A recent U.S. study published by the Workers Compensation Research Institute (“Do Higher Fee Schedules Increase the Number of Workers’ Compensation Cases?” ) raises some interesting research questions for Canadian workers’ compensation systems, particularly in light of the austerity measures implemented in recent years by the Ontario WSIB.
The study’s conclusion is in some ways predictable: When they looked at the effect of workers’ compensation paying physicians higher rates, they found that when deciding whether the cause of injury is work-related is not straightforward (e.g., with soft tissue conditions), case-shifting to the higher paying option (workers’ compensation or private insurance) is more common. They estimated that a 20% increase in workers’ compensation pay rates for physician services increases the likelihood of a soft tissue injury being identified as work-related by 6 percent.
What about our Canadian systems?
There are a lot of differences. In the USA, publicly funded medicare is still limited. Most medical treatment is billed to private payors such as insurance companies and workers’ compensation boards. In Canada, if the injury is not covered by workers’ compensation, health care providers are mostly paid by the provincial health care system.
But is there a relationship between the way the WSIB respects doctors and the extent to which they are willing to put their patients in the hands of the WSIB?
The Prism 2013 study of claims suppression (not reporting work related injury and disease to the WSIB) by the Ontario WSIB concluded that the “most important conclusion to be drawn from the research is that claim suppression appears to be a real problem. It is unlikely that claim suppression is restricted to a small number of anecdotal cases.”
Some worker advocates are advising injured workers to claim a work injury under short term disability insurance rather than the WSIB because WSIB decision making has become too negative. Last fall, a group of health care practitioners has presented their experience with the WSIB ignoring treatment recommendations in the report “Prescription Overruled” and the Ombudsman of Ontario is considering their request for a public investigation.
Board’s health care cutbacks
The WSIB reports a dramatic reduction in spending on health care in recent years. While the province’s health care costs were rising by about 3% a year, the WSIB’s expenditures on health care were decreasing by about 2.5% a year between 2009 and 2014.
Take lower back injuries for example. The average amount spent by the WSIB on health care per claim in the first year after injury has decreased by over $1000 a year per injured worker, a 23% cutback between 2008 and 2012 (WSIB 2015 Economic Statement)
- If you were a family doctor today, and your patient needs physiotherapy to recover from a low back strain, would you fill in the short term disability insurance or the WSIB claim form?
- Do the rates paid to health care providers differ between OHIP, private insurance, social assistance and WSIB?
- What are the chances of a health care provider not getting paid on time or not getting paid at all in the different systems?
- What are the chances of a patient getting the medication or treatment prescribed by their doctor, between the WSIB, private insurance or social assistance?
What’s really behind those statistics?
Since 2009, the number of lost-time injuries reported to the WSIB has fallen by 19%. This rate represents an historic low and is the lowest of any jurisdiction in Canada. Does the extent to which our workers’ compensation system respects the treating health care providers affect the extent to which doctors and patients are willing to make use of the workers’ compensation system?