SPINE Volume 40, Number 14, p 1148 ©2015, Wolters Kluwer Health, Inc. All rights reserved.
LITERATURE REVIEW
Point of View Brook I. Martin, PhD, MPH,* and Jon D. Lurie, MD, MS†
C
ontrary to the voluminous evidence that patients covered on Workers’ Compensation have worse outcomes when compared with patients on commercial insurance, the series by Robertson et al. reports equivalent outcomes after lumbar fusion among patients of a single practice in New Zealand, where there exists a “no-fault” compensation system.1 New Zealand’s no-fault system provides medical care and up to 80% of work loss income for (work, leisure, and automobile) accident, while eliminating a patient’s right to sue for damages or malpractice. A contentious determination that narrows entitlement is whether an injury is traumatic (covered) or gradual (not covered), as opposed to work or nonwork related. The authors appropriately acknowledge limitations of observational designs, which prohibit making a strong causal inference, and of a small sample, which limited their ability to control for confounding differences (e.g., age). We should be cautious in generalizing the findings of a single provider to all of New Zealand, let alone the heterogeneous systems
from other countries. A no-fault system may remove aspects of “adversarial” care, but other forms of litigation, access, and stigma are likely to remain, and policies defining Workers’ Compensation systems are often politically charged.2 A no-fault system may ultimately be the best path toward promoting patient well-being, but such findings should be confirmed in other settings and with improved study design. In the meantime, we should echo the urgent call to prioritize comparative effectiveness research, including populationbased studies, that seek to reduce the burden of disability for individuals and compensation systems.3
References
1. Robertson P, et al. The influence of a no fault compensation on functional outcomes after lumbar spine fusion. Spine 2015;40:1140–7. 2. Lippel K. Preserving workers’ dignity in workers’ compensation systems: an international perspective. Am J Ind Med 2012;55: 519–36. 3. Franklin GM, Wickizer TM, Coe NB, et al. Workers’ compensation: poor quality health care and the growing disability problem in the United States. Am J Ind Med 2015;58:245–51.
From the *Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH; and †Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH. Acknowledgment date: March 3, 2015. Acceptance date: March 15, 2015. The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work. Relevant financial activities outside the submitted work: consultancy, grants, stocks. Address correspondence and reprint requests to Brook I. Martin, PhD, MPH, Department of Orthopaedics, Dartmouth College, One Medical Center Dr, HB 7541, Lebanon, NH 03756; E-mail: [email protected] DOI: 10.1097/BRS.0000000000000965
1148
www.spinejournal.com
July 2015
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. SPINEI1404POV_LR 1148
23/06/15 10:35 AM
LITERATURE REVIEW
Point of View Brook I. Martin, PhD, MPH,* and Jon D. Lurie, MD, MS†
C
ontrary to the voluminous evidence that patients covered on Workers’ Compensation have worse outcomes when compared with patients on commercial insurance, the series by Robertson et al. reports equivalent outcomes after lumbar fusion among patients of a single practice in New Zealand, where there exists a “no-fault” compensation system.1 New Zealand’s no-fault system provides medical care and up to 80% of work loss income for (work, leisure, and automobile) accident, while eliminating a patient’s right to sue for damages or malpractice. A contentious determination that narrows entitlement is whether an injury is traumatic (covered) or gradual (not covered), as opposed to work or nonwork related. The authors appropriately acknowledge limitations of observational designs, which prohibit making a strong causal inference, and of a small sample, which limited their ability to control for confounding differences (e.g., age). We should be cautious in generalizing the findings of a single provider to all of New Zealand, let alone the heterogeneous systems
from other countries. A no-fault system may remove aspects of “adversarial” care, but other forms of litigation, access, and stigma are likely to remain, and policies defining Workers’ Compensation systems are often politically charged.2 A no-fault system may ultimately be the best path toward promoting patient well-being, but such findings should be confirmed in other settings and with improved study design. In the meantime, we should echo the urgent call to prioritize comparative effectiveness research, including populationbased studies, that seek to reduce the burden of disability for individuals and compensation systems.3
References
1. Robertson P, et al. The influence of a no fault compensation on functional outcomes after lumbar spine fusion. Spine 2015;40:1140–7. 2. Lippel K. Preserving workers’ dignity in workers’ compensation systems: an international perspective. Am J Ind Med 2012;55: 519–36. 3. Franklin GM, Wickizer TM, Coe NB, et al. Workers’ compensation: poor quality health care and the growing disability problem in the United States. Am J Ind Med 2015;58:245–51.
From the *Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH; and †Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH. Acknowledgment date: March 3, 2015. Acceptance date: March 15, 2015. The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work. Relevant financial activities outside the submitted work: consultancy, grants, stocks. Address correspondence and reprint requests to Brook I. Martin, PhD, MPH, Department of Orthopaedics, Dartmouth College, One Medical Center Dr, HB 7541, Lebanon, NH 03756; E-mail: [email protected] DOI: 10.1097/BRS.0000000000000965
1148
www.spinejournal.com
July 2015
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. SPINEI1404POV_LR 1148
23/06/15 10:35 AM
