Comparing Workers’ Compensation and Group Health Hospital Outpatient Payments

By Richard A. Victor, Olesya Fomenko

June 1, 2013 Related Topics: Comparing Group Health and Workers’ Compensation, Medical Costs

The study is the first to compare hospital payments for the same surgical procedure when paid for by group health versus workers’ compensation. Policymakers looking to contain medical costs in these states may want to ask if the difference is necessary to induce hospital outpatient departments to treat injured workers.    

The study compares hospital outpatient payments made by workers’ compensation and group health for treatment of common surgical cases in 16 large states, which represent 60 percent of the workers’ compensation benefits paid in the United States, and covers hospital outpatient services delivered in 2008. 

Given that most study states, except Illinois, North Carolina, and Texas, did not have substantial changes in their fee schedule regulations after 2008, the interstate comparisons should provide a reasonable approximation for current state rankings in workers’ compensation/group health payment differences.

The following 16 states are included in this study: California, Florida, Illinois, Indiana, Iowa, Louisiana, Maryland, Massachusetts, Michigan, New Jersey, North Carolina, Pennsylvania, Tennessee, Texas, Virginia and Wisconsin.

Comparing Workers' Compensation and Group Health Hospital Outpatient Payments. WC-13-18. June 2013. 


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