Discretionary Surgery: A Comparison of Workers’ Compensation andCommercial Insurance

摘要

Workers’ compensation is intended for injuries thatoccur at work and is expected to be mostly for trauma and mostlynondiscretionary conditions. We tested the null hypothesis that there is nodifference in the ratio of likely discretionary to likely nondiscretionarysurgery between patients treated under workers’ compensation compared withcommercial insurance controlling for age, sex, and anatomical site for eithertraumatic or nontraumatic diagnoses. Using claims datafrom the Texas workers’ compensation database and Truven Health commercialclaims we classified (ICD-9-CM) diagnoses and procedure codes as likelydiscretionary or likely nondiscretionary, and as traumatic or nontraumatic.Ratios of likely discretionary to likely nondiscretionary surgery werecalculated and compared. Among patients treated underworkers’ compensation, the ratio of likely discretionary to likelynondiscretionary 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], < .05) and significantly lower for nontraumaticdiagnoses (9.4 [95% CI = 9.20-9.42] vs 13.2 [95% CI = 12.9-13.3], < .05) compared with commercial insurance. Workers’ compensation often covers likelydiscretionary musculoskeletal surgery, and insurance type may influencetreatment.