Volume 193 - Issue 3
Does access to compensation have an impact on recovery outcomes after injury?
Authors: Meaghan L O’Donnell, Mark C Creamer, Richard A Bryant, Alexander C McFarlane and Derrick Silove
Med J Aust 2010; 193 (3): 188-190. || doi: 10.5694/j.1326-5377.2010.tb03856.x
Published online: 2 August 2010
Published online: 2 August 2010
In reply: We thank the authors of the above letters for their comments. Our response will focus only on the major themes raised.
We note the concerns about excluding people with private health insurance. The issue here is not whether having health care costs met by private health insurance is the same as having motor vehicle accident (MVA) compensation entitlements. Rather, it is whether access to private insurance payments for health care is the same as not having any compensation at all. We argue that injury patients with private insurance have access to a broader range of health care services and providers than those in the public system, and can access these services more quickly because they avoid long public sector waiting lists. The suggestion that patients who are dependent on public health care in the 2 years following injury (non-compensable patients) receive the same health care as those who have private insurance is unjustified. Most studies to date have not considered other schemes such as private insurance, ignoring the potential impact they may have on health outcomes. We recognise that there may be demographic differences between patients who are involved with other schemes such as private health insurance, and these factors may contribute to outcomes. In noting the inherent limitation in this approach, we nonetheless argue that there are also limitations to including these patients, and therefore an analysis that excludes privately insured patients is a valid addition to the literature on compensation.
In response to the point raised by Gabbe and colleagues, we note that our analysis showing that “stressful interaction with the compensation agency” accounted for variance in anxiety scores was designed to investigate potential mechanisms that may explain why anxiety was higher in the MVA-compensable group. We did not conduct the analysis to argue that this group was not more anxious than the non-compensable group. They were more anxious.
Glozier and Large were concerned that differential attrition may affect comparisons between the two groups. To clarify, there were no significant baseline differences between completers and non-completers on any measure. Their second issue relates to the removal of patients with private health insurance from the analyses. To clarify, we removed anyone who indicated at 24 months that they had accessed private or other forms of compensation, regardless of their original compensation classification.
Studdert and colleagues were concerned that we used univariate differences to identify control variables. We adopted this process to replicate the statistical methodology used by Gabbe et al,1 in an attempt to replicate their findings.
In conclusion, our study illustrates the complexity of compensation research and the importance of carefully defining populations — a point that has not yet been adequately addressed. Indeed, a recent review of the literature argues that most compensation research is methodologically limited.2 We agree that there are limitations to our methodology, as there are in previous studies, and recognise that conducting this kind of research is inherently difficult. We welcome the establishment of the Institute for Safety, Compensation and Recovery Research, noted by Collie and Ellis, and its support of this challenging and complex research.
References
- 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_CHDECEBH
- Spearing NM, Connelly LB. Is compensation “bad for health”? A systematic meta-review. Injury 2010. [Epub ahead of print.] 0_i1092203