Legislative change is associated with improved health status in people with whiplash.
METHODS
Interrupted time series.


OBJECTIVE
To assess whether a change in legislation improved health status and quality of life for people with whiplash.


BACKGROUND
Whiplash was the most prevalent injury in a compulsory, fault based, third party motor vehicle insurance scheme in New South Wales, Australia. Legislative change removed financial compensation for "pain and suffering" for whiplash, introduced clinical practice guidelines for its treatment; and changed regulations to permit earlier acceptance of compensation claims, and earlier access to treatment, for all types of injury.


METHODS
Three independent groups of people with whiplash were identified from insurance data (before legislative change--the 1999 group and, after legislative change--the 2001 and 2003 groups). Health status was assessed 2 years after injury by a telephone interviewer blinded to the study hypotheses. The main outcome measure was disability, as assessed by the Functional Rating Index (FRI). Pain and health-related quality of life was also assessed.


RESULTS
The mean FRI at 2 years after injury was 38.0% (SE, 1.9) for the 1999 group, 31.8% (SE, 2.1) for the 2001 group, and 30.1% (SE, 1.8) for the 2003 group (F = 5.0, P = 0.007). Improvement in secondary outcomes, including pain, also occurred.


CONCLUSIONS
Health status of people with whiplash improved after legislative change. Design of compensation schemes should be undertaken with the understanding that the scheme structure may have substantial effects on the long-term health of injured people.
Cameron
Ian D
ID
Rehabilitation Studies Unit, University of Sydney, Ryde NSW, Australia. ianc@mail.usyd.edu.au
Rebbeck
Trudy
T
Sindhusake
Doungkamol
D
Rubin
George
G
Feyer
Anne-Marie
AM
Walsh
John
J
Schofield
William N
WN
D000328:Adult; D004185:Disability Evaluation; D005260:Female; D006304:Health Status; D006801:Humans; D007342:Insurance Benefits / Q000331:legislation & jurisprudence*; D007346:Insurance, Accident / Q000331:legislation & jurisprudence*; D008297:Male; D009313:National Health Programs / Q000331:legislation & jurisprudence*; D009517:New South Wales; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D013315:Stress, Psychological; D014911:Whiplash Injuries / Q000191:economics* / Q000628:therapy