Ducatman A M
J Occup Med. 1986 Nov;28(11):1174-6.
Contract health care plans exclude workers' compensation from among the prepaid medical benefits. Under present contract relationships, compensable injury and illness can be billed to the employer as fee-for-service care. The provision of health care, normally an expense for the prepaid health care provider, generates income when it is given under a compensation rubric. Per capita workers' compensation costs at eight federal shipyards range from less than $500 in yards with no health maintenance organization (HMO) coverage to more than $1,000 in yards with more than two-thirds of employees enrolled in prepaid health care plans. A statistically significant relationship between prepaid health care plan enrollment and per capita workers' compensation costs at these yards suggests the likelihood of systematic cost-shifting by overdiagnosis of compensable injury and illness. Changes in prepaid contract incentives may improve the ethical and economic health care climate for workers' compensation.
合同制医疗保健计划将工伤赔偿排除在预付医疗福利之外。在目前的合同关系下，可补偿的伤病可以按服务收费的方式向雇主计费。通常由预付医疗保健提供者承担费用的医疗保健服务，在工伤赔偿的框架下提供时会产生收入。八个联邦造船厂的人均工伤赔偿成本从没有健康维护组织（HMO）覆盖的船厂不到500美元到超过三分之二员工参加预付医疗保健计划的船厂超过1000美元不等。这些船厂的预付医疗保健计划参保情况与人均工伤赔偿成本之间存在统计学上的显著关系，这表明可能存在通过过度诊断可补偿的伤病来进行系统性成本转移的情况。预付合同激励措施的改变可能会改善工伤赔偿的道德和经济医疗保健环境。
