Spine. 1998 Nov; 23(21): 2329-36.

Health care and indemnity costs across the natural history of disability in occupational low back pain.

Williams DA, Feuerstein M, Durbin D, Pezzullo J.

Department of Psychiatry, Georgetown University Medical Center, Washington, D.C.

STUDY DESIGN: The administrative database maintained by the National Council on Compensation Insurance (United States) was used to compare health care use and indemnity costs within the natural history of work-related low back pain disability. OBJECTIVES: To determine the relative costs of health care services and indemnity at different phases of work disability. SUMMARY OF BACKGROUND DATA: Existing studies have compared total costs along the work disability continuum. This study replicates and extends these earlier studies by providing detailed evaluations of costs by service categories along this continuum. METHODS: Total health care and indemnity costs accrued along the disability curve were examined. Based on the number of days workers were absent from work and receiving indemnity payments (disability days), detailed mean health care costs by type of medial service were computed and compared across four time intervals for the sample. RESULTS: Health care costs were disproportionately distributed along the disability curve, with 20% of claimants disabled 4 months or more, accounting for 60% of health care costs. The most costly service category was diagnostic procedures (25% of total medical costs), with surgical costs (21%) and physical therapy (20%) representing the next two most costly categories. Mental health and chiropractic care represented a small percentage of overall costs (0.4% and 2.9%, respectively). CONCLUSIONS: These data provide policy-makers, program development, and health care industry groups with cost information from which to establish benchmarks for future decisions that facilitate the allocation of resources for more cost-effective management and prevention of work disability.