Oregon Tests Concept of Combining Workers' Compensation Insurance with Health Insurance

Pilot projects combining workers' compensation and health insurance

From 1993 to 1996, the State of Oregon, Department of Insurance and Finance piloted programs to test an untried approach to contain medical costs, called "24-hour coverage."

Twenty-four hour coverage uses a single health policy to cover employees' injuries or illnesses, whether or not they were work related.

Key Results

  • Oregon successfully launched four pilots of modified 24-hour coverage plans, but changes during the grant led to extremely low enrollment that prevented the completion of a proposed evaluation. These changes included:

    • Significant decreases in workers' compensation premiums.
    • The repeal of Oregon's law mandating employer-sponsored health insurance.
    • The failure of President Clinton's health care reform proposal.
  • Despite this, the project:

    • Transformed an imprecise concept, "24-hour coverage," into a real-world demonstration.
    • Accelerated the process of cooperation between group health and workers' compensation insurers.
    • Accelerated the development of managed care in workers' compensation.
    • Facilitated negotiations between workers' compensation insurers and managed care networks to adopt a unified fee schedule for all medical services.

Key Findings

  • Coordinating the medical care for workers' compensation and health insurance is feasible.

  • Due to political and economic changes during the grant, there was not viable interest in integrating medical care for group health insurance and workers' compensation into a single insurance policy.

  • There is modest interest in coordinating group health insurance and medical coverage for workers' compensation as long as two separate insurance policies remain in effect.

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