Gp Insights Into Drivers of Claim Rates John Wren ACHRF 2012

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Social Epidemiology InsightsInto The Drivers of Change in

ACC Claims Rates

The Social Production of ACCClaim Rates

John Wren

Principal Advisor ACC Research Grant Pittams

ACC Research Manager



Key premises

• Well founded sociological and economic behaviouraltheories and evidence are available to inform

understanding of the drivers of ACC Claims rates

• The Scheme is a social and political construct rooted in

New Zealand’s social dynamics

– Understanding this helps to understand drivers of

claims rates



What are SociologicalInsights?

• Systematic ideas about:

– How social relationships influence people’s attitudes and

behaviour

– How major social institutions affect us – How we affect other individuals, groups, and

organisations

• Involves the use of the sociological perspective and

imagination respectively Alan Berger (2006 & 2010). Sociology.



Insights may emphasise …

• Patterns and Predictability in “social order” – Social Systems or Individual Actions

• Source of Motivation of individuals and social groups

– Why people / social groups “act”

• Macro or Micro social effects / interactions

• Patterns of Power / Resistance

– e.g. Economic differences, Use of Language, Gender Politics,

– Class Politics, Group Dynamics

• Everything in between



System and Individual ActionEffects Co-payments example:



Weekly Comp &

Serious Injury Claims

respectively

Med Fees A c t u a

l & P o t e

n t i a l C l

a i m V o l u m e

Extent

“Type of Injury”

Cover

Extent Treatment, Rehab Services and CompensationCover

Most

Clear

Least

Clear

Least

Clear

Line moves right as clients

access treatment or providers

register more claims

Line moves up if providers and

clients perceive claims are more

likely to be accepted

Potential Scope Injury / Occ Health

Cover

Number of Claims

Impact of Policy, Legal or Operational Entitlement Decisions OnClaims Volumes



Fundamental insightsinforming model…

Consistent:

• seasonal fluctuations

• long-term patterns by type of Claim

• patterns vary by type of Claim• macro and micro economic behavioural effects impact

differently upon Type of Claim

– Med Fees Only

– Weekly Comp

– Other Entitlement Claims



Significant differences between the Scheme Accounts in terms of : – claim volume

– claim proportion

– cost

– types of injury claim

– Small % changes can = large volumes and costs in some

accounts

Fundamental insightsinforming model…

Work

Motor Vehicle

Earner

Non-Earner

Self-employed

Scheme Accounts comprise:



Fund Type

-

200,000

400,000

600,000

800,000

1,000,000

2 0 0 1

2 0 0 2

2 0 0 3

2 0 0 4

2 0 0 5

2 0 0 6

2 0 0 7

2 0 0 8

2 0 0 9

2 0 1 0

Non Earners

Earners

Work

MV



Basic Structure of ACC Claims



Basic Structure of ACC Claims:Cost vrs Volume

$324

$850

$76$94

$444 $479

$0

$200

$400

$600

$800

$1,000

$1,200

$1,400

$1,600

Weekly Comp Claims Entitlements other than

WC

Med Fees Only

$M

Expenditure on WeeklyCompensation

Expenditure on Entitlements

Expenditure on Med Fees

Example: 2010 Expenditure by Claim Type



WC Claims per 10,000 workers

60

70

80

90

100

110

M a r

- 0 1

M a r

- 0 2

M a r

- 0 3

M a r

- 0 4

M a r

- 0 5

M a r

- 0 6

M a r

- 0 7

M a r

- 0 8

M a r

- 0 9

M a r

- 1 0

W

C C l a i m s p e r 1 0 , 0

0 0 w o r k e r s

Unemployment Rises

ES ChangesImplementation

of 'Giltrap'



Social Dynamics

• ACC Research commissioned research among GPs to explore whetherthey had changed their behaviour in any way that may account for thereduction in GP initiated Med Fee claims. GPs were asked:

• Did they have an opinion as to why claim numbers may have dropped?

• Had they changed the way they decide whether a claim should be lodgedwith ACC or not?

• Had they noticed whether injured workers are more or less likely to taketime off work on ACC – and why?



Had GPs changed the way they certified

time-off for their patients – and in what ways?

GP responses:

• 18% of GPs said they had changed the way they decide whether a claim

should be lodged with ACC – most attributed this to ACC tightening up

on which claims are accepted and which are declined – particularly those

related to gradual process

– so why lodge a claim if it may not be accepted?

• The recession has impacted access to health services (due to the cost)

and people are more reluctant to take time off work in case it jeopardises

their job

• Some GPs commented that with minor injuries it wasn’t worth the time

or hassle filling in the paperwork



Social dynamics

• 33% felt that their patients were taking less time off work due toinjury – largely attributed to financial restraints and concerns about

loss of jobs.

• 27% of GPs stated that they have changed the way they certify timeoff – this generally reflected a shift towards encouraging gradual

return to work.



Summary

• Claim rates are the same now as they were in 2001 – i.e. the net growth in

claims over the decade is explained by the increase in population.

• Changes in strategic direction are observed to be associated with changes

in claim rates. Claim rates rose from 2005 until 2008 falling back to

previous levels by 2010. From 2005 the focus was ‘improved access’, thenfrom 2009 it changed to ‘value for money’.

• The downward trend in claim numbers has now levelled off, and in the

absence of significant changes in funding or policy settings, new claims

can be expected to increase gradually over time in line with population

change.



Summary• There is a time lag between turning points in economic series and claim

numbers – claims turned before economy in 2008

– no clear economic association for some types of claims

– for work claims there is international evidence that lower employment leads to

fewer claims

• Clear policy effects associated with some types of claims but not all• Need to treat Med Fees differently from Weekly Comp Claims in terms of

drivers of change.

– Plausible drivers of Med Fees – Provider and Claimant Behaviour in

short-term. Long term – Health System change in role of service delivery

• Plausible Drivers of Weekly Comp are: – Risk

– Exposure (Hours Worked)

– Entitlement (Policy and Legal cover decisions)



From Model to Policy Implication

• Firstly – Policy-makers have to weigh … two opposite effects according

to their priorities.

– If accident prevention or better insurance coverage is a primary

goal, one could increase benefits, while evaluating claims forminor and hard-to-diagnose injuries more vigorously to alleviate

moral hazard effects and control costs

– If financial constraints are binding, policy-makers should beaware of the empirical evidence…that higher benefits lead to an

increase in total compensation costs (and moral hazard effects or

increased inequity in entitlement access).

(Lanoie. 1992:66).



From Model to Policy Implication

• Secondly – investment in effective injury prevention interventions is

necessary to improve the sustainability of the Scheme in the long

term

• Thirdly

– operational efficiencies have a role in contributing to the cost of

services and efficacy of outcome.

Gp Insights Into Drivers of Claim Rates John Wren ACHRF 2012

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