That was the first thing that popped in my mind this afternoon when I read about a study in Australia that was first published in JAMA Psychiatry last week. That study, Relationship Between Stressfulness of Claiming for Injury Compensation and Long-term Recovery A Prospective Cohort Study, by Grant, O’Donnell, Spittal, Creamer, & Studdert was the subject of an article by Kathryn Doyle in Reuters Health. Robert Wilson was the person who brought the study to my attention when I received his “Bob’s Cluttered Desk” blog on WorkersCompensation.com’s Daily Report in my email this afternoon.
Both Doyle and Wilson’s articles, Stress of filing injury claims linked to poorer health later and Does Claims Stress Increase Disability? states that researchers at Stanford University found that the stress of filing a claim for an injury may actually increase the severity of the disability over the long term. A survey of accident victims found that stress often comes from confusion over the process, delays and related medical assessments. The researchers found, it was reported, that those who “were most stressed by filing a claim tended to have higher levels of disability years later”.
Doyle and Wilson both quoted David M. Studdert of Stanford as saying that, “The novelty of this study was to look within a group of claimants to test whether those who reported experiencing the most stress also had the slowest recoveries”. The researchers found they did, according to Studdert.
“A random selection of more than 1,000 patients hospitalized in Australia for injuries between 2004 and 2006. Six years later, 332 of the patients who had filed for workers’ compensation or another accident claim told the researchers how stressful the process had been.”
A third of the claimants, the study found, reported high stress form understanding the claims process and another third were stressed by delays in that process. A slightly smaller proportion, the study said, said repeated medical evaluations and concern for the amount of money they would receive were sources of stress.
Studdert and his fellow researchers made the point of recommending that programs such as workers’ compensation could be redesigned to respond faster and make it easier for patients to understand. I am relatively sure that had this study been conducted in the US, and with a cohort of native-born and foreign-born workers, the results might be somewhat the same. It is why I have repeatedly said in previous posts that having workers treated in home country or similar facilities where the language and culture are the same or nearly the same, would not only relieve much of the stress of filing a claim, but with dealing with the stress of surgery and recovery.
Doyle reported that negative attitudes from doctors, friends, family or colleagues, did not seem to be common sources of stress. People with the most stress tended to score higher on a disability scale and have higher levels of anxiety and depression, as well as lower quality of life, Doyle said the researchers reported in the JAMA Psychiatry paper.
David Studdert even said that, “While it’s intuitive that the compensation process is going to be stressful for some claimants, what is less clear is whether that stress has a substantial impact on recovery many years after the injury.” Studdert also said, “We were surprised by the size of the compensation effects on outcomes like level of disability and quality of life – they were fairly strong.”
Doyle also wrote that the researchers took into account that some patients seemed to be more vulnerable to stress from the start, they found that the link between claim stress and long-term recovery as similar but not as strong. Michele Sterling, who studies injuries and rehabilitation at the University of Queensland in Herston, Australia said, “There is much debate at the moment about the role of ‘systems,’ in this case ‘compensation systems’ on health outcomes. She was not involved with the study conducted by Stanford University.
Sterling went on to add that, “If it can be established which parts of the process causes stress and/or poor outcomes or recovery then the system could look at targeting these specific areas and improve them”. Finally, Sterling told Reuters Health that “Some insurance regulators are already trying to do this in some areas.”
It is interesting to note here that the study deals with severe injuries that required hospitalization. Whether they required surgery is not clear, but is probable. This is probably where medical tourism can play a role, because if the surgery is performed in a facility that treats medical tourism patients, and recovery can be made in serene and restful surroundings, then the level of stress of the patient would be that much more reduced, even if the process of filing a claim and going through the claims process is still stressful. That would certainly be true for patients suffering through harsh winters like the ones we are experiencing in much of the US this winter.
Robert Wilson’s take on this study is also interesting, at least to myself, since I was once involved with workers’ comp claims, and Auto No-Fault claims, and it was while I handled No-Fault claims that I encountered a claimant who exhibited extreme stress from having an accident with his limousine, which my company insured for Automobile insurance at the time.
This gentleman was from Egypt and was a Coptic Christian, whose job driving executives and business people in what are called, ‘black cars’, must have been stressful enough having to negotiate Manhattan traffic and hurried professionals. The fact that the accident occurred and he was unable to work as a result of it, caused him more stress, and by the time he came to our office to be examined by our medical expert, he broke down in tears right in front of my eyes.
Now I am someone who never wants to see anyone cry when they are hurt and cannot work, so before he saw our doctor, I spoke to the doctor and told him about this man. I appealed to the doctor out of human decency and out of our shared cultural heritage of caring for those who are suffering, since our culture has suffered a lot in our long history, but that is for another blogger to discuss. I cannot recall what the outcome of this man’s case was, as it was a long time ago, but I do hope that he found some solace in knowing that there were good people trying to help him.
Back to Robert Wilson.
Wilson was struck by the finding of the study where the respondents said that, “repeated medical evaluations and concern for the amount of money they would receive [Emphasis added by Wilson] were sources of stress.” Wilson reiterated something he has said many times, that people rarely ask how they can get better, but rather how much they will make.
Wilson believes that the system is not and was never designed to fully meet that goal. He says that the workers’ compensation industry needs a new identity and a focus on Return to Function. Some of the prescriptions he recommends are:
- Changing the name of Workers’ Compensation to Workers’ Recovery, where recovery specialists would work with workers with the goal of restoring whatever function was possible to their lives.
- Better communication, more clear explanations, and increased expectations for recovery can be instilled to those coming into the system
Finally, Wilson quoted from the source article about the study from Katherine Lippel, of the University of Ottawa , where she studies occupational health and safety law. Lippel said, “I think the point that needs to be made is that those managing these systems, insurers of workers’ compensation boards, or no-fault automobile compensation schemes, should realize that they are undermining their own mission of getting workers back on their feet if the process is unnecessarily stressful.”
Medical tourism cannot make the process of filing a claim or the claims process itself less stressful; that is the responsibility of the industry itself, the regulators of the system and the insurance companies that write the policies or the Third Party Administrators who handled the claims for the insurers or employers. What medical tourism can do, and should do, is to make the final stage of the claims process, surgery and recovery, as stress-less as possible, and to return the injured worker to a state of health similar to what they experienced before their injury. This would serve the medical tourism well and would win it many more supporters and more repeat customers.
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