Workers' Compensation Health Initiative

An RWJF National Program

Dates of Program: 1995 through 2008

Field of Work: Containing the cost and improving the quality of health care received through workmen's compensation.

Problem Synopsis: Approximately 95 percent of American workers are covered by workers' compensation insurance, which typically includes payments for medical and rehabilitative expenses resulting from work-related injury or disease, as well as reimbursement for a portion of lost wages. Despite attempts to simplify claims and limit lawsuits, workers' compensation has evolved into an expensive, complicated and adversarial system that often pits an injured worker against an employer's insurance company, creating significant barriers to obtaining appropriate medical care.

Synopsis of the Work: The Workers' Compensation Health Initiative supported demonstration and evaluation projects that tested new models for improving the quality of workers' compensation health care and containing its costs.

Key Conclusions

  • Managed care can contain workers' compensation medical costs more successfully than traditional fee-for-service care.

  • Effective communication among patients, employers, providers and insurers throughout the course of treatment, including return to work, can result in cost savings and improved patient satisfaction.

  • Efforts to coordinate or integrate medical care and wage replacement benefits available through workers' compensation with other private and public health insurance programs (i.e., 24-hour coverage) have proved technically challenging and politically difficult.