Background: Recent research documents the consequences of workplace injuries, and the resulting time off work, on the mental health and quality of life of workers and their families. This study examines several social and economic consequences of workplace injury for an entire provincial population of injured workers and their families, using a linked administrative database of health care and social service records. Given prior evidence of such consequences, there is an important issue of fair compensation to workers and cost transfer from the workers' compensation system to health care plans and social security. Our study provides crucial evidence to address this. Methods: The BC Linked Health Dataset (BCLHD) was used to examine Workers' Compensation Board (WCB) records and publicly insured health services (all visits to health care professionals and hospitals are recorded) for the entire population of British Columbia (BC), Canada. The Ministry of Human Resources (MHR) provides information on individuals in BC who were awarded Income Assistance (welfare), along with individuals who were denied benefits. We examined change in service use for workers who required time off for their injuries (lost time - L T workers) relative to a year before a 1994 injury. We compared their change in use to that for other injured workers (no lost time - NL T workers) and individuals who were not injured (non-injured comparisons - NI). Change in service use was also examined for the spouses and children of injured workers and comparisons. Key Findings: In general, LT workers slightly decreased their use of GP services before a workplace injury and then increased their use steadily thereafter, compared to the NIs whose use remained relatively stable before 1994 (year of injury) and then increased only slightly thereafter. For the NLT workers, the level of increased use following the injury was between that of these two groups, although they increased GP use prior to the injury. These patterns persisted when controlling for registration in the BC MSP and several workplace characteristics. While the NI spent more days in hospital and averaged more mental healthcare services than the two injured worker groups, the latter had larger increases in their use of these services following the injury than the NI group. The NI actually decreased the number of days in hospital following the injury. Modest changes were observed for change in residence and income assistance use for all groups. Spouses of injured workers increased their use of GP services one year after the workplace injury and decreased use thereafter. Spouses of the NI comparisons followed the same pattern, but at a lower level of use. The children of all three groups decreased their service use at the same rate and, by the end of follow-up period, service use levels were the same. The latter finding is not surprising. Data from the National Population Health Survey show that 95% percent of children in Canada under the age of three visited a physician at least once in the one-year period between 1998 and 1999. By the time children reach the age of 12 to 14, only 65% of children visited a physician during the same time period. Importance of Research: Our findings of increased healthcare use following a workplace injury have important public policy implication. For example, any increase in use among injured workers that is directly or indirectly related to the injury should be paid for by the WCB system, which is funded by employer premiums. If it is paid by MSP, this represents a cost shift, in the Canadian context, from the private to the public sector - an important issue, especially at a time when the healthcare systems in both Canada and the US are under financial. In the US, workers without health benefits provided by their employer would have to absorb these costs themselves or through their health insurance.
McMaster University, Program in Occupation Health and Environmental Medicine, Hamilton Ontario, Canada