Anne Hudon1,2,3, Ellen MacEachen4, Katherine Lippel5. 1. School of Rehabilitation, Faculty of Medicine, Université de Montreal, Pavillon du Parc, Office 402-5, C.P. 6128, Succ. Centre-ville, Montréal, QC, H3C 3J7, Canada. anne.hudon@umontreal.ca. 2. Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, QC, Canada. anne.hudon@umontreal.ca. 3. Centre de Recherche en Éthique (CRÉ), Montréal, QC, Canada. anne.hudon@umontreal.ca. 4. School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada. 5. Faculty of Law, Civil Law Section, University of Ottawa, Ottawa, ON, Canada.
Abstract
PURPOSE: The objective of this study was to explore how workers' compensation policies related to healthcare provision for workers with musculoskeletal injuries can affect the delivery and trajectories of care for injured workers. The principal research question was: What are the different ways in which workers' compensation (WC) policies inform and transform the practices of healthcare providers (HCPs) caring for injured workers? METHODS: We conducted a cross-jurisdictional policy analysis. We conducted qualitative interviews with 42 key informants from a variety of perspectives in the provinces of Ontario and Quebec in Canada, the state of Victoria in Australia and the state of Washington in the United States. The main methodological approach was Framework Analysis. RESULTS: We identified two main themes: (1) Shaping HCPs' clinical practices and behaviors with injured workers. In this theme, we illustrate how clinical practice guidelines and non-economic and economic incentives were used by WCs to drive HCP's behaviours with workers; (2) Controlling workers' trajectories of care. This theme presents how WC policies achieve control of the workers' trajectory of care via different policy mechanisms, namely the standardization of care pathways and the power and autonomy vested in HCPs. CONCLUSIONS: This policy analysis shed light on the different ways in which WC policies shape HCP's day-to-day practices and workers' trajectories. A better understanding and a nuanced portrait of these policies' impacts can help support reflections on future policy changes and inform policy development in other jurisdictions.
PURPOSE: The objective of this study was to explore how workers' compensation policies related to healthcare provision for workers with musculoskeletal injuries can affect the delivery and trajectories of care for injured workers. The principal research question was: What are the different ways in which workers' compensation (WC) policies inform and transform the practices of healthcare providers (HCPs) caring for injured workers? METHODS: We conducted a cross-jurisdictional policy analysis. We conducted qualitative interviews with 42 key informants from a variety of perspectives in the provinces of Ontario and Quebec in Canada, the state of Victoria in Australia and the state of Washington in the United States. The main methodological approach was Framework Analysis. RESULTS: We identified two main themes: (1) Shaping HCPs' clinical practices and behaviors with injured workers. In this theme, we illustrate how clinical practice guidelines and non-economic and economic incentives were used by WCs to drive HCP's behaviours with workers; (2) Controlling workers' trajectories of care. This theme presents how WC policies achieve control of the workers' trajectory of care via different policy mechanisms, namely the standardization of care pathways and the power and autonomy vested in HCPs. CONCLUSIONS: This policy analysis shed light on the different ways in which WC policies shape HCP's day-to-day practices and workers' trajectories. A better understanding and a nuanced portrait of these policies' impacts can help support reflections on future policy changes and inform policy development in other jurisdictions.
Authors: Susan Stock; Nektaria Nicolakakis; Hicham Raïq; Karen Messing; Katherine Lippel; Alice Turcot Journal: Am J Public Health Date: 2014-01-16 Impact factor: 9.308