title: Barriers to use of workers' compensation for patient care at Massachusetts community health centers.
abstract: OBJECTIVE
  To examine barriers community health centers (CHCs) face in using workers' compensation insurance (WC).
  
  
  METHODS
  Leadership of CHCs in Massachusetts.
  
  
  METHODS
  We used purposeful snowball sampling of CHC leaders for in-depth exploration of reimbursement policies and practices, experiences with WC, and decisions about using WC. We quantified the prevalence of perceived barriers to using WC through a mail survey of all CHCs in Massachusetts.
  
  
  METHODS
  Emergent coding was used to elaborate themes and processes related to use of WC. Numbers and percentages of survey responses were calculated.
  
  
  RESULTS
  Few CHCs formally discourage use of WC, but underutilization emerged as a major issue: "We see an awful lot of work-related injury, and I would say that most of it doesn't go through workers' comp." Barriers include lack of familiarity with WC, uncertainty about work-relatedness, and reliance on patients to identify work-relatedness of their conditions. Reimbursement delays and denials lead patients and CHCs to absorb costs of services.
  
  
  CONCLUSIONS
  Follow-up studies should fully characterize barriers to CHC use of WC and experiences in other states to guide system changes in CHCs and WC agencies. Education should target CHC staff and workers about WC.
authors: Occupational Health Surveillance Program, Massachusetts Department of Public Health, Boston, MA 02108, USA. letitia.davis@state.ma.us
authors: Lenore S
authors: LS
authors: Azaroff
authors: Letitia K
authors: LK
authors: Davis
authors: Robert
authors: R
authors: Naparstek
authors: Dean
authors: D
authors: Hashimoto
authors: James R
authors: JR
authors: Laing
authors: David H
authors: DH
authors: Wegman
mesh_terms: D003151:Community Health Centers / Q000458:organization & administration / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000592:standards; D008404:Massachusetts; D060051:Occupational Injuries / Q000628:therapy; D014942:Workers' Compensation / Q000458:organization & administration / Q000706:statistics & numerical data
keywords: Workers compensation; community health center; medical insurance; work-related injuries and illnesses