PROPOSAL TO REIMBURSE OCCUPATIONAL-MEDICINE DISEASE AND INJURY CLAIMSTHROUGH 3RD-PARTY HEALTH-INSURANCE

The current system of compensation for the medical costs of occupation al illnesses and injuries, a component of health insurance coverage fo r most workers in the United States, has recently come under scrutiny in the national health care reform debate. The cost of treatment of th ese conditions is significant, and there exist numerous disincentives for physicians and patients to use the workers' compensation system. P hysicians who treat workers with occupationally related diseases may f ind compensation for a condition is disputed at the same time that it is excluded from payment by third party insurance coverage, leaving th e patient selectively uninsured for at least some medical care service s. In addition, most workers' compensation programs have been designed in a way that discourages efficient resource use by providers and cla imants. We propose allowing health care providers to bill third party health insurers for all care, including work-related diseases and inju ries. Insurers, in turn, would bill workers' compensation programs for associated treatment costs. The potential advantages of such a system include reductions in inefficiency and unfair burdens placed on provi ders and patients, in reporting bias, and in administrative costs bala nced against the risks of insurers excluding workers in high risk occu pations from obtaining low cost health insurance and shifting away fro m employers the administrative burden for workers' compensation. (C) 1 994 Wiley-Liss, Inc.