Recent attention given to the rising costs of health care in the campaign is a sign of the times. At long last, the country is beginning to awaken to the fact that we do not have a healthy health care system. It is too costly, too inefficient, and has done little to provide the average American with better health. The vast majority of our resources are spent on end-stage disease and illness, with only a fraction spent on prevention and education.
One of the problems associated with the health care issue is the increasing number of individuals without any type of health insurance. Many in the United States receive what insurance they do have through their employer. Unfortunately, for many this too is changing. With rising costs of production, the competition to produce a quality product at a competitive price is forcing many companies to view health insurance as a luxury they can no longer afford.
At the beginning of the 1990s, American industry faces many critical problems. Of these, one of the most significant is the spiraling cost of health care. Some estimates place the cost of health care as second only to payroll. Faced with these skyrocketing costs, industry is forced to direct its attention to cost containment. The primary objective of any cost containment program must be a reduction of expenditures.
One of the most expensive health problems in many industries is back pain. Studies show that musculoskeletal problems in general account for nearly one-half of the costs of workers' compensation. Back pain alone accounts for slightly more than one-third of total costs. As the cost of back injuries continues to escalate, industry must find new ways to address this problem. Injury prevention and management, once considered a low-priority issue, is rapidly becoming a necessity. Recent legislative changes have forced every industry to develop an effective injury and illness prevention program.
Recently, the chiropractic profession has taken an active role in the industrial arena. The impact of the chiropractic industrial consultant is growing. The chiropractor is uniquely positioned to provide the industrial client with a comprehensive approach to managing back problems. Combined with their understanding of the spine, the development of back problems, and the holistic approach to health care, the chiropractor becomes a natural resource for the prevention-minded industrial client. The chiropractor is equipped to assist industry in the following ways:
- preplacement employee physicals
- care of the injured worker -- back school programs (employee, employer, and patient education) -- health promotion (stress reduction, weight reduction, substance abuse, etc.) -- claims review and second opinion -- litigation support and expert testimony
One of the most important aspects of a cost containment program involves education and awareness. Consequently, the back school is a vital part of any industrial health program. The back school is defined as a particular method of teaching back pain prevention and self care. It is a precisely directed presentation conducted in a setting designed and supplied for the sole purpose of educating the patient. Classic use of the back school involves education of injured workers and safety training programs for employees. The format varies with different programs, but the emphasis of each program is essentially the same.
One of the newest areas of back pain prevention programs is education of the management staff. This involves addressing methods of prevention and worker training and, perhaps more importantly, appropriate management skills for supporting the injured employee. The emphasis of most industrial back safety programs is on preventing injuries from occurring. Here, the emphasis is on minimizing the impact of the injury on the injured worker and on preventing drawn-out litigated cases that often end in disability.
Several studies have shown that the manner in which a supervisor, company doctor, or employer responds to the injured worker may have a significant impact on the seriousness of the injury. Chronic back pain and disability are not solely a result of physical injury. It is, rather, associated with a complex interaction of factors, including psychosocial issues. Efforts must be made by management and by the clinician to understand the impact of the injury on the individual.
Industry can facilitate worker recovery by providing early return-to-work policies, by maintaining contact with the injured worker, and by accepting the injury as real. Efforts should be made to reduce the likelihood of litigation. One study by the California Workers' Compensation Institute showed that the most critical element in reducing litigation was information. Most injured workers went to an attorney because they felt they did not properly understand the workers' compensation system. Other studies have clearly demonstrated that the presence of an attorney delays the "healing" time.
It is our belief that appropriate management of on-the-job injuries must include a cooperative effort between the injured worker, the company, the clinician, and the insurer. This may only be achieved through proper education. The individual who provides this information is placed in a unique position in the industrial arena.
Paul D. Hooper, D.C.
Diamond Bar, California
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