零成本工人赔偿医疗索赔真的没有成本吗？工作场所伤害对团体健康保险利用和成本的影响。
Do zero-cost workers' compensation medical claims really have zero costs? The impact of workplace injury on group health insurance utilization and costs.
机构信息
From the Office of the Director, Centers for Disease Control and Prevention-National Institute for Occupational Safety and Health, Washington, DC.
出版信息
J Occup Environ Med. 2013 Dec;55(12):1394-400. doi: 10.1097/JOM.0000000000000030.
OBJECTIVE
Previous research suggests that non-workers' compensation (WC) insurance systems, such as group health insurance (GHI), Medicare, or Medicaid, at least partially cover work-related injury and illness costs. This study further examined GHI utilization and costs.
METHODS
Using two-part model, we compared those outcomes immediately after injuries for which accepted WC medical claims made zero or positive medical payments.
RESULTS
Controlling for pre-injury GHI utilization and costs and other covariates, our results indicated that post-injury GHI utilization and costs increased regardless of whether a WC medical claim was zero or positive. The increases were highest for zero-cost WC medical claims.
CONCLUSION
Our national estimates showed that zero-cost WC medical claims alone could cost the GHI $212 million per year.
目的
既往研究表明，非工人赔偿（WC）保险体系，如团体健康保险（GHI）、医疗保险或医疗补助，至少部分覆盖与工作相关的伤害和疾病成本。本研究进一步考察了 GHI 的使用情况和费用。
方法
我们使用两部分模型，比较了那些接受 WC 医疗理赔的零支付或正支付医疗费用的受伤者的 GHI 使用和费用情况。
结果
控制受伤前 GHI 的使用和费用以及其他协变量，我们的结果表明，无论 WC 医疗理赔是零支付还是正支付，受伤后的 GHI 使用和费用都会增加。零成本 WC 医疗理赔的增加幅度最高。
结论
我们的全国估计显示，仅零成本 WC 医疗理赔每年就可能使 GHI 支出 2.12 亿美元。
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