title: Financial and employment impacts of serious injury: a qualitative study.
abstract: OBJECTIVE
  To explore the financial and employment impacts following serious injury.
  
  
  METHODS
  Semi-structured telephone administered qualitative interviews with purposive sampling and thematic qualitative analysis.
  
  
  METHODS
  118 patients (18-81 years) registered by the Victorian State Trauma Registry or Victorian Orthopaedic Trauma Outcomes Registry 12-24 months post-injury.
  
  
  RESULTS
  Key findings of the study were that although out-of-pocket treatment costs were generally low, financial hardship was prevalent after hospitalisation for serious injury, and was predominantly experienced by working age patients due to prolonged absences from paid employment. Where participants were financially pressured prior to injury, injury further exacerbated these financial concerns. Reliance on savings and loans and the need to budget carefully to limit financial burden were discussed. Financial implications of loss of income were generally less for those covered by compensation schemes, with non-compensable participants requiring welfare payments due to an inability to earn an income. Most participants reported that the injury had a negative impact on work. Loss of earnings payments from injury compensation schemes and income protection policies, supportive employers, and return to work programs were perceived as key factors in reducing the financial burden of injured participants. Employer-related barriers to return to work included the employer not listening to the needs of the injured participant, not understanding their physical limitations, and placing unrealistic expectations on the injured person. While the financial benefits of compensation schemes were acknowledged, issues accessing entitlements and delays in receiving benefits were commonly reported by participants, suggesting that improvements in scheme processes could have substantial benefits for injured patients.
  
  
  CONCLUSIONS
  Seriously injured patients commonly experienced substantial financial and work-related impacts of injury. Participants of working age who were unemployed prior to injury, did not have extensive leave accrual at their pre-injury employment, and those not covered by injury compensation schemes or income protection insurance clearly represent participants "at risk" for substantial financial hardship post-injury. Early identification of these patients, and improved provision of information about financial support services, budgeting and work retraining could assist in alleviating financial stress after injury.
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Australia; College of Medicine, Swansea University, United Kingdom. Electronic address: belinda.gabbe@monash.edu.
authors.forename: Belinda J
authors.initials: BJ
authors.lastname: Gabbe
authors.affiliation: Department of Sociology, University of Surrey, Guildford, United Kingdom.
authors.forename: Jude S
authors.initials: JS
authors.lastname: Sleney
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Australia.
authors.forename: Cameron M
authors.initials: CM
authors.lastname: Gosling
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Australia.
authors.forename: Krystle
authors.initials: K
authors.lastname: Wilson
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Australia; Emergency and Trauma Centre, The Alfred, Australia.
authors.forename: Ann
authors.initials: A
authors.lastname: Sutherland
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Australia; Department of Orthopaedics, Royal Melbourne Hospital, Australia.
authors.forename: Melissa
authors.initials: M
authors.lastname: Hart
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Australia; Occupational Therapy Department, Alfred Health, Australia.
authors.forename: Dina
authors.initials: D
authors.lastname: Watterson
authors.affiliation: Centre for Transport Studies, Department of Civil, Environmental and Geomatic Engineering, University College London, United Kingdom.
authors.forename: Nicola
authors.initials: N
authors.lastname: Christie
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D035881:Compensation and Redress; D017281:Cost of Illness; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D004651:Employment / Q000191:economics; D005260:Female; D005382:Financing, Personal / Q000191:economics*; D006264:Health Benefit Plans, Employee; D006801:Humans; D007182:Income; D019458:Insurance Coverage; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012720:Severity of Illness Index; D014947:Wounds and Injuries / Q000191:economics* / Q000453:epidemiology / Q000534:rehabilitation
keywords: Disability; Financial impact; Outcomes; Return to work; Trauma