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Evaluation of the Washington State Workers' Compensation Managed Care Pilot Project I: Medical Outcomes and Patient Satisfaction

Kyes, Kelly B. PhD*; Wickizer, Thomas M. PhD, MPH*; Franklin, Gary MD, MPH†‡; Cain, Kevin PhD§; Cheadle, Allen PhD*; Madden, Carolyn PhD*; Murphy, Linda BA; Plaeger-Brockway, Roy MPA; Weaver, Marcia PhD*

Original Articles

Objectives. This study examined the effect of managed care on medical outcomes and patient satisfaction as part of an evaluation of the Washington State Workers' Compensation Managed Care Pilot.

Methods. One hundred twenty firms (7,041 employees) agreed to have their injured workers treated in managed-care plans. Managed care introduced two changes from the fee-for-service (FFS) delivery system currently used by injured workers in Washington State: (1) experience-rated capitation, and (2) a primary occupational-medicine delivery model. The FFS control group included injured workers employed at 392 firms (12,000 employees). A total of 1,313 workers who experienced occupationally related injuries or illnesses between April 1995 and June 1996 were interviewed by telephone at 6 weeks after injury regarding their medical outcomes and satisfaction with care. Workers whose injuries resulted in four or more lost workdays (n = 372) were also interviewed at 6 months after injury on the same topics. The areas surveyed included functional outcomes and satisfaction with care, providers, and access to providers.

Results. The measures of functional outcome reflected no consistent differences between the managed care and the FFS conditions. The workers who attended the managed-care system reported lower levels of satisfaction with care, particularly with access to providers. For example, 58% of managed-care patients reported satisfaction with their attending physician as compared with 69% of FFS patients (P < 0.01).

Conclusions. Workers treated through managed-care arrangements were less satisfied with their care, but their medical outcomes were similar to those of workers who received traditional FFS care. The current workers' compensation system in Washington State affords injured workers great latitude in choosing providers. If provider choice is substantially restricted by managed care, worker satisfaction is likely to diminish.

*From the University of Washington, Department of Health Services, Seattle, Washington.

From the University of Washington, Department of Environmental Health, Seattle, Washington.

From the Washington State DLI, Olympia, Washington.

§From the University of Washington, School of Nursing, Seattle, Washington.

Supported by funding provided by the Washington State DLI. Partial support was also provided by the Robert Wood Johnson Foundation Workers' Compensation Health Initiative (grant #030319).

The opinions and conclusions expressed are those of the authors and do not necessarily represent the views of the DLI or the Robert Wood Johnson Foundation.

Address correspondence to: Thomas M. Wickizer, PhD, Department of health Services, Box 357660, University of Washington, Seattle, WA 98195-7660.

Received August 25, 1998; initial review completed November 10, 1998; accepted April 9, 1999.

© 1999 Lippincott Williams & Wilkins, Inc.