title: The error of using returns-to-work to measure the outcomes of health care.
abstract: This article uses data from The Survey of Ontario Workers With Permanent Impairments. the world's largest survey of injured workers, to show that, as currently used, return-to-work is a misleading measure of the effectiveness of health care. The article discusses examples of two serious limitations on the use of return-to-work to measure the outcomes of health care, where health care refers to all the medical and rehabilitative services provided to a worker following a workplace injury. The first limitation is that return-to-work, like many other outcomes of health care, is influenced by factors that are not directly related to health care. Using a logit model to estimate the determinants of first absences from work after an injury, we find that socioeconomic characteristics, economic incentives, and job characteristics have a significant influence on return-to-work. The second limitation on return-to-work as an outcome measure is that the first return-to-work after an injury, like a hospital discharge, frequently marks the end of only the first of several episodes of work disability caused by the original injury. Using first post-injury returns-to-work as a proxy for recovery, we would assume that 85% of the Ontario workers recovered from their injury when, in fact, 61% had subsequent spells of work disability. We identified four mutually exclusive patterns of post-injury work and work disability. Multinomial logit estimates of the determinants of the patterns show that health care is only one of several influences on return-to-work. The results also demonstrate that if return-to-work is used to measure outcomes, it must be evaluated over a time horizon that permits multiple spells of work disability.
authors.affiliation: Department of Economics, East Carolina University, Greenville, NC 27858-4353, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Baldwin
authors.forename: W G
authors.initials: WG
authors.lastname: Johnson
authors.forename: R J
authors.initials: RJ
authors.lastname: Butler
mesh_terms: D015982:Bias; D004651:Employment; D015981:Epidemiologic Factors; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008962:Models, Theoretical; D009042:Motivation; D015999:Multivariate Analysis; D009784:Occupational Diseases / Q000534:rehabilitation*; D017063:Outcome Assessment, Health Care; D018582:Sick Leave / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors