In this latest research brief, NCCI taps into data from employer-sponsored group health (GH) programs as a source of information that might be critical to maintaining a viable WC benefit delivery system. Employing several advances in methodology and data analysis, this paper continues and extends a series of NCCI studies comparing costs for treating comparable injuries between WC and GH—research that goes back over the last 10 years.
In this latest study, those extensions include:
- Analyzing differences between WC and GH for the cost of physician services in unit prices and utilization
- Refining the measurement of utilization differences into differences in quantity and mix of medical procedures
- Affirming that utilization of services continues to be the greatest driver pushing WC costs above GH
Key findings include that:
- WC pays more than GH to treat comparable injuries
- The most pronounced difference between WC and GH is the greater quantity of physical medicine services in WC
- Traumas to arms and legs consistently have smaller cost and utilization differences in WC, while chronic pain-related injuries, such as bursitis and back pain, have larger differences
- A more expensive mix of procedures in complex WC cases contributes to higher costs relative to GH, especially for referral-based care, like radiology and surgery
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