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Who is Paying the Bills? Health Care Costs for Musculoskeletal Back Disorders, Washington State Union Carpenters, 1989–2003

Lipscomb, Hester J. PhD; Dement, John M. PhD; Silverstein, Barbara PhD; Cameron, Wilfrid MS; Glazner, Judith E. MS

Journal of Occupational and Environmental Medicine: October 2009 - Volume 51 - Issue 10 - p 1185-1192
doi: 10.1097/JOM.0b013e3181b68d0a
Original Articles

Objective: Factors associated with private health insurance payment rates for musculoskeletal back disorders were examined among a 15-year cohort of union carpenters. Payment patterns were contrasted with work-related back injury rates over time.

Methods: Negative binomial regression was used to assess payment rates; generalized estimated equations accounted for multiple observations per person and cost correlation within subjects.

Results: Payment rates increased after work-related injury and with the number of injuries. Increasing private payments and deductibles (inflation-adjusted and discounted) were observed in contrast with a marked decline in reported work-related injuries.

Conclusions: Private insurance payments do not appear to be independent of work-related back injury. Findings suggest cost-shifting from workers’ compensation to the union-provided health insurance and to the worker; they also provide a warning regarding reliance on workers’ compensation statistics for surveillance of work-related disorders or disease.

From the Department of Community and Family Medicine (Dr Lipscomb, Dr Dement), Division of Occupational and Environmental Medicine, Duke University Medical Center, Durham, NC; Department of Labor and Industries, State of Washington (Dr Silverstein), Safety and Health Assessment and Research Program (SHARP), Olympia, Wash; Center for Construction Research and Training (Mr Cameron), Silver Spring, Md; and Department of Health Systems Management and Policy (Ms Glazner), Colorado School of Public Health, Denver, Colo.

Address correspondence to: Hester J. Lipscomb, PhD, Box 3834, Duke University Medical Center, Durham, NC 27710; E-mail:

©2009The American College of Occupational and Environmental Medicine