California Workers Research Articles

Vietnamese immigrants’ shifting patterns of status display at work

This study compared language choices made by Vietnamese speakers in a circuit-board manufacturing company in California with utterances constructed for similar situations by Vietnamese speakers in Hanoi, Vietnam. Particular attention was paid to how both groups of speakers signaled social relationships during talk at work, primarily through their selection or omission of Vietnamese address forms and other honorific markers. The California supervisor and assistant, during high-pressure problem-solving events, bypassed the use of kinship terms and, instead, chose non-honorific terms and other markers of informality, thus invoking a normative frame of teamwork and open debate about courses of action that pervade the contemporary American workplace. Excerpts of videotaped interactions between these California workers were shown to the Hanoi participants, after which they were asked to imagine a context in Hanoi similar to the one that they observed. Their constructed utterances were found to contain a variety of address forms — mostly personal names and kinship terms — along with other honorific and politeness forms. The Hanoi participants tended to incorporate these forms even within the economy of talk found in high-pressure moments. In including these forms, they highlighted the hierarchical relationship between the interlocutors as elder and younger, superior and subordinate. Their inclusion of these expressions reflects a cultural norm: the salience of maintaining interpersonal relationships in the workplace, which are managed elegantly through the Vietnamese person-reference system. The findings in this study suggest evidence of a shift in the norms of language use by Vietnamese immigrants living and working in the United States.

Physician Perceptions of Access to Quality Care in California's Workers' Compensation System

We measured the association of physician perceptions of access to quality care with intentions to change workers' compensation (WC) participation levels, barriers to delivery of quality care, levels of payment, and type of provider after the implementation of California WC reforms in 2004. Bivariate and logistic regression models were employed using a representative survey of WC providers. The analyses revealed that intentions to quit or decrease the volume of WC patients, reporting utilization review as a barrier to quality care, and being a chiropractor or acupuncturist were significantly associated with perceptions of decline in access or quality since 2004 and the belief that injured workers do not have access to quality care. The results indicate specific aspects of WC reform that lead to negative perceptions among providers and require further scrutiny and improvement.

Repackaged pharmaceuticals in the California workers' compensation system: From distribution and pricing options to physician and retail dispensing

The California Workers' Compensation (WC) pharmaceutical pricing system cannot price 60% of National Drug Codes (NDCs) (mostly repackaged pharmaceuticals). This study will estimate the lost savings due to repackaged pharmaceuticals and potential cost savings associated with alternative pharmacy fee schedules for repackaged pharmaceuticals. In addition, we will determine what characteristics explain repackaged costs to identify reasons for repackaged pharmaceutical use. All pain-related repackaged pharmaceuticals were identified by NDC using claims data from the California Workers' Compensation Institute (CWCI) database during 2002. Repackaged pharmaceuticals represented 55% of all NDCs and 92% of all Medi-Cal non-equivalent NDCs, but only 22% ($8,494,297/$38,968,233) of total pharmacy costs. Total repackaged pharmaceutical costs could be reduced by 36% ($3,059,177) using an alternative formula based on Medi-Cal. Compared with Medi-Cal priced manufacturer-packaged pharmaceuticals, repackaged pharmaceuticals are approximately 85% more expensive on a cost-per-pill basis. We propose limiting the generous pricing of repackaged pharmaceuticals. However, Medi-Cal payment rates may be extreme, and more moderate repricing might compensate physician-dispensing time more fairly and preserve patient access.

Which Came First, the Telecommuting or the Residential Relocation? An Empirical Analysis of Causality

Researchers have questioned whether the ability to telecommute is encouraging workers to relocate to more desirable residences farther from work, and in doing so, exacerbate sprawl and increase their net vehicle-miles traveled. The research presented here directly asks, is telecommuting a "friend or foe" of travel-reducing policies? Given that telecommuters tend to have longer commutes than non-telecommuters, is the ability to telecommute prompting workers to move farther away from work? Or rather, does the ability to telecommute allow those who for other reasons have already chosen, or would in any case choose, to live in more distant locations to commute less frequently? These questions are addressed using data collected from more than 200 State of California workers, including current, former, and non-telecommuters. The survey inquired retrospectively about their residential relocations, as well as their telecommuting engagements, over a 10-year period. The results indicate that, as expected, residential moves that are temporally associated with telecommuting episodes tend to increase commute time and length compared to other moves—although the differences are not statistically significant. Analyzing the temporal order of telecommuting engagement and residential relocation, the data show that those who are telecommuting and then move actually tend to relocate closer to their workplace, whereas those who begin telecommuting following a residential relocation tended to have moved much farther from their workplace. Analysis of the stated importance of telecommuting to specific residential relocations did not show a convincing effect toward more distant moves. Thus, the evidence more strongly supports the positive view of telecommuting, that it is ameliorating the negative transportation impacts of moves that occur for other reasons.

Differences in Workers??? Compensation Disability and Impairment Ratings Under Old and New California Law

California's workers' compensation law experienced an historic change on January 1, 2005. Previous methods used to rate permanent disability were replaced by new methods to rate permanent impairment. We sought to estimate the difference in ratings under the old and new law. We obtained 218 reports on injured workers from attorneys who represented injured workers. A disability expert rated disability and 15 physicians rated impairment. Average percentage point ratings for impairment under the 2005 law were approximately one third the size of ratings for disability under the old law. This estimate showed little variation across demographic groups, physician-evaluators, or injured body part. Because cash benefits are keyed to impairment ratings, benefits for permanently disabled workers may decrease as much as 60% under the new law.

Physician Shopping in Workers' Compensation: Evidence from California

Physician evaluations of impairment severity have a significant impact on the size of permanent disability benefits awarded to injured workers in workers' compensation. This gives both parties in a disputed claim the incentive to “shop” for physicians who will provide them with sympathetic evaluations. In this article we use data from the California workers' compensation system on competing physician evaluations for the same injury to study the extent to which the ability to select a physician results in a more favorable disability rating. We find that disability ratings based on evaluations from physicians selected by the applicant are 23 percent higher than those based on a neutral evaluation, while ratings based on a defense physician's evaluation tend to be about 5 percent lower. Moreover, we match these data to earnings loss data and estimate the extent to which applicant, defense, or neutral ratings best predict the outcomes of injured workers. The neutral ratings appear to do the best job of predicting earnings losses overall, though not by a substantial margin.

New workers' compensation legislation: Expected pharmaceutical cost savings

California Workers' Compensation (WC) system costs are under review. With recently approved California State Assembly Bill (AB) 749 and Senate Bill (SB) 228, an assessment of proposed pharmaceutical cost savings is needed. A large workers' compensation database provided by the California Workers' Compensation Institute (CWCI) and Medi-Cal pharmacy costs obtained from the State Drug Utilization Project are utilized to compare frequency, costs and savings to Workers' Compensation in 2002 with the new pharmacy legislation. Compared to the former California Workers' Compensation fee schedule, the newly implemented 100% Medi-Cal fee schedule will result in savings of 29.5% with a potential total pharmacy cost savings of $125 million. Further statistical analysis demonstrated that a large variability in savings across drugs could not be controlled with this drug pricing system. Despite the large savings in pharmaceuticals, inconsistencies between the two pharmaceutical payment systems could lead to negative incentives and uncertainty for long-term savings. Proposed alternative pricing systems could be considered. However, pain management implemented along with other cost containment strategies could more effectively reduce overall drug spending in the workers' compensation system.

Legal Update: Apportionment and California Workers’ Compensation Reform

Abstract In April 2004, California implemented workers’ compensation reforms to reduce workers’ compensation premiums for California employers while speeding medical treatment for injured workers. The new law requires the use of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, particularly regarding apportionment analysis for impairment; the AMA Guides does not directly evaluate disability. Under the new California law, the following are clear: apportionment of permanent disability is based on a) causation and requires both the overall percentage of permanent disability caused by the industrial injury, and b) the percentage of permanent disability due to all other factors, including previous injuries. Less clear about the new law are the following: does apportionment to “causation” mean the physician should apportion out preexisting “pathology” even if it was not disabling prior to aggravation; what happens if a worker fails to disclose a prior injury; and are the standards of the AMA Guides on apportionment similar to those in California's new Labor Code? In the AMA Guides, the discussion of causation, apportionment analysis, and aggravation is different from the legal precedent for disability in California. New in the law is the explicit statement that the employer shall be liable only for the percentage of permanent disability directly caused by the industrial injury. Legal decisions are expected to clarify the interpretation of apportionment.

Apportionment Analysis

Abstract In the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, apportionment refers to the “distribution or allocation of causation among multiple factors that caused or significantly contributed to the injury or disease and existing impairment,” and causation is the process of determining “an identifiable factor (eg, accident or exposure to hazards) that results in a medically identifiable condition.” Causality assessment requires a clear understanding and discussion of causal relationships; apportionment analysis refers to the extent to which factors may have contributed to a particular effect or impairment. A causal relationship requires three elements—a cause, an effect, and a specific relationship between them—the absence of any one of which disqualifies causality. Apportionment is an estimate of the degree to which each of various medically probable occupational or nonoccupational factors contributed to a particular impairment. The unique legal standards of compensability and apportionment vary by locality, and the apportionment of disability involves assessing the functional effects of different injuries over time. Evaluators should consider the effect of using the Combined Values Chart on the final assessment and must carefully distinguish factors that are combined vs those that are added or subtracted. A sidebar discusses important changes to the State of California's Workers’ Compensation.

California Workers’ Compensation System: Are Occupational Medicine Practice Guidelines Sufficient for the Treatment of Chronic Spinal Pain or Do They Require Supplementation by Guidelines for Interventional Techniques?

The California Workers' Compensation system mandates the use of occupational medicine practice guidelines developed by the American College of Occupational and Environmental Medicine (ACOEM). These Guidelines cover the treatment of acute (less than three months' duration) injuries. The presence in the ACOEM Guidelines of references to procedures which may be of use after the three-month acute period creates ambiguity as to whether the ACOEM Guidelines are applicable after three months. ASIPP's "Evidence-Based Practice Guidelines for Interventional Techniques in the Management of Chronic Spinal Pain" are comprehensive, focusing on management of chronic spinal pain. ACOEM guidelines, mandated by the legislature, do not deal explicitly with chronic pain. Their application in managing chronic pain may result in denial of access to appropriate treatment. Thus, ASIPP guidelines may be supplemental to the ACOEM Guidelines. Evaluation of the two Guidelines may clarify which should be followed in the event of ambiguity or conflict. The ACOEM and ASIPP Guidelines were evaluated to determine which more closely conformed with accepted standards for guideline creations; which was listed in the Agency for Health Care Research and Quality's (AHRQ) National Guideline Clearinghouse; and what the common references were, how these references were evaluated, how they supported the treatment guidelines offered, and how the ACOEM and ASIPP guidelines differed. The ASIPP Guidelines complied with 23 out of 25 elements of guideline creation, whereas ACOEM complied with only 12 out of 25. Only ASIPP is listed in the National Guideline Clearinghouse. ACOEM lists 154 references; ASIPP, 1175; only 20 appear in common. ASIPP's evaluation methodology more closely adhered to the AHRQ methodology. ASIPP's Guidelines are based upon a more robust, detailed analysis. The ASIPP Guidelines may be considered the applicable Guidelines for the treatment of work-related low back activity limitations persisting beyond three months.

Workers’Compensation Reformin California: AB749 of 2002 and AB227 of 2003

Effective 1995, California workers’ compensation moved from administered to competitive pricing as part of a reform program directed primarily at lowering employer costs. Premium rates fell drastically under legislative and administrative fiat and a destructive price war followed. Although this proved a boon to employers, by 1999 insurers were going out of business or withdrawing from the market. Meanwhile, benefits had again fallen behind. Against this backdrop, Assembly Bill 749 was enacted, effective 2003. It increased benefits and employer costs while making a number of changes to offset those costs. This approach cannot work. Employer costs will continue to increase as insurers struggle to regain solvency and grapple with increased benefit costs. Additional reform is needed. However, given the State’s $38 billion budgetary shortfall and the gubernatorial recall election, it is unlikely that effective measures will be adopted and implemented before the problem becomes worse.

Earl Warren's California Health Insurance Plan: What Might Have Been

In the mid-1940s, Governor Earl Warren failed to obtain legislative enactment of a universal single-payer state health insurance plan for California workers. Had he succeeded, the California example might well have been emulated by other states, producing a very different state and national health care system than what actually developed. But a combination of miscalculation on Warren's part and divided support from organized labor doomed three separate versions of tfie Warren health plan.

Comparing severity of impairment for different permanent upper extremity musculoskeletal injuries.

The labor market impact of upper extremity musculoskeletal injuries that result in permanent disability was estimated using data from the State of California. Administrative data on disability evaluations and resulting ratings was matched to data on the earnings of over 7000 injured workers. Using these data, labor market experience pre- and postinjury was tracked. Each injured worker was matched to a set of control workers who worked at the same firm, had the same tenure at the firm, and earned the same income at the time of injury. By comparing the injured and uninjured workers, lost earnings and the impact of injury on return to work was estimated. Evidence of considerable lost earnings resulting from injury was found. The results are compared to "disability ratings" that are used to set compensation under California's workers' compensation program. The disability rating was also found to predict poorly differences across upper extremity injuries in losses. In particular, those with shoulder injuries have larger losses than those with elbow or wrist injuries, despite receiving the same disability ratings.

Costs of Occupational Injuries and Illnesses in California

Objectives. The purpose of this study was to estimate the annual incidence, the mortality, and the direct and indirect costs associated with occupational injuries and illnesses in California in 1992. To achieve this, we performed aggregation and analysis of national and California data sets collected by the U.S. Bureau of Labor Statistics, California Workers' Compensation Insurance Rating Bureau, California Division of Industrial Relations, the National Center for Health Statistics, and the U.S. Health Care Financing Administration.Methods. To assess incidence of and mortality from occupational injuries and illnesses, we reviewed data from state and national surveys and applied an attributable risk proportion method. To assess costs, we used the cost-of-illness, human capital, method that decomposes costs into direct categories such as medical expenses and insurance administration expenses as well as indirect categories such as lost earnings, lost home production, and lost fringe benefits. Some cost estimates were drawn from California data, whereas others were drawn from a national study but were adjusted to reflect California's differences. Cost estimates for injuries were calculated by multiplying average costs by the number of injuries. For the majority of diseases, cost estimates relied on the attributable risk proportion method.Results. Approximately 660 job-related deaths from injury, 1.645 million nonfatal injuries, 7,079 deaths from diseases, and 0.133 million illnesses are estimated to occur annually in the civilian California workforce. The direct ($7.04 billion, 34%) plus indirect ($13.62 billion, 66%) costs were estimated to be $20.7 billion. Injuries cost $17.8 billion (86%) and illnesses $2.9 billion (14%). These estimates are likely to be low because: (1) they ignore costs associated with pain and suffering, (2) they ignore home care provided by family members, and (3) the numbers of occupational injuries and illnesses are likely to be undercounted.Conclusion. Occupational injuries and illnesses are a major contributor to the total cost of health care and lost productivity in California. These costs are on a par with those of all cancers combined and only slightly less than the cost of heart disease and stroke in California. Workers' compensation covers less than one-half of the costs of occupational injury and illness.

The integration movement in California's workers' compensation market.

Over the past two decades the California workers' compensation industry has been responding to rapidly rising medical costs. The first response was to attempt to adopt principles of managed care; the second, to increase efficiency by integrating activities, first within companies, then between companies and providers, and finally across companies providing both group health and workers' compensation. This article chronicles the integration movement, analyzes the forces driving it, and discusses how contradictory government incentives have both propelled and hindered integration.

Design of a state-based workers' compensation information system.

California policy makers have long been hampered by a lack of credible information for use in making legislative or administrative changes to address serious problems in the workers' compensation system. In 1993, the legislature directed the California Division of Workers' Compensation to develop a Workers' Compensation Information System (WCIS). An advisory committee developed key questions and identified data sources regarding injury/illness incidence, costs, promptness of benefit delivery, adequacy of benefits, satisfaction with services, and other outcomes. Key data elements were identified, mostly from existing mandated reporting forms for employers and physicians, and from standardized medical billings. Data collection will be carried out using: 1) rapid electronic data interchange (EDI) for a minimum number of data elements; 2) electronic collection of data on medical services for a sample of claims; and 3) surveys to address adequacy of benefits, satisfaction with services, return to work, and other outcomes. A state-based repository will analyze data and provide de-identified public use data files. The proposed WCIS will provide information to improve the performance and to increase the accountability of all the participants in California's Workers' Compensation system. More importantly, it will provide information which will allow improved quality in the provision of mandated benefits to injured workers.

A Success Story: Workers' Compensation Reform in Californiia

Throughout much of the 1980s and 1990s, California's workers' compensation system was on the brink of crisis. Now, California's system is much improved: legal and medical costs, fraud and abuse, stress claims, and use of vocational rehabilitation are down, while counterproductive pricing arrangements have been eliminated and inadequate maximum benefit levels reevaluated. The California Workers' Compensation Reform Act and two sets of later amendments have contributed greatly to reining in abuse and reducing costs. But improvement is always possible. The main constituencies of workers' compensation-insurers, management, and in many states, organized labor-must continue to cooperate in improving the system.

Respiratory cancer and other chronic disease mortality among silicotics in california

Silicotics have increased mortality from tuberculosis (TB) and from nonmalignant respiratory diseases (NMRD), including silicosis and silicotuberculosis. Since the publication of the International Agency for Research on Cancer monograph in 1987 indicating that silica was a probable human carcinogen, there has been an extensive debate about the cancer risks among silicotics. The authors identified 590 claims for silicosis among a registry of lung diseases compiled from California Workers' Compensation cases from 1945 to 1975. Using state vital records, we determined the mortality risks from 1946 to 1991. Our findings confirmed that these claimants had a significantly elevated risk for all causes of death with a standardized mortality ratio (SMR) of 1.30 (95% confidence interval [CI] = 1.18, 1.43); TB had a SMR of 56.35 (95% CI = 41.10, 75.40) and NMRD a SMR of 3.80 (95% CI = 3.11, 4.60). Cancers of the trachea, bronchus, and lung had a SMR of 1.90 (95% CI = 1.35, 2.60). For malignancies of the large intestine, there was a previously unreported SMR of 2.08 (95% CI = 1.14, 3.50). Mortality from all diseases of the heart was significantly less than expected with a SMR of 0.68 (95% CI = 0.55, 0.83); cancers of the prostate and lymphatic system were also significantly low with SMRs of 0.26 (95% CI = 0.03, 0.94) and 0.17 (95% CI = 0.04, 0.97), respectively. Workers with silicosis should be warned about these chronic disease risks, and prevention efforts to control occupational silica dust exposure should become a higher priority.

Integration of Energy Concepts by Modeling Techniques

The TDN system uses only one feed energy value, although the partial efficiency of energy use for maintenance is greater than for gain. The California net energy system overcomes this limitation by separating energy requirements for maintenance from those for weight gain. Michigan researchers developed a set of adjustments for age, frame size, previous growth rate, breed type, environment, feed additives, and growth stimulants. In 1986, California workers proposed more general, dynamic models that include prediction of body composition based on cell number and size mechanisms of growth to predict net protein synthesis. However, accuracy of fat gain prediction is variable; therefore, integrated models of growth with digestion and metabolism have been developed in England and in California. The later model has equations for two pools of DNA and protein and one fat pool; partial efficiencies of nutrients for maintenance and production may be evaluated. With each new model, prediction accuracy was improved by addition of new terms to conceptually validated models that were already accepted and in use. These terms were added using either empirical adjustment factors or mechanistic concepts and representations of biological functions at lower levels of aggregation.

Increased costs and rates of use in the California workers' compensation system as a result of self-referral by physicians.

There is widespread concern that ownership by physicians of testing or treatment facilities to which they refer patients leads to overuse of such facilities. We determined the patterns of use of three services--physical therapy, psychiatric evaluation, and magnetic resonance imaging (MRI)--among physicians treating patients whose care was covered under workers' compensation. We then compared the rates of use among physicians who referred patients to facilities of which they were owners (self-referral group) with the rates among physicians who referred patients to independent facilities (independent-referral group). We used a large data base to analyze claims under workers' compensation in California from October 1, 1990, through June 30, 1991, to determine the frequency and cost of these three selected services and determined whether the referring physicians were practicing self-referral or independent referral. We evaluated the cost per case for all three services, measured the frequency with which physical therapy was initiated, and evaluated the medical appropriateness of MRI. We found that physical therapy was initiated 2.3 times more often by the physicians in the self-referral group (68 percent) than by those in the independent-referral group (30 percent; P < 0.01). The mean cost per case for physical therapy was significantly lower in the self-referral group ($404 +/- 102) than in the independent-referral group ($440 +/- 167; P < 0.01). The mean cost of psychiatric evaluation services was significantly higher in the self-referral group than in the independent-referral group (psychometric testing, $1,165 +/- 728 vs. $870 +/- 482; P < 0.01, psychiatric evaluation reports, $2,056 +/- 1,063 vs. $1,680 +/- 578; P < 0.01). The total cost per case of psychiatric evaluation services was 26.3 percent higher in the self-referral group ($3,222 +/- 1,451) than in the independent-referral group ($2,550 +/- 742; P < 0.01). Of all the MRI scans requested by the self-referring physicians, 38 percent were found to be medically inappropriate, as compared with 28 percent of those requested by physicians in the independent-referral group (P < 0.05). There was no significant difference in the cost per case between the two groups. This study demonstrates that self-referral increases the cost of medical care covered by workers' compensation for each of the three types of service studied.