Workers' compensation reform

Throughout the history of workers' compensation, reform efforts have been responses to the competing interests of business seeking affordable costs, labor demanding adequate and prompt benefits, and insurers attempting to attain reasonable profits in the light of larger social and economic trends. In the 1960s and 1970s, workers' compensation programs and increase the amount of benefits in response to the recognition that existing benefits were inadequate and failed to provide support for workers and their families during periods of disability. The increase in benefits, accompanied by unprecedented increases in the price and use of health services, drove up the cost of workers' compensation. In the 1980s and 1990s, reform efforts focused on reducing the cost of medical care in response to the concerns of businesses and insurers that workers' compensation had become too costly and was reducing profitability. States responded by tightening fee schedules, limiting physician choice, restricting eligibility, lowering benefits, and integrating managed care into workers' compensation. Cost management is now generally in use for workers' compensation. Although managed care had resulted in significant medical savings, the cost of workers'compensation is again rapidly increasing in some states, where workers'compensation legislation is again at the center of debate. Overuse of medical services, fraud, and subjective and inconsistent disability determination that increases litigation have been identified as cost drivers in some of the states with the most costly workers' compensation [32]. Increasing the use of treatment guidelines, placing limitations on use of services such as chiropractic and physical therapy, developing more objective criteria for determining level of disability, and streamlining dispute resolutions have been offered as solutions. Controlling costs alone, however, cannot solve other problems of workers' compensation. For instance, studies continue to show that only a fraction of injured workers files claims, and the benefits received are often inadequate [30,33]. Future workers' compensation reform will need to focus on the costs of the system and its inclusiveness and effectiveness to support the workers and their families it was intended to protect.