injuries. Increasing private payments and deductibles (inflation-adjusted and discounted) were observed in contrast with a marked decline in reported work-related injuries.
Private insurance payments do not appear to be independent of work-related back injury. Findings suggest cost-shifting from workers' compensation to the union-provided health insurance and to the worker; they also provide a warning regarding reliance on workers' compensation statistics for surveillance of work-related disorders or disease.

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