Volume 193 - Issue 3
Does access to compensation have an impact on recovery outcomes after injury?
Authors: Alex Collie and Niki Ellis
Med J Aust 2010; 193 (3): 188-190. || doi: 10.5694/j.1326-5377.2010.tb03855.x
Published online: 2 August 2010
Published online: 2 August 2010
To the Editor: As noted by O’Donnell and colleagues,1 there is a growing body of evidence suggesting that provision of compensation is associated with poor recovery after injury. Most of this evidence arises from international workers compensation jurisdictions. However, two recent Victorian studies have examined health and work outcomes in compensable and matched non-compensable groups after transport injury.1,2 Despite examining broadly similar patient groups and using broadly similar outcome measures, the two articles reach very different conclusions.
There has been substantial community reaction to these findings. Gabbe and colleagues’ suggestion that compensation is associated with poor recovery2 provoked public criticism of its methodology from the Law Institute of Victoria, and a prominent plaintiff legal firm released a public statement3 3 days after publication of the study by O’Donnell et al.
There is a disconnection in conceptualisation of this issue between the research community and those involved in compensation regulation and policy. Researchers are focusing on the question “Does compensation lead to poor health outcomes?”, while the more nuanced policy question attracting the attention of many injury compensation regulators is “Which, if any, aspects of the compensation scheme have a positive or negative impact on health, vocational and social outcomes?”.
Close inspection of the published literature suggests that there are individual components of compensation systems that may have a negative impact on outcome, including the provision of payments for pain and suffering4 and the provision of income benefits.5 There are also examples of compensation organisations acting to improve outcomes via their broader remit as government regulators. For example, the Transport Accident Commission was a major driver of the reorganisation of the Victorian state trauma system, which has resulted in a significant reduction in mortality after road trauma.6
O’Donnell and colleagues1 note the complex relationship between compensation and health outcomes, with particular reference to patient characteristics. The compensation schemes themselves are also highly complex. However, there has been very little research effort directed towards identifying the impact of specific scheme components on patient outcome. In Victoria, the two major injury compensation regulators have funded the Institute for Safety, Compensation and Recovery Research to address this issue. This level of interaction between policymakers and researchers is needed to improve outcomes for those injured in transport- and work-related accidents.
Competing interests
Alex Collie was previously employed by the TAC of Victoria, and in his current position receives research funding from the TAC. He is also a board member of the Victorian Neurotrauma Initiative Pty Ltd, a subsidiary of the TAC.
Acknowledgements
The Institute of Safety, Compensation and Recovery Research receives funding from WorkSafe Victoria and the Transport Accident Commission (TAC) of Victoria.
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.
- Gabbe BJ, Cameron PA, Williamson OD, et al. The relationship between compensable status and long-term patient outcomes following orthopaedic trauma. Med J Aust 2007; 187: 14-17. 0_i1092217
- Maurice Blackburn Lawyers. Myths about road trauma compensation questioned in new study. Media release, 18 March 2010. 0_i1092219
- Cameron ID, Rebbeck T, Sindhusake D, et al. Legislative change is associated with improved health status in people with whiplash. Spine (Phila Pa 1976) 2008; 33: 250-254. 0_i1092221
- McNaughton HK, Sims A, Taylor WJ. Prognosis for people with back pain under a no-fault 24-hour-cover compensation scheme. Spine (Phila Pa 1976) 2000; 25: 1254-1258. 0_i1092223
- Cameron PA, Gabbe BJ, Cooper DJ, et al. A statewide system of trauma care in Victoria: effect on patient survival. Med J Aust 2008; 189: 546-550. 0_i1092226
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