Workers' compensation cost-shifting: a unique concern of providers and purchasers of prepaid health care.

Contract health care plans exclude workers' compensation from among the prepaid medical benefits. Under present contract relationships, compensable injury and illness can be billed to the employer as fee-for-service care. The provision of health care, normally an expense for the prepaid health care provider, generates income when it is given under a compensation rubric. Per capita workers' compensation costs at eight federal shipyards range from less than $500 in yards with no health maintenance organization (HMO) coverage to more than $1,000 in yards with more than two-thirds of employees enrolled in prepaid health care plans. A statistically significant relationship between prepaid health care plan enrollment and per capita workers' compensation costs at these yards suggests the likelihood of systematic cost-shifting by overdiagnosis of compensable injury and illness. Changes in prepaid contract incentives may improve the ethical and economic health care climate for workers' compensation.