School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Occup Environ Med. 2020 Jul;77(7):470-477. doi: 10.1136/oemed-2019-106325. Epub 2020 Mar 27.
To determine whether step-downs, which cut the rate of compensation paid to injured workers after they have been on benefits for several months, are effective as a return to work incentive.
We aggregated administrative claims data from seven Australian workers' compensation systems to calculate weekly scheme exit rates, a proxy for return to work. Jurisdictions were further subdivided into four injury subgroups: fractures, musculoskeletal, mental health and other trauma. The effect of step-downs on scheme exit was tested using a regression discontinuity design. Results were pooled into meta-analyses to calculate combined effects and the proportion of variance attributable to heterogeneity.
The combined effect of step-downs was a 0.86 percentage point (95% CI -1.45 to -0.27) reduction in the exit rate, with significant heterogeneity between jurisdictions (=68%, p=0.003). Neither timing nor magnitude of step-downs was a significant moderator of effects. Within injury subgroups, only fractures had a significant combined effect (-0.84, 95% CI -1.61 to -0.07). Sensitivity analysis indicated potential effects within mental health and musculoskeletal conditions as well.
The results suggest some workers' compensation recipients anticipate step-downs and exit the system early to avoid the reduction in income. However, the effects were small and suggest step-downs have marginal practical significance. We conclude that step-downs are generally ineffective as a return to work policy initiative.Postprint link: https://www.medrxiv.org/content/10.1101/19012286.
确定降低补偿率（即对已领取数月福利的受伤工人的补偿率进行下调）作为促进重返工作岗位的激励措施是否有效。
我们汇总了来自澳大利亚七个工人赔偿系统的行政索赔数据，以计算每周计划退出率，这是重返工作岗位的一个替代指标。各管辖区进一步细分为四个伤害亚组：骨折、肌肉骨骼、心理健康和其他创伤。使用回归不连续性设计检验降级对计划退出的影响。结果被汇总到荟萃分析中，以计算综合效果和归因于异质性的方差比例。
降级的综合效果使退出率降低了 0.86 个百分点（95%CI-1.45 至-0.27），各管辖区之间存在显著的异质性（=68%，p=0.003）。降级的时机和幅度都不是影响的显著调节因素。在伤害亚组中，只有骨折具有显著的综合效果（-0.84，95%CI-1.61 至-0.07）。敏感性分析表明，精神健康和肌肉骨骼状况也可能存在潜在影响。
结果表明，一些工人赔偿受助人预计会降级，并提前退出系统，以避免收入减少。然而，影响很小，表明降级作为重返工作岗位的政策举措具有边际实际意义。我们的结论是，降级作为一项促进重返工作岗位的政策举措通常效果不佳。
