It is the season at a time for political change. With the current power structure being shifted significantly, one must take into consideration the politics of healthcare and the Worker’s Compensation system. Healthcare within the Worker’s Compensation system is deeply intermingled with the prevailing political forces within any particular jurisdiction. A key question is are cost issues more important than providing all appropriate care to address the actual injury sustained?
Workers compensation is a safety net providing medical treatment, indemnity benefits, and overall balancing the priorities of the injured individual. There is a natural give-and-take between employer interests, injured employee interests and what is best practices. It is the balancing act between providing what is thought to be all proper care and controlling costs associated with this program.
It has been my experience that most responsible employers want the best for their teammates that were injured as part of the job. However, a concern compared to what constitutes best practices is always an issue, and often times a political issue. Multiple solutions have been proposed to include limited provider networks, the deployment of utilization review protocols to ascertain if the treatment is clinically indicated, unnecessary or excessive. An additional focus on tangential costs is always noted.
From the employee perspective (to include labor unions, employee advocates, and other professional organizations), injured workers want to choose those providers that they have the most confidence in treating the current pathology. Additionally, the injured employee wants to pursue a treatment plan as outlined by that provider who enjoys their respect. This is made more challenging by the clinical tenant that the treating provider is treating that whole person irrespective of who was paying the bill. Furthermore, when there are tangential factors like no group health insurance and there is clear objectification of specific pathology or symptomology, all too often injured employees’ default to workers compensation as providing that clinically indicated (and wholly unrelated) treatment.
It has been said (and repeated by me on a number of occasions) that all workers compensation is the same, except it is different in every state. Each local jurisdiction modifies their Worker’s Compensation process to their own standards and belief systems. Clearly, this can lead to significant political discussions, as we have seen throughout the history of our current workers compensation system as to what is correct and appropriate. Outside the political process, a number of legitimate devices and tools have been developed to achieve this perfect balance.
The purpose of this blog is to outline that all politics, and political discussions, are good for the entire workers compensation protocol. Understanding that the political discussion relating to healthcare can be somewhat onerous, a detailed discussion on every facet of Worker’s Compensation healthcare needs to be pursued.
Is the current system perfect, absolutely not! Can it be made better, absolutely. However, it takes an effort on all sides to fully discuss, and appropriately compromise, so that the best possible arrangement can be made. Everyone must be open to a thorough and honest discussion of the facts. My preference, with respect to any clinical decision, would be that any proper clinical determination is a function of evidence-based medicine and not whose pocket gets lined. As balance between healthcare and other interests are always evolving, all parties need to pay particular attention and always look to improve an untenable situation.