Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2019 Jan;14(1):95-101.
doi: 10.1177/1558944718799392. Epub 2018 Sep 7.

Discretionary Surgery: A Comparison of Workers' Compensation and Commercial Insurance

Bonheur A T D van der Gronde  1 , Tom J Crijns  1 , David Ring  1 , Nina Leung  1
Affiliations
Comparative Study

Discretionary Surgery: A Comparison of Workers' Compensation and Commercial Insurance

Bonheur A T D van der Gronde et al. Hand (N Y). 2019 Jan.

Abstract

Background: Workers' compensation is intended for injuries that occur at work and is expected to be mostly for trauma and mostly nondiscretionary conditions. We tested the null hypothesis that there is no difference in the ratio of likely discretionary to likely nondiscretionary surgery between patients treated under workers' compensation compared with commercial insurance controlling for age, sex, and anatomical site for either traumatic or nontraumatic diagnoses.

Methods: Using claims data from the Texas workers' compensation database and Truven Health commercial claims we classified International Statistical Classification of Diseases and Related Health Problems, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses and procedure codes as likely discretionary or likely nondiscretionary, and as traumatic or nontraumatic. Ratios of likely discretionary to likely nondiscretionary surgery were calculated and compared.

Results: Among patients treated under workers' compensation, the ratio of likely discretionary to likely nondiscretionary surgery was significantly higher for traumatic diagnoses (0.57 [95% confidence interval, CI, = 0.56-0.61] vs 0.38 [95% CI = 0.37-0.40], P < .05) and significantly lower for nontraumatic diagnoses (9.4 [95% CI = 9.20-9.42] vs 13.2 [95% CI = 12.9-13.3], P < .05) compared with commercial insurance.

Conclusions: Workers' compensation often covers likely discretionary musculoskeletal surgery, and insurance type may influence treatment.

Keywords: commercial insurance; discretionary surgery; nontraumatic; traumatic; workers’ compensation.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: One of the authors (D.R.) received royalties from Tornier (Memphis, TN, USA) (formerly Wright Medical) for elbow plates in the amount of less than USD 10 000 per year and from Skeletal Dynamics for an internal joint stabilizer elbow in the amount of less than USD 10 000 per year. One of the authors certifies that he (D.R.) is a Deputy Editor for Hand and Wrist, Journal of Orthopaedic Trauma, and Clinical Orthopaedics and Related Research and has received or may receive payments or benefits in the amount of USD 5000 per year. One of the authors certifies that he (D.R.) received honoraria from meetings of the AO North America (Wayne, PA, USA), AO International (Davos, Switzerland), and various hospitals and universities. All other authors have nothing to disclose.

Similar articles

See all similar articles

Cited by

References

    1. Insureon. A Brief (Non-Boring) History of Workers’ Compensation. https://www.insureon.com/blog/post/2014/05/06/history-of-workers-comp.aspx. Published 2014. Accessed July 27, 2018.
    1. Lucire Y. Constructing RSI: Belief and Desire. University of New South Wales Limited; https://books.google.nl/books?id=R6AKAAAACAAJ. Published 2003. Accessed August 23, 2018.
    1. Malleson A. Whiplash and Other Useful Illnesses. Kingston, ON: McGill-Queen’s University Press; 2005.
    1. Shorter E. From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era. Free Press; 1992.
    1. Dersh J, Polatin PB, Leeman G, et al. The management of secondary gain and loss in medicolegal settings: strengths and weaknesses. J Occup Rehabil. 2004;14:267-279. - PubMed

Publication types

MeSH terms

LinkOut - more resources