This report is the second in an innovative series of studies measuring key outcomes for workers who were injured on the job and received medical care and income benefits. The four states in this report represent large and diverse systems, with differing state laws about provider choice, medical fee schedules, claim costs and other system features. The study focused on a set of core outcomes that are, in addition to costs, typically at the center of public policy debates.

• How well did injured workers recover their physical health and functioning?
• What percent returned to work and how quickly? Were they able to remain on the job for at least one month?
• Were workers able to access health care easily? Were they satisfied with their medical care?

Combining worker outcomes with other benchmarks (system performance and medical costs and utilization) can assist public officials in addressing a range of issues, including whether different system features (e.g., higher medical costs or medical fee schedules) are associated with better outcomes or simply reflect greater injury severity or certain system features.

 Among the key findings:

• Although workers in all four states reported similar preinjury levels of health and functioning, workers in Texas and California reported the least satisfactory recoveries of physical health and functioning (see Table A), despite higher medical costs and greater use of medical services in those states (see Table B).

• For workers with more than seven days of lost time, those in Massachusetts and Pennsylvania achieved better return-to-work outcomes than did workers in Texas and California . In Massachusetts and Pennsylvania , workers were more likely to have (1) any return-to-work, however brief it might be, (2) a return to work that was more substantial, lasting for at least one month, and (3) substantial returns to work sooner.

• An overwhelming majority of workers in all four states reported they were able to obtain timely access to the providers and services they sought. However, some workers (9-20 percent, depending on the question asked) reported big problems in accessing the desired providers or services.

• Most workers surveyed (80-85 percent) reported that, overall, they were somewhat or very satisfied with their medical care. When workers reported on satisfaction with initial providers, however, there were large differences. In California, only 68 percent of injured workers reported that they were somewhat or very satisfied with their initial providers, compared with 78 percent in Pennsylvania and Texas and 84 percent in Massachusetts.

Outcomes for Injured Workers in California, Massachusetts, Pennsylvania, and Texas. Richard A. Victor, Peter S. Barth, and Te-Chun Liu. December 2003. WC-03-07.