Biopsychosocial law, health care reform, and the control of medical inflation in Colorado.
OBJECTIVE
A noteworthy attempt at health care reform was the 1992 Colorado workers' compensation reform bill, which led to the creation of what has been called "biopsychosocial laws." These laws mandated the use of treatment guidelines for patients with injury or chronic pain, which advocated a biopsychosocial model of rehabilitation, and aspired to use a "best practice" approach to controlling costs. The purpose of this study was to examine the financial impact of this health care reform process, and to test the hypothesis that this approach can be an effective strategy to contain costs while providing good care.


METHODS
This study utilized a dataset collected prospectively from 1992 to 2007 in 45 U.S. states for regulatory purposes. These data summarized the medical treatment and disability costs of 520,314 injured workers in Colorado, and an estimated 28.6 million injured workers nationally. As no other state passed a comparable bill, the Colorado worker compensation reform bill created a natural experiment, where a treatment group was created by legally enforceable medical treatment guidelines.


RESULTS
In the 15 years following the implementation of the reform, the inflation of medical costs in Colorado workers' compensation was only one third that of the national average, saving an estimated $859 million on patients injured in 2007 alone.


CONCLUSIONS
Although there were confounding variables, and causality could not be determined, these data are consistent with the hypothesis that Colorado's 1992 legislative efforts to reform workers compensation law using the biopsychosocial model worked as intended to provide good care while controlling costs.
daniel.bruns@healthpsych.com
Daniel
D
Bruns
Kathryn
K
Mueller
Pamela A
PA
Warren
D059350:Chronic Pain / Q000191:economics* / Q000534:rehabilitation*; D003120:Colorado; D003363:Cost Control / Q000331:legislation & jurisprudence*; D004185:Disability Evaluation; D019317:Evidence-Based Medicine / Q000191:economics* / Q000331:legislation & jurisprudence*; D019983:Guideline Adherence / Q000191:economics / Q000331:legislation & jurisprudence*; D018166:Health Care Reform / Q000191:economics* / Q000331:legislation & jurisprudence*; D006801:Humans; D007250:Inflation, Economic / Q000331:legislation & jurisprudence; D011057:Politics; D011446:Prospective Studies; D014481:United States; D014942:Workers' Compensation / Q000191:economics* / Q000331:legislation & jurisprudence*; D014947:Wounds and Injuries / Q000191:economics* / Q000534:rehabilitation*