Contrasting patterns of care for musculoskeletal disorders and injuries of the upper extremity and knee through workers' compensation and private health care insurance among union carpenters in Washington State, 1989 to 2008.
BACKGROUND
Musculoskeletal symptoms and disorders (MSDIs) are common reasons for visits to medical providers in the general population and they are common work-related complaints. Prior reports raise concerns as to whether declines in workers' compensation (WC) rates represent true improvement in occupational health and safety or shifting of care to other payment systems.


METHODS
By linking administrative records, we compared patterns of WC claims and private health care utilization for disorders of the upper extremity (UE) and knee among a large cohort of union carpenters over a 20-year period.


RESULTS
As WC claim rates declined, private health care utilization increased. The increase was muted somewhat but sustained when adjusting for other patterns of health care utilization.


CONCLUSIONS
Findings suggest the decline of WC claim rates do not solely represent improved occupational safety in this population, but also a considerable shifting of care to their private insurance coverage over time.
Division of Occupational and Environmental Medicine, Duke University Medical Center, Durham, North Carolina.
Hester J
HJ
Lipscomb
Division of Occupational and Environmental Medicine, Duke University Medical Center, Durham, North Carolina.
Ashley L
AL
Schoenfisch
Strategic Solutions for Safety, Health and Environment, Seattle, Washington.
Wilfrid
W
Cameron
Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina.
Kristen L
KL
Kucera
Safety and Health Assessment and Research Program (SHARP), Department of Labor and Industries, State of Washington, Olympia, Washington.
Darrin
D
Adams
Safety and Health Assessment and Research Program (SHARP), Department of Labor and Industries, State of Washington, Olympia, Washington.
Barbara A
BA
Silverstein
D000328:Adult; D060389:Construction Industry / Q000706:statistics & numerical data* / Q000639:trends; D003695:Delivery of Health Care / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data* / Q000639:trends; D007718:Knee Injuries / Q000453:epidemiology / Q000209:etiology; D007750:Labor Unions; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000453:epidemiology / Q000209:etiology; D009784:Occupational Diseases / Q000453:epidemiology / Q000209:etiology; D060051:Occupational Injuries / Q000453:epidemiology / Q000209:etiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017149:Private Sector; D034941:Upper Extremity / Q000293:injuries; D014861:Washington / Q000453:epidemiology; D014942:Workers' Compensation / Q000706:statistics & numerical data* / Q000639:trends
care-shifting; cohort; compensation; construction; cost-shifting; health care utilization; health insurance; longitudinal; musculoskeletal; workers'