The Effect of Managed Care on Surgical Rates Among Individuals Filing for Workers' Compensation

Abstract

This work evaluates the imposition of managed care techniques on the rate of claims and surgeries utilizing a pre- versus post-program analysis. The purpose was to ascertain whether managed care techniques-specifically, an ergonomic program, medical treatment guidelines, nurse case management, and utilization of a preferred provider organization consisting of academic physicians-would reduce the rate of the claims and surgery in a population of predominantly health care and university workers. The claims frequency rate and surgical frequency rates per 1,000 employees and per 1,000 claims was significantly lower during the managed care period than during the year prior to the initiation of managed care. The distribution of surgical procedures, as well as the duration of disability in the years of injury, after the initiation of managed care (1993-1997) were different from those same parameters in the fiscal years prior to the initiation of managed care(1990-1992). The results suggest that even in the workers' compensation environment, where financial incentives encourage a higher claims and surgical frequency rate than do the fee-for-service or prepaid medical environments, managed care techniques can be successfully utilized. A unique feature of the study was the use of university-based physicians as a specific managed care technique to influence surgical rates.