Evaluating the Impact of Intensive Case Management for Severe Vocational Injuries on Work Incapacity and Costs

Rolando Leiva,Noémie Kiefer,Jean-Claude K Dupont,Lise Rochaix

doi:10.1007/s10926-021-09967-6

Abstract

Purpose This study investigates the impact of an intensive case management program on sick leave days, permanent work incapacity levels and treatment costs for severe vocational injuries set up by the French National Insurance Fund in five health insurance districts. Methods The method employed relies on a four-step matching procedure combining Coarsened Exact Matching and Propensity Score Matching, based on an original administrative dataset. Average Treatment effects on the Treated were estimated using a parametric model with a large set of covariates. Results After one-year follow-up, workers in the treatment group had higher sickness absence rates, with 22 extra days, and the program led to 2.7 (95% CI 2.3–3.1) times more diagnoses of permanent work incapacity in the treatment group. With an estimated yearly operational cost of 2,722 € per treated worker, the average total extra treatment cost was 4,569 € for treated workers, which corresponds to a cost increase of 29.2% for the insurance fund. Conclusions The higher costs found for the treatment group are mainly due to longer sick leave duration for the moderate severity group, implying higher cash transfers in the form of one-off indemnities. Even though workers in the treated group have more diagnoses of permanent work incapacity, the difference of severity between groups is small. Our results on longer sick leave duration are partly to be explained by interactions between the case managers and the occupational physicians that encouraged patients to stay longer off-work for better recovery, despite the higher costs that this represented for the insurance fund and the well-documented adverse side effects of longer periods off-work.

Highlights

While case management has been practiced as early as the 1860s in the United States [1], it is relatively new in healthcare in France, with the first large scale case management program introduced in 2007 in an experiment targeting frail elderly autonomy enhancement through service coordination [2]
Section "Matching and Balance of Samples" documents the performance of the combined Coarsened Exact Matching (CEM) and Propensity Score Matching (PSM) preprocessing at balancing covariates between the treatment and control groups, while Section "Outcome Results" presents the program results
In line with the Swiss experiment evaluated by Scholz et al [4], our results show that an ICM program is not sufficient to reduce work incapacity of severely injured patients

Summary

Introduction

While case management has been practiced as early as the 1860s in the United States [1], it is relatively new in healthcare in France, with the first large scale case management program introduced in 2007 in an experiment targeting frail elderly autonomy enhancement through service coordination [2]. From the employer’s perspective, a fast RTW may reduce some of the negative impacts of work disability, i.e. a lower individual and collective productivity (as disability imposes changes in the internal organization of labor), increases in insurance premiums as well as compensation costs [3, 5]. From the insurer’s perspective, better health outcomes could result in lower treatment costs [1, 3] as well as reduced cash transfers (indemnities and pensions). From the worker and his household’s perspective, fast RTW will reduce health and quality of life losses, as well as income losses [5]

Methods

Results

Discussion

Conclusion