Wah, Wah, Wah

Everybody has to get their share.

At least that's the message that I got out of the latest study from researchers at National Institute for Occupational Safety and Health in their study just published by the Journal of Occupational and Environmental Medicine.

According to them, accepted workers' compensation claims that do not result in medical payments could be costing group health insurers at least $212 million a year because folks who don't get their treatment through work comp for their work injuries or illnesses do so through their group health provider.

Claims that do not result in medical payments through work comp are referred to as "zero-cost claims" in the study.

The researchers' analysis of more than 12,000 claims from 2002 through 2005 revealed that 15.9% of the claims were zero-cost claims. Claimants with zero-cost claims were more likely to use group health insurance services and incur more group health costs.

"In the three months before an occupational injury, 53.9% of workers with positive-cost workers' compensation medical claims and 61.6% of workers with zero-cost workers' compensation medical claims used the outpatient group health insurance at least once," the study says. "Within three months after an occupational injury, group health insurance utilization for outpatient services increased to 61.2% and 74.1% for workers with positive- and zero-cost workers' compensation medical claims, respectively."

In addition, one of the study's most significant findings is that group health insurance costs increased after a work-related injury, regardless of whether the workers' compensation claim resulted in any medical payments.

Claimants with zero-cost claims used group health insurance 20.3% more after their date of injury, which created 400% more group health costs. Meanwhile, claimants with positive-cost workers' compensation claims used group health services 13.5% more after their date of injury, creating a 225% cost increase.

The differences could be due to the fact that zero-cost claims have no workers' compensation medical benefits payments, whereas positive-cost claims may be creating more group health costs due to "under-compensation," the authors wrote in the study.

According to IBISWorld’s Health & Medical Insurance market research report total revenue for the health insurance market is $620 billion.

So while $212 million may seem like a lot, it is only 0.003 percent of the total revenue taken in by the health insurance industry.

In other words, a drivel.

In the meantime the health insurance industry drives workers' compensation costs up through its subrogation efforts. In California, for instance, Kaiser Health System and Anthem Blue Cross are the number 6 and 7 largest lien filers in the state system by volume.

And of course there are studies suggesting that workers' compensation takes on its unfair share of non-industrial medical care because the injured or ill don't have medical insurance or can't afford the care.

Which is why all of these "cost-shifting" studies are ridiculous and highlight the insanity of our fractured medical provision systems.

Maybe the answer isn't "24 hour care" or "universal coverage" but there has to be some way of getting over this finger pointing and cost shifting.

In the grand scheme of things the 0.003 percent of medical care that should have been the jurisdiction of work comp but is paid for by group health doesn't amount to a hill of beans - in the end it us: you, me and the rest of society that eventually pays for all of this anyhow.

To us, it really doesn't matter where the coin comes from because ultimately it's out of our pocket anyhow, whether in the form of higher premiums, higher taxes, higher medical fees, higher consumer prices, etc.

We all pay.

How that money is divided up at the back end is just more special interest pandering.

So group health pays more than it should for medical treatment.

Wah, wah, wah.

The industry should rejoice that this special interest pandering creates more jobs within the system, thereby creating more insurance premium, thus more "capacity" to handle more claims.

Want to stop cost shifting? Take down the walls between the systems - voila, no shifting...