Position Statement

Folding Workers' Compensation Health Insurance Coverage into National Health Insurance, the "24 Hour Coverage" Concept

This Position Statement was developed as an educational tool based on the opinion of the authors. It is not a product of a systematic review. Readers are encouraged to consider the information presented and reach their own conclusions.

Unlike general health insurance, workers' compensation insurance provides wage replacement, disability payments, and vocational rehabilitation benefits. Return to work is a primary treatment goal.

The "24 Hour Coverage" concept will fold the medical component of workers' compensation insurance coverage into traditional employer-provided general health insurance. Proponents say that this effort will lessen cost shifting and streamline administrative processes.

The American Academy of Orthopaedic Surgeons (AAOS) is concerned about the health of workers and supports health care reform measures that improve the ability of physicians to provide timely, high quality and cost-effective medical care to those who are injured on the job.

The AAOS believes, however, that there are critical points to address before medical care to injured workers can be folded successfully into a general health insurance program.

These issues include:

• The medical-legal issues in causation of injury.
• The cause of injury related to diagnosis in the claims process.
• The link between medical care benefits and indemnity (wage loss), and permanent loss of function.
• The program goals of return to work and prevention of chronic disability.
• The need for greater intensity of medical case management, including more frequent consultations, to prepare the worker for early return to work.
• Other unique aspects of the workers' compensation medical care environment, such as the role of vocational rehabilitation and the involvement of both medical and nonmedical disciplines in the overall treatment process.

The AAOS supports efforts to control the rising costs of workers' compensation and believes that well implemented and appropriately coordinated measures dealing with these issues may control indemnity benefit costs and build incentives for state level cost control.

The AAOS supports the development and implementation of programs in states to test the feasibility of combining workers' compensation and general health insurance before any pilot program or other implementation is carried out on a wider scale.

© April 1994 American Academy of Orthopaedic Surgeons

This material may not be modified without the express written permission of the American Academy of Orthopaedic Surgeons^®.

Position Statement 1126

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