Tuesday, October 19, 2010

What drives Duration... and what can we do about it?

Duration of disability is a complex measure within workers’ compensation systems.  Duration has natural drivers such as age (it takes longer to recover as we get older), injury type (more severe injuries take longer to recover), and even obesity (obese of workers as a group take longer to recover than non-obese workers with similar injuries) can drive duration higher.  We can’t do much about these drivers once an injury takes place. 

After an injury, there are some things we can do to speed recovery and militate against excessive duration.  We have strong disability management programs that can speed return-to-work (assuming the programs are well staffed, the staff well trained in DM principles, and stakeholders are willing to support DM efforts).  There are guidelines for expected recoveries and programs that encourage early and safe return to work (research literature shows that work is actually good as therapy and contributes rather than works against good health).  Medical science and physiotherapy have advanced dramatically over the last century and each of these can contribute to more rapid recover and return-to-work outcomes. 

External factors put pressure on duration.  In a slowing economy, durations tend to rise.  This makes sense since workers not on wage-loss benefits are likely in a position to carry some of the extra load at no direct or current cost to the payroll.   Rising and hot economies tend to contribute to shorter duration.  Workers are enticed to return to work and are more likely to be accommodated by their employers in these circumstances.  

Access to healthcare can also delay recovery.  If it takes a year to get an MRI and six months to see a surgeon, you can bet that duration statistics will rise.   

Despite these factors, it appears some general measures of duration of disability from work-related injury have remained remarkably stable over time.  In Sir William Meredith’s Final Report, Meredith muses “…it may, I think, fairly be assumed that the great bulk of the accidents for which compensation would be payable under the proposed law will incapacitate the workman for short periods—84 per cent probably for less than fourteen weeks.

I looked at WorkSafeBC claims with an injury date in 2008 where there was at least one day away from work.  WorkSafeBC pays wage-loss benefits beginning the day following the day of injury so our way of counting may not fully match with Meredith’s assumption.  That said, his projection looks pretty good— 85.14% of time-loss claims with an injury date in 2008 had durations of less than 14 weeks

One factor contributing to the relative stability of duration is the common denominator of human biology and physiology.  Healing times have not really changed over the last 100 years for many conditions.  Fractures still take the same time to mend; lacerations take about the same to heal.  Yes, we have antibiotics and new technology.  These save lives.  Many victims of severe injury would not have survived in Meredith’s time. They survive today… but their recovery and return to work can take a lot longer.

I’ve also looked at duration by age category. Over the last couple of decades for which I have data, the average duration for 20-24 year olds or 35-40 year olds has barely changed.  What has changed is the demographic mix with older workers now dominating the distribution of injured workers.   This change in mix is another factor that will continue for some time to put upward pressure on duration. 

Of all the factors listed, effective disability management is the leading candidate to counter the upward pressures on duration.

1 comment:

Ian Munroe said...

Good article Terry. Ian