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Overview

Work-related injuries have a staggering impact upon the healthcare system, in addition to the pain and suffering endured by the afflicted individual. At least 31 % of the US adult population report suffering from chronic pain. In addition, the total costs incurred in terms of both healthcare and productivity losses due to chronic pain amount to approximately $635 billion annually. The present chapter serves as a guide to navigate through several online resources to contain national- and state-level data on the incidence rate of chronic pain, as well as the direct healthcare costs and indirect costs associated with occupational disability. The chapter explores in detail the US Bureau of Labor Statistics (BLS) Industry Injury and Illness reports and datasets, as well as data reports from the Agency for Healthcare Research and Quality’s Medical Expenditure Panel Survey (MEPS). Finally, the chapter provides a guide for estimating and quantifying disability benefit costs accrued to injured workers from their respective Workers’ Compensation jurisdiction. Upon conclusion of the chapter, readers should be familiar with at least three sources of comprehensive incidence and cost data that should be useful in conducting research studies on the economic impact of occupational pain and disability.

Introduction

The impact of chronic pain in the United States is staggering. According to a recent report by the Institute of Medicine, chronic pain impacts approximately 116 million adults in the United States, amounting to treatment costs and losses in productivity totaling $635 billion annually (Institute of Medicine, Committee on Advancing Pain Research, Care, and Education, 2011). In a recent Web-based cross-sectional survey of American adults, the results indicated a prevalence rate of 31 % for chronic pain, defined as chronic, recurrent, long-lasting pain for durations of at least 6 months (Johannes, Le, Zhou, Johnston, & Dworkin, 2010). Also noteworthy in this survey was that the top two conditions reported were low back pain and osteoarthritis pain. Both conditions also predominate within the subpopulation of patients suffering from occupational-related pain and disability due to injuries on the job (Janwantanakul, Pensri, Jiamjarasrangsri, & Sinsongsook, 2008; Yeung, Genaidy, Deddens, Alhemood, & Leung, 2002). The relationship between costs and prevalence of occupational pain and disability is also striking. It has been noted that a small minority of patients (approximately 7 %) account for up to 70 % of the annual costs accrued to the Workers’ Compensation payor system (Hashemi, Webster, & Clancy, 1998; Hashemi, Webster, Clancy, & Courtney, 1998; Hashemi, Webster, Clancy, & Volinn, 1997). To complicate matters further, patients within occupational disability compensation systems have been noted for having persistently poor outcomes following standard treatment modalities (DeBerard, Masters, Colledge, Schleusener, & Schlegel, 2001; Franklin et al., 2005; Franklin, Haug, Heyer, McKeefrey, & Picciano, 1994; Maghout-Juratli, Franklin, Mirza, Wickizer, & Fulton-Kehoe, 2006).

Compounding the problem further is the exponential increase in the use of prescription opioids to treat chronic pain since 1990, a trend that also coincided with a spike in the rate of unintentional poisonings and overdoses due to prescription opioids since 1990 (Okie, 2010). Patients suffering from work-related injuries were also not exempt from this trend. For example, Washington State endured not only a doubling in the rate of prescribing for Schedule II opioids between 1996 and 2002 but also a 50 % increase in the morphine equivalence dose prescribed (Franklin et al., 2005). That study also reported an increase in deaths due to accidental overdose during that duration of time. The nationwide economic impact of rising rates of associated opioid abuse, dependence, and misuse has also become staggering. The total costs to society from this rising tide of prescription opioid abuse and misuse amounted to $55.7 billion in 2007, which included workplace costs due to productivity losses, healthcare costs, and costs to the criminal justice system (Birnbaum et al., 2011).

Given the magnitude of its impact on society, it is clear that the present model of care in managing chronic pain is becoming increasingly unsustainable. The culture of evidence-based guidelines and treatment approaches are now being reinforced by calls to document the cost-effectiveness of treatment modalities. Ever since the seminal publication of cost-effectiveness guidelines almost two decades ago (Gold, Siegel, Russell, & Weinstein, 1996), there have been growing calls to incorporate cost-effectiveness methodology within new clinical trials and evaluations of treatment modalities, including those programs tailored for occupational disability (Baldwin, Côté, Frank, & Johnson, 2001; Dowd et al., 2010; Kepler et al., 2012; Tompa, de Oliveira, Dolinschi, & Irvin, 2008; Turk, 2002). However, the impact of occupational pain and disability does not always fit neatly within the protocols of a defined clinical trial or research study, where as many factors as possible are controlled for, or kept equivalent, among groups being studied. The typical individual suffering from occupational pain and disability often has a history of intersecting and interacting factors that must be accounted for when trying to quantify the costs associated with their case.

Occupational injuries that result in pain and disability often result in a cascading effect beyond the injured worker. Although pain and disability impose the most immediate and primary effects upon the individual, it is important to also account for the broader societal perspective when discussing the implications of occupational pain and disability. As implied by the biopsychosocial perspective on pain, there is indeed a complex interplay among various factors such as the individual’s interaction with healthcare system, medicolegal system, and the employer and interpersonal relationships that define the impact of occupational disability. The most rigorous research on occupational pain and disability should therefore carefully attempt to estimate and quantify, as best as possible, these various components. With the combination of increased transparency, as well as access to well-developed online resources (e.g., Federal and State electronic databases), the once arduous task to estimate these components is made relatively easier.

This chapter is written with the objective to familiarize readers with several sources from which to obtain data on incidence and cost associated with occupational pain and disability. Three major examples will be discussed on the topic of obtaining incidence rates of occupational disability, estimating costs of healthcare costs, and finally estimating the cost of disability benefits, such as wage-replacement schemes, and impairment benefits.

Incidence of Occupational Pain and Disability

The most reliable source for obtaining the incidence of occupational injuries, and resulting disability, is the United States Department of Labor’s Bureau of Labor Statistics. This Web-based resource can be found within the section of the BLS website’s section for Injuries, Illnesses, and Fatalities (http://www.bls.gov/iif/). The website provides two major categories of data for each year: (1) the incidence data for government and private sector work-related injuries and illnesses (http://www.bls.gov/iif/oshsum.htm) and (2) case and demographic characteristics of work-related injuries and illnesses involving days away from work (http://www.bls.gov/iif/oshcdnew.htm). These data are further broken down by each State.

The available data are generally dated by about a year, with data up to year 2011 available at the time of writing this chapter. For each year, there is an overall summary followed by multiple reports that include breakdowns by type of industry, category of injuries or illnesses, and the variability in the incidence of injuries and illnesses among different industries. However, the most useful report to begin with will be the summary news release and statistics for the year in question. For example, the 2011 summary news release can be accessed at http://www.bls.gov/news.release/archives/osh_10252012.pdf (also see Fig. 9.1). As reported, we see that there were a total of approximately three million cases of nonfatal work-related injuries and illnesses across the United States during year 2011, corresponding to an incidence rate of 3.5 injuries and illnesses per 100 full-time workers. Figures 9.2 and 9.3 illustrate some examples of the type of charts available in the BLS incidence reports for work-related injuries. As illustrated, the data show the breakdown of the overall incidence of injuries and illnesses to those with and without resulting days away from work.

Fig. 9.1
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Accessing the summary news release and statistics for the US Bureau of Labor Statistics Industry Injury and Illness Data

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Fig. 9.2
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US Bureau of Labor Statistics national incidence data for workplace injuries and illnesses. Source: U.S. Bureau of Labor Statistics, U.S. Department of Labor, October 2012

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Fig. 9.3
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US Bureau of Labor Statistics incidence data for workplace injuries and illnesses by US states. Asterisk: Total recordable case (TRC) incidence rate per 100 full-time workers. Source: U.S. Bureau of Labor Statistics, U.S. Department of Labor, October 2012

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Similarly, a rich resource of data is available for the case and demographic characteristics of work-related injuries and illnesses involving days away from work. Similar to the data on incidence rate, an ideal starting point would be the summary news release and statistics report (e.g., for year 2011, http://www.bls.gov/news.release/archives/osh2_11082012.pdf). The summary report provides detailed information on the incidence rates by gender, age group, type of occupations that have the most frequent injuries, the nature of injuries (e.g., fall, strain), the injured musculoskeletal area (e.g., back injuries account for the majority at 36 %), and the median days away from work (by occupation/industry as well as by injured musculoskeletal region). Figures 9.4 and 9.5 illustrate some examples of the type of charts available in the BLS case and demographic reports for work-related injuries involving days away from work.

Fig. 9.4
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US Bureau of Labor Statistics distribution of injuries and illnesses with days away from work by sex. Source: Bureau of Labor Statistics, U.S. Department of Labor, November 2012

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Fig. 9.5
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US Bureau of Labor Statistics median days away from work by age group. Source: Bureau of Labor Statistics, U.S. Department of Labor, November 2012

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Although for most purposes the summary reports and charts from each of the two major categories of data discussed above will be all that is required to obtain relevant statistics for research and reporting, readers can also peruse the variety of supplemental data tables available that go into very granular detail such as the type of injury for each industry sector and the related incidence rates and resulting median days away from work. Having the incidence data is the first step toward estimating the impact of chronic pain and disability due to work-related injuries. We now focus on sources for estimating the costs of work-related injuries and its resulting pain and disability.

Estimating Costs Associated with Occupational Pain and Disability

The task of accurately estimating and quantifying the costs associated with occupational pain and disability is complex and requires attention to details, such as the specific medicolegal jurisdiction under study. However, there are various sources and guidelines available to aid in undertaking this task. To begin, one must first understand the broad categories of costs usually associated with occupational pain and disability. Associated costs can be broadly categorized into direct costs (e.g., medical costs, indemnity/disability benefits) and indirect costs (e.g., productivity losses and other intangible costs). While the cost components in this chapter are emphasized due to their central importance to occupational pain and disability and availability of online resources in quantifying these costs, readers are encouraged to familiarize themselves with broader definitions of cost components as discussed in Haddix, Corso, and Gorsky (2003) and Luce, Manning, Siegel, and Lipscomb (1996).

Depending on the nature of the intervention, medical costs may include any screening and diagnostics, specific surgical or nonsurgical intervention, hospitalization costs, medication, and visits to healthcare providers (Haddix et al., 2003). Indemnity or disability compensation includes any type of compensation such as Workers’ Compensation wage-replacement schemes, lump-sum payments, and Federal, State, or private short-term or long-term disability (LTD) insurance (e.g., impairment benefits, Social Security Disability Insurance (SSDI), short-term disability (STD) and LTD policies).

Productivity losses involve any costs associated with the patient’s inability to engage in occupational activities, leisure activities, or activities of daily living during the period of intervention and also any period following the intervention. The most common cost associated with productivity losses is the patient’s time spent receiving the intervention. For occupational disability, productivity losses mainly focus on the inability to return to work or engage in gainful employment, either through absenteeism or presenteeism (Langleya et al., 2010).

Finally, intangible costs refer to any type of costs associated with the intervention or outcomes that are often difficult to estimate or express in monetary units. Within the healthcare setting, intangible costs refer to resulting differences among the interventions being investigated on constructs such as pain, function, emotional distress, and quality of life (Haddix et al., 2003). Although these are not domains that can be expressed in monetary units, and therefore outside the scope of this chapter, it should be stressed that these are often useful outcomes to monitor (Turk & Melzack, 2011) within the context of a cost-benefit appraisal of treatment modalities or policy guidelines that impact patients suffering from occupational pain and disability.

Estimating Healthcare Costs

Estimating healthcare costs can be somewhat of a daunting challenge for several reasons. Firstly, there are a comprehensive range of medical services that must be accounted for, including inpatient services and hospitalization, outpatient services, emergency department visits, medications, ergonomic devices and supplies, and any home-based care received. Table 9.1 details some of the more common examples of costs that should ideally be itemized and accounted for in estimating healthcare costs. The second challenge in estimating healthcare costs is that the most detailed records of costs are often not easily available. The most accurate source for what was paid for these services is often the individual payors or the Workers’ Compensation jurisdiction overseeing the reimbursement of healthcare services for the injured worker. However, these datasets may not necessarily be made available to researchers, or it may require a fee for access to these. A third challenge is due to the variability in the costs for a given service. In practice, there is often a chasm between the cost of the service and the charges incurred for the service (or price of the service). Whereas costs in theory should reflect the true resource cost of the service delivered (Finkler, 1982), charges often vary due to various reasons, such as geographic location, rural versus urban settings, the negotiated rates between the healthcare providers and the employer, insurance company, or the Workers’ Compensation authority. This can often distort the true cost of the service.

Table 9.1 Common healthcare costs to be included in cost estimation
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However, if lacking direct access to healthcare costs data from the insurance carrier or the Workers’ Compensation jurisdiction, there are several alternatives available from Federal databases. A relatively comprehensive source of data is available from the Agency for Healthcare Research and Quality (AHRQ) MEPS, at no cost and open to the public. As described in their website (http://meps.ahrq.gov/mepsweb/index.jsp), the MEPS:

…which began in 1996, is a set of large-scale surveys of families and individuals, their medical providers (doctors, hospitals, pharmacies, etc.), and employers across the United States. MEPS collects data on the specific health services that Americans use, how frequently they use them, the cost of these services, and how they are paid for, as well as data on the cost, scope, and breadth of health insurance held by and available to U.S. workers.

Although the data are aggregate in nature, the MEPS database does provide a breakdown of median and mean costs per person, for various healthcare services as summarized in Table 9.2. To access the MEPS database for healthcare costs, access the link for the Summary Data Tables under the left-hand menu for Data and Statistics. From here, access the Household Component summary tables link (see Fig. 9.6). Then select an appropriate year and the type of summary table desired among the expenditures data (see Fig. 9.7). At the time of writing this chapter, expenditures were available through year 2010. For each of the expenditure tables presented, the total cost for all patients surveyed, as well as the median and mean costs per person, is reported and is further broken down into demographic characteristics such as by sex, age group, ethnicity, type of health insurance, socioeconomic status, region of the country, and baseline health status.

Table 9.2 Available cost data for various healthcare services in the Medical Expenditures Panel Survey (MEPS)
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Fig. 9.6
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Accessing the Medical Expenditure Panel Survey summary data tables

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Fig. 9.7
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Accessing the Medical Expenditure Panel Survey cost data

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Despite the comprehensive nature of the costs available in MEPS, there are at least two notable limitations inherent in the data that readers should be aware of. Firstly, the data are aggregate in nature for each major type of medical service. Therefore, it will not allow the quantification of costs with more granularity [e.g., to compare more expensive surgical procedures (e.g., lumbar fusion surgery) versus relatively less expensive procedures (e.g., lumbar epidural steroid injections)]. Secondly, these cost estimates are surveyed at the population level and reported nationally as well as by State. While it will be valid to use in estimating the healthcare costs related to occupational injuries in general, it will become less accurate when trying to estimate costs incurred by those injured workers who are suffering from chronic pain and disability. As mentioned in the introduction to this chapter, chronic occupational disability usually comprises a very small minority of patients who account for the vast majority of the incurred healthcare costs (Hashemi et al., 1997; Hashemi, Webster, & Clancy, 1998; Hashemi, Webster, & Clancy, et al., 1998). Therefore, use of the MEPS database will inevitably underestimate the true costs associated with chronic cases.

Despite these limitations, the MEPS datasets have been a wealth of resource for researchers investigating the cost and quality of healthcare in the United States (Jimenez, Cook, Bartels, & Alegría, 2013; Sharp & Fendrick, 2013; Shi et al., 2013; St Sauver et al., 2013). To overcome some of the limitations in granularity, there are several other Federal databases that can be accessed. Also from the AHRQ, the Healthcare Cost and Utilization Project (HCUP, http://www.hcup-us.ahrq.gov/) pools data from Federal and State governments, hospital associations, and private organizations and presents these as patient-level and encounter-level data on a broad range of healthcare variables, including cost. Similarly, the Center for Medicare and Medicaid Services also provides access to more granular, patient-level data (http://www.cms.gov/Research-Statistics-Data-and-Systems/Research-Statistics-Data-and-Systems.html). However, access to both these resources requires payment of fees and execution of data use agreements, unlike MEPS which is publicly available for free. Finally, another possibility to overcome the limitation of MEPS is to negotiate access to billing records from payors. This option would be the most desirable, especially when estimating healthcare costs of chronically disabled workers, as database queries can be limited to patients who meet certain criteria for having a certain number of days of temporary total disability (TTD) and days away from work.

Estimating Disability Benefits

As described in a previous section, disability benefits include any type of compensation such as Workers’ Compensation wage-replacement schemes, lump-sum payments, and Federal, State, or private short-term or LTD insurance (e.g., impairment benefits, SSDI, STD and LTD policies). Each State has its own unique policy in terms of how disability benefits are calculated, the amount of wages replaced during periods of TTD (approximately 2/3 of pre-injury wage for most states), statutory limits on the duration that payments are effective, and deadlines to meet ratings of maximum medical improvement and subsequent payouts of impairment benefits or lifetime benefits. Similarly, Federal employees fall under unique rules related to Federal Workers’ Compensation policies. Specific rules for each State, as well as Federal jurisdictions, can be obtained from their respective websites. These are conveniently compiled into a single linked resource in an online directory maintained by the School of Human Resources and Labor Relations at Michigan State University (http://hrlr.msu.edu/hr_executive_education/wcid/wc_state.php). To give an example of the methodology used in estimating the various types of disability benefits, we will focus on a single jurisdiction’s rules. The Texas Workers’ Compensation jurisdiction is used, as it is the most familiar to this author from previous research. All the information from the following subsections was sourced from fact sheets published online by the Texas Department of Insurance—Division of Workers’ Compensation (http://www.tdi.texas.gov/wc/publications.html#factsheets).

Temporary total disability benefit. The TTD benefit is a temporary wage-loss compensation that supplements a portion of injured workers’ wages that are unable to be earned due to disability. The TTD benefit is the most common across all State and Federal jurisdictions. In the Texas Workers’ Compensation (WC) system, the TTD benefit is referred to as temporary income benefits (TIBS). An injured worker becomes eligible for TIBS after missing more than 7 days from work. Benefits are not paid for the first week of lost wages unless the injured worker is unable to return to work at least 2 weeks. In general, the weekly TIBS rate is equivalent to 70 % of the average weekly wage, but not exceeding statutory ceiling limits based on the State average weekly wage for the given fiscal year that the injury occurred (i.e., a wage cap that is updated annually by the State Legislature). However, for workers earning less than $8.50 per hour, the first 26 weeks of TIBS is computed at 75 % of the average weekly wage and reverts to 70 % following this initial period, in both cases to not exceed the statutory ceiling limit for wages. The duration of TIBS is for a maximum of 104 weeks, or until the injured worker is defined to have reached maximum medical improvement (whichever comes first). In addition to the TIBS, or the TTD benefit in general, there are several other types of wage-replacement benefits that are often paid out within most State jurisdictions.

Permanent impairment benefits. This benefit amount is awarded for permanent impairment due to a work-related injury and, within the Texas Workers’ Compensation jurisdiction, is known as impairment income benefits (IIBS). In general, IIBS payments begin after an injured worker receives an impairment rating, either at the time of determination for maximum medical improvement or after 104 weeks has elapsed and TIBS payments are stopped. Impairment ratings are a percentage that documents the degree of permanent damage to the body as a whole and are assigned based on guidelines published in the American Medical Association’s Guides to the Evaluation of Permanent Impairment (American Medical Association, 2007). Every percentage point of impairment entitles the injured worker to 3 weeks of IIBS payments. The actual IIBS rate corresponds to 70 % of the injured worker’s pre-injury weekly wage and not to exceed a statutory wage ceiling limit of 70 % of the State average weekly wage.

Supplemental income benefits (SIBS). In the Texas jurisdiction, SIBS payments begin after all TTD and impairment benefits have been exhausted. However, SIBS are not an automatic payment and have to be applied for quarterly, according to several criteria. Firstly, the injured worker would have to be disabled or, if having returned to work, is working less than the original capacity and consequently earning less than 80 % of his or her pre-injury weekly wage. Secondly, the impairment rating of 15 % or more must have been determined at maximum medical improvement. Thirdly, impairment benefits must have been paid out in installments and not as a one-time lump-sum. And finally, the injured worker should have demonstrated good faith in actively complying with the Texas Department of Insurance’s work-search requirements to successfully return to work. Having met all these criteria, the SIBS payments are determined as a portion of the original pre-injury wage and paid out following expiration of impairment benefits and continued for up to 401 weeks (7.5 years) since the work-related injury.

Lifetime benefits. Finally, for those injured workers with serious injuries resulting in total loss (or loss of use) of limbs or sight, severe traumatic brain injury that results in mental incapacitation, spinal injuries that result in paralysis of two or more limbs, or third-degree burns in a substantial amount of the body, the Texas jurisdiction provides lifetime income benefits (LIBS). LIBS, as the name implies, are permanent wage-replacement benefits and can begin as soon as any of the conditions described has been medically determined. The amount paid out by LIBS corresponds to 70 % of the pre-injury weekly wage, subject to statutory wage caps determined by the State annually. In addition, there is a 3 % adjustment for inflation annually.

Other benefits. The benefits discussed above, although specific to the Texas Workers’ Compensation jurisdiction, are similarly available in most other states and Federal jurisdictions, with some variations in the rules and eligibility criteria. In addition to the Workers’ Compensation benefits, another Federal benefit that is available to injured workers nationwide is the SSDI. SSDI eligibility, and its payout rate, is determined by such factors as the individual’s age, contributions to date to Social Security, and receipt of any other TTD or disability benefits from Workers’ Compensation or private disability insurance. The specific rules of the SSDI calculation are beyond the scope of this chapter, but the Social Security Administration provides online calculators that can help estimate possible SSDI benefits, given knowledge of other factors that go into its calculation. The SSDI calculator can be accessed here: http://www.ssa.gov/planners/benefitcalculators.htm. Besides the SSDI, some injured workers may also have access to private insurance benefits such as STD and LTD. These are generally specific to the individual policies purchased and the underwriting agreements determined at time of purchase. To date, no specific online resources exist to help estimate these types of benefits. However, it is important to recognize the presence of these other sources of benefits when describing the economic impact of occupational pain and disability.

Estimating Productivity Losses

Although no validated online resources or databases are available to estimate productivity losses due to occupational pain and disability, this is too important a cost component to be excluded from the discussion. However, there are several methods available to estimate these costs. In general, productivity losses can be attributed to absenteeism as well as presenteeism (Langleya et al., 2010). While absenteeism is straightforward and is defined by time away from work, presenteeism involves reduced productivity while at work due to injury or illness. In a systematic review of methods available to estimate productivity losses, Mattke and colleagues reviewed 20 self-reported assessment instruments in the published literature that aimed to measure productivity losses due to both absenteeism and presenteeism (Mattke, Balakrishnan, Bergamo, & Newberry, 2007). This review concluded that there are considerable challenges in valid documentation of presenteeism due to various factors, most notably being the nature of self-reported assessments on one’s productivity, as well as lack of objective or even easily measurable criteria to define the scope of productivity decline due to presenteeism. However, recent work improving on the psychometric properties and predictive validation of self-reported presenteeism assessments are bridging the gap in not only estimating the productivity losses due to presenteeism but also monetizing those losses through statistical modeling (Mitchell & Bates, 2011).

Given the level of documentation afforded by Workers’ Compensation systems in accounting for time away from work due to total or partial disability, there exist methods to more objectively quantify the costs of productivity losses among injured workers. The most direct method in accounting for productivity losses is through the Human Capital method (Rice, Hodgson, & Epstein, 1985), specifically by multiplying the pre-injury weekly wage of the injured worker by the duration of time absent from work (either total absence or modified/reduced work schedule due to disability or both). A newer approach also accounts for the intangible cost incurred by the employer when a particular worker is absent for extended durations, either through retraining of another worker, hiring of a temporary worker, or reduction in output or profits. The Lost Wages method (Berger, Murray, Xu, & Pauly, 2001; Mattke et al., 2007) is a modification of the Human Capital method in that an additional multiplier is introduced into the equation, consisting of the cost to the employer due to a worker’s absence as a proportion of the worker’s daily wage (Mitchell & Bates, 2011). These multipliers have been determined across various occupational types and demonstrate the economic impact to the employer that goes beyond merely the daily wage of the absent worker due to disability (Nicholson et al., 2006).

To be certain, this is not the only methodology to estimate productivity losses. In general, the Human Capital approach (and its variant described above) accounts for productivity loss mainly from the perspective of the injured worker, and it spans the entire duration of the temporary total or partial absence from work. Other methods account for the costs of productivity losses from the perspective of the employer, such that the cost terminates upon the hiring of a replacement or reorganization of the existing workforce to compensate for the loss in productivity due to the disabled worker. This method, called the Friction-Cost method, is sometimes used as an alternative estimate for the cost of productivity losses (Goeree, O’Brien, Blackhouse, Agro, & Goering, 1999). Ultimately, the choice of which method to use depends on the perspective of analysis one is undertaking (i.e., is it a patient-centered perspective or an employer-centered perspective?). To be sure, both cases apply when considering the broader societal impact of productivity losses, although health economists have argued for the superiority of the Friction-Cost method as being more accurate because it takes into account realities in the labor market (Koopmanschap, Rutten, van Ineveld, & van Roijen, 1995; van den Hout, 2010).

Conclusions

The sections above point readers toward online State and Federal resources that allow for relatively easy estimation and quantification of the impact of occupational pain and disability due to work-related injuries. Table 9.3 summarizes these resources and the Web addresses where they can be found. These resources detail the Federal datasets on the incidence and characteristics of occupational injuries and illnesses, as well as resources on how to account for the costs of disability benefits for all State and Federal Workers’ Compensation jurisdictions. As with most undertakings that attempt to estimate the economic impact of a phenomenon, the reader should be aware that there are some theoretical considerations and assumptions that have to be made about these online datasets and their applicability to the population they wish to study.

Table 9.3 Summary of online resources discussed for incidence and cost data relevant to occupational pain and disability
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Therefore, it is important to appreciate some of the limitations of these online resources, in that they may not apply to all cases of occupational disability, especially when the available data are in aggregate form and the population under study is one that has been chronically disabled. In such cases, access to patient-level, longitudinal data should be sourced from agencies such as CMS and the AHRQ HCUP databases or through access to State Workers’ Compensation billing databases. In addition, to best use the State and Federal resources on Workers’ Compensation jurisdictions, the reader should be aware that they will need to plan to collect key data elements that will serve as the inputs to the computation of benefits (e.g., pre-injury weekly wages, duration of disability, impairment ratings, other non-Workers’ Compensation benefits received). However, with an appreciation of these inherent limitations, and appreciation of the data inputs required, it is my hope that readers will conclude this chapter with the satisfaction of having a few more tools in their toolkits to help them with some rewarding and productive research on the societal impacts of occupational pain and disability.