title: Who is paying the bills? Health care costs for musculoskeletal back disorders, Washington State Union Carpenters, 1989-2003.
abstract: OBJECTIVE
  Factors associated with private health insurance payment rates for musculoskeletal back disorders were examined among a 15-year cohort of union carpenters. Payment patterns were contrasted with work-related back injury rates over time.
  
  
  METHODS
  Negative binomial regression was used to assess payment rates; generalized estimated equations accounted for multiple observations per person and cost correlation within subjects.
  
  
  RESULTS
  Payment rates increased after work-related injury and with the number of injuries. Increasing private payments and deductibles (inflation-adjusted and discounted) were observed in contrast with a marked decline in reported work-related injuries.
  
  
  CONCLUSIONS
  Private insurance payments do not appear to be independent of work-related back injury. Findings suggest cost-shifting from workers' compensation to the union-provided health insurance and to the worker; they also provide a warning regarding reliance on workers' compensation statistics for surveillance of work-related disorders or disease.
authors.affiliation: Department of Community and Family Medicine, Division of Occupational and Environmental Medicine, Duke University Medical Center, Durham, NC 27710, USA. hester.lipscomb@duke.edu
authors.forename: Hester J
authors.initials: HJ
authors.lastname: Lipscomb
authors.forename: John M
authors.initials: JM
authors.lastname: Dement
authors.forename: Barbara
authors.initials: B
authors.lastname: Silverstein
authors.forename: Wilfrid
authors.initials: W
authors.lastname: Cameron
authors.forename: Judith E
authors.initials: JE
authors.lastname: Glazner
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D019567:Back Injuries / Q000191:economics*; D001416:Back Pain / Q000191:economics*; D015331:Cohort Studies; D003361:Cost Allocation; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007221:Industry; D007349:Insurance, Health, Reimbursement / Q000639:trends; D007750:Labor Unions; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009784:Occupational Diseases / Q000191:economics*; D017678:Sex Distribution; D014861:Washington; D014942:Workers' Compensation; D055815:Young Adult