Impact of organizational policies and practices on workplace injuries in a hospital setting.

OBJECTIVE: This study aimed to assess relationships between perceptions of organizational practices and policies (OPP), social support, and injury rates among workers in hospital units. METHODS: A total of 1230 hospital workers provided survey data on OPP, job flexibility, and social support. Demographic data and unit injury rates were collected from the hospitals' administrative databases. RESULTS: Injury rates were lower in units where workers reported higher OPP scores and high social support. These relationships were mainly observed among registered nurses. Registered nurses perceived coworker support and OPP as less satisfactory than patient care associates (PCAs). Nevertheless, because of the low number of PCAs at each unit, results for the PCAs are preliminary and should be further researched in future studies with larger sample sizes. CONCLUSIONS: Employers aiming to reduce injuries in hospitals could focus on good OPP and supportive work environment.

Paths of reentry: employment experiences of injured workers.

BACKGROUND: An injury at work can result in a change in jobs or employers, unemployment, or withdrawal from the labor force. Substantial life changes can occur, often mediated by the initial attempt to return to employment. METHODS: This study uses ethnographic interviews of 204 workers injured in Florida. RESULTS: The study describes three paths to reemployment taken by the injured workers. The "welcome back" path provides workers with a sense of being valued by their preinjury employers. This positive effect remains, even for those who are unable to continue working because of limitations imposed by their injuries. Other paths cause workers to feel undervalued, as discarded or damaged goods, and generate hostility and resentment. Females in all groups are less likely to be currently working. White males were more likely than other groups to be employed in skilled jobs and are also the most likely to return to light-duty jobs and to remain in their preinjury jobs over time. CONCLUSIONS: Half of the workers in this study experience employer indifference or hostility in response to their attempts to return to work after an occupational back injury. After injury, there are both commonalities and meaningful disparities in post-injury experiences of White, Black, and Hispanic male and female workers.

Moral hazard: a question of morality?

Economists use the term moral hazard to describe the tendency for insurance plans to encourage behavior that increases the risk of insured loss. Numerous economic studies have examined moral hazard effects in workers' compensation. Many of these have focused on the supposed propensity of workers to exercise less caution or to file more claims in response to increases in workers' compensation benefit levels. Although many authorities insist that moral hazard is a value-neutral concept, there are often pejorative connotations associated with contemporary discussions of moral hazard that intentionally or unintentionally disparage the motives of workers and undermine public support for workers' compensation programs. This article critically examines that literature and explores the conceptual underpinnings of economists' claims that employee moral hazard is rampant in workers' compensation. We examine the historical roots of moral hazard and its role in recent economic analyses of workers' compensation, consider the practical and ethical implications of that discourse, and offer suggestions for a truly value-neutral approach that would describe the system more fairly and accurately.

Economic consequences of workplace injuries and illnesses: lost earnings and benefit adequacy.

BACKGROUND: This is the first study based on individual data to estimate earnings lost from virtually all reported workplace injuries and illnesses in a state. METHODS: We estimated lost earnings from workplace injuries and illnesses occurring in Wisconsin in 1989-90, using workers' compensation data and 6 years of unemployment insurance wage data. We used regression techniques to estimate losses relative to a comparison group. RESULTS: The average present value of losses projected 10 years past the observed period is over $8,000 per injury. Women lose a greater proportion of their preinjury earnings than do men. Replacement of after-tax projected losses averages 64% for men and 50% for women. CONCLUSIONS: Overall, workers with compensated injuries and illnesses experienced discounted pre-tax losses projected to total over $530,000,000 (1994 dollars), with about 60% of after-tax losses replaced by workers' compensation. Generally, groups losing over eight weeks' work received workers' compensation benefits covering less than 40% of their losses.

Policy evaluation: better living through research.

Public health scientists have produced valuable research about the epidemiology of occupational hazards, their measurement, and engineering controls. Still, many firms do not apply available knowledge to eliminate workplace hazards. Occupational safety and health policy research helps to bridge the gap between current scientific understanding and effective public policies. It focuses on four areas: (1) primary prevention policies, including standards focusing on controlling specific hazards, standards requiring health and safety programs, surveillance, education and training, targeting of enforcement, and nonregulatory safety incentives; (2) secondary prevention policies, including medical care, vocational rehabilitation, and laws and regulations fostering reemployment of injured workers; (3) compensation policies, including the range and level of medical benefits and income benefits to injured workers; and (4) behavioral responses to policies that lead to unintended consequences. This article provides examples of existing research in these areas and discusses the direction of future occupational safety and health policy evaluation research.

Company characteristics and workplace medical testing.

OBJECTIVES: This study measures the relative impact of company economic characteristics and workplace hazards on the prevalence of several types of medical testing. It uses the results to assess likely public health impacts of testing. METHODS: We used data on potential exposure to workplace hazards, medical testing, unionization, firm size, and turnover from the National Occupational Hazards Survey and the National Occupational Exposure Survey. Other sources provided industry-specific data on wages and turnover. Logistic regression analysis estimated the relationship of economic variables and workplace health risks to the prevalence of medical testing. RESULTS: Economic variables were related to the prevalence of testing. However, consistent positive relationships were not found between health hazards and testing. CONCLUSIONS: Employers' testing decisions may not be beneficial to the health of workers and may shift the costs of illness to workers or other employers. Safer firms may provide too much medical testing, and firms that are less safe may provide too little.

Workers' compensation in the United States: high costs, low benefits.

Studies suggest that income replacement is low for many workers with serious occupational injuries and illnesses. This review discusses three areas that hold promise for raising benefits to workers while reducing workers' compensation costs to employers: improving safety, containing medical costs, and reducing litigation. In theory, workers' compensation increases the costs to employers of injuries and so provides incentives to improve safety. Yet, taken as a whole, research does not provide convincing evidence that workers' compensation reduces injury rates. Moreover, unlike safety and health regulation, workers' compensation focuses the attention of employers on individual workers. High costs may lead employers to discourage claims and litigate when claims are filed. Controlling medical costs can reduce workers' compensation costs. Most studies, however, have focused on costs and have not addressed the effectiveness of medical care or patient satisfaction. Research also has shown that workers' compensation systems can reduce the need for litigation. Without litigation, benefits can be delivered more quickly and at lower costs.

Science and persuasion: environmental disease in U.S. courts.

The U.S. system for determining liability for environmental disease requires plaintiffs to demonstrate that the defendant was the legal cause of their illnesses. The determination of cause takes place in an adversary setting. Both sides in the dispute present evidence about causation to a lay judge or jury, who is responsible for deciding whether the defendant is legally responsible. In injury cases this generally means providing evidence of a specific, concrete event or condition that gave rise to the plaintiff's harm. Environmental disease usually presents a very different picture, one in which there is considerable uncertainty about the relationship between exposure to toxic substances and the plaintiff's disease. Scientific evidence about this uncertain link is often an essential part of the case. The reliance on scientific evidence appears to present almost insurmountable problems of proof of causation to the plaintiff. The law requires the plaintiff to demonstrate that, without the defendant's action, the harm would not have occurred. This strict requirement appears incompatible with the substantial scientific uncertainty about the cause of many environmental diseases. A second attribute of legal causation is that it is based on common experience, and is easily understood by lay citizens who are likely to be the final arbiters of causation. Scientific explanations of environmental disease causation, on the other hand, may not draw on common experience and may not have the intuitive appeal necessary to convince a lay decision-maker. Because scientific evidence of causation is difficult for a lay judge or jury to understand, and because of the adversary use of experts with very different opinions about causation, it might be expected that plaintiffs would have a great deal of difficulty demonstrating causation in environmental liability cases. However, the U.S. legal system appears to have accommodated to the plaintiff's difficulty in meeting the formal burden of persuasion. The courts allow juries considerable leeway in using their own experience and beliefs to determine causation, as long as there is some scientific evidence to support the plaintiff's contention. The U.S. environmental disease liability system has been criticized by some for plaintiffs' difficulty in proving causation and by others because plaintiffs can win cases without evidence that would be convincing to a scientist.(ABSTRACT TRUNCATED AT 400 WORDS)

Impact of workplace characteristics on costs and benefits of medical screening.

This paper discusses medical screening from an economist's perspective. The benefits and costs of testing are described, including health benefits, direct costs of testing, and labor market impacts. The paper then discusses how workplace characteristics unrelated to worker health can affect the value to employers of medical screening. As a result, employers who maximize the benefits to them of medical screening may reduce the net social benefits of screening. The differences between the private and social benefits of medical screening suggest some areas where medical screening should be used with great care and others that may be the appropriate subjects of regulation.

Government regulation of occupational safety: underground coal mine accidents 1973-75.

The purpose of this paper is to determine the influence of federal mine safety inspections on underground coal mine accidents. An economic incentives model is developed to relate federal enforcement activities to accident rates. The determinants of accident rates are analyzed for 535 coal mines during the period 1973-75. Estimates based on these data when applied to the model indicate that increasing inspections by 25 per cent would have produced a 13 per cent decline in fatal accidents and an 18 per cent decline in disabling accidents.

The impact of health and safety committees. A study based on survey, interview, and Occupational Safety and Health Administration data.

In a study conducted to determine if the existence of a joint labor-management health and safety committee (HSC) was correlated with either the number of Occupational Safety and Health Administration (OSHA) complaints or hazardousness, as measured by OSHA serious citations, virtually no effect could be detected in a sample of 127 Massachusetts manufacturing firms. At a sample of 13 firms, interviews of HSC members were conducted. Committee attributes and perceptions about committee effectiveness were compared with the number of OSHA complaints and serious citations. There were fewer complaints and fewer serious citations at firms with HSCs that were perceived as effective. Results of the study suggest that the objective attributes of the committee may be less important to its success than the commitment of management and labor to solving workplace safety problems.

The accuracy of self-reported regulatory data: the case of coal mine dust.

Coal-mine owners are required to measure miner exposures to respirable dust so that compliance with Federal health regulations can be monitored. This study analyzes the problem of possible underreporting of dust exposures. Using two statistical approaches, data for three mining occupations in 54 large underground coal mines during 1976-1978 are examined for evidence of underreporting. First, regression estimates compare dust concentrations reported by coal-mine owners with those reported by government health inspectors. Then, the statistical distribution of concentrations reported by coal-mine owners are examined for the size and nature of their deviation from log-normality. Both approaches suggest widespread underreporting.

Regulating safety. OSHA's "new look".

The Occupational Safety and Health Administration (OSHA) has had a short but stormy history. Over the past 12 years, OSHA has been criticized by labor unions as being insufficiently effective and by companies for being too costly. OSHA's reliance on enforcement of health and safety regulations, combined with inadequate resources to promulgate regulations and enforce them, has limited its ability to improve workplace conditions. The current OSHA leadership has changed directions, reducing enforcement activity and altering existing health standards to reduce their costs. The implications of this new policy are discussed.

Occupational health values in the Supreme Court: cost-benefit analysis.

KIE: In American Textile Manufacturers Institute v. Donovan, the Supreme Court refuted an industry challenge, supported by the Reagan administration, to the cotton dust standard established under the Occupational Safety and Health Act. Petitioners argued that the Act required cost-benefit analysis, but the Court ruled in favor of workers' health where toxic materials were concerned. An earlier Supreme Court decision, Industrial Union Dept. v. American Petroleum Institute, invalidated OSHA's standard on occupational exposure to benzene as too stringent for the determined risk. These two decisions provide boundaries within which standards may be promulgated balancing industrial growth and development against worker safety and health.^ieng