Volume 193 - Issue 3
Does access to compensation have an impact on recovery outcomes after injury?
Authors: David M Studdert, Harold Luntz and Genevieve Grant
Med J Aust 2010; 193 (3): 188-190. || doi: 10.5694/j.1326-5377.2010.tb03854.x
Published online: 2 August 2010
Published online: 2 August 2010
To the Editor: O’Donnell and colleagues seek to extend and improve on previous research into the relationship between compensation status of injuries and medium-term health outcomes.1 Improvements are needed because much of the empirical analysis in this area has had major methodological limitations.2 Their analysis uses an impressive array of mental health measures to probe the “compensation effects”. However, several aspects of the study design raise questions.
First, with very few exceptions, the transport accident compensation scheme in Victoria covers all injuries arising from transport accidents. It is therefore unclear how a quarter of patients in the non-compensable group could have suffered injuries due to motor vehicle accidents (MVAs) yet have fallen outside the scheme.
Second, the purpose of control variables in a multivariate model is to address potential confounders of the relationship between the predictor of interest (MVA compensability) and the outcomes (measures of health status at 24 months). Using significant univariate differences between the predictor of interest and other covariates as the basis for selecting control variables is statistically inappropriate, and this approach may have affected the results of the regression analyses.
Third, a key study finding is that significant differences in health outcomes were detected between MVA-compensable and non-compensable patients at 24 months after injury. These then “all but disappeared” when the non-compensable group was altered by shifting three patients who had accessed Transport Accident Commission compensation over to the MVA-compensable group and dropping 54 patients who had accessed “other forms of compensation”. The result casts the spotlight on the removed group. It suggests that their mean health status at 24 months was relatively high. But who were they? Little information is provided, other than that nearly two-thirds (36/57) had private health insurance and were dropped for this reason. (In our view, private health insurance should not be construed as compensation, because policies tend to be highly selective about services covered and generally do not provide payment for lost income or non-economic losses.) Another possible explanation, not addressed, is that with only 88 patients left in the non-compensable group, the multivariate analyses lacked power to find differences.
The relationship between compensation availability and injury recovery is complex. Policy interest in the relationship looks set to increase in the next few years, as the federal government explores the merits of a national disability scheme.3,4 In this environment, the need for rigorous research and reliable findings will be greater than ever. O’Donnell and colleagues’ welcome contribution to the evidence base should stimulate further debate about how best to disentangle the effects of injury compensation systems on the health outcomes of Australians who call upon them.
References
- O’Donnell ML, Creamer MC, McFarlane AC, et al. Does access to compensation have an impact on recovery outcomes after injury? Med J Aust 2010; 192: 328-333. <eMJA full text>
- Grant G, Studdert DM. Poisoned chalice? A critical analysis of the evidence linking personal injury compensation processes with adverse health outcomes [8 December 2009]. Melbourne University Law Review: forthcoming University of Melbourne Legal Studies Research Paper No. 442. http://ssrn.com/abstract=1520788 (accessed Apr 2010).
- Disability Investment Group. The way forward: a new disability policy framework for Australia. Canberra: Department of Families, Housing, Community Services and Indigenous Affairs, 2009. http://www.fahcsia.gov.au/sa/disability/pubs/policy/way_forward/Documents/dig_report_19oct09.pdf (accessed Apr 2010).
- Productivity Commission. Disability care and support: terms of reference. 17 February 2010. http://www.pc.gov.au/projects/inquiry/disability-support/terms-of-reference (accessed Apr 2010).