Workers' Compensation Health Care Costs Containment. - book reviews

Judith Greenwood, PhD, and Alfred Taricco, MD, Editors. Workers' Compensation Health Care Costs Containment. Horsham, Pa.: LRP Publications, 1992. 350 pages. $59.50.

The issue of workers' compensation health care costs is clearly a pressing one. While there have been stringent efforts to contain general increases in health care costs, too little attention has been focused on workers' compensation, an area where costs are increasing at a faster relative pace.

Judith Greenwood, PhD, and Alfred Taricco, MD, have gathered and organized a group of contributors that cover a broad spectrum of the issues associated with this important topic. Whether the reader is a novice searching for a historical perspective on workers' compensation or an experienced professional fully conversant with the nuances of present day law and practice, this work is an important addition to your library.

This work covers every conceivable perspective and issue of importance. It is an essential primer for the neophyte in the field. It describes not only the history of the movement and relevant legislation, but also the impact on employees and employers of the '90s. For someone knowledgeable about the subject, the issues of the day--and tomorrow-- are fully identified, analyzed, and explored. The table of contents alone runs a full and detailed 10 pages (the text is 344 pages, plus appendices).

One fault, yet at the same time a strength of the book, is that a number of contributors describe the genesis of workers' compensation legislation and its history. However, through different perspectives, these individual narratives provide a balanced and interesting picture of the whole.

Judith Greenwood, PhD, leads the volume with an excellent historical perspective of workers' compensation. She is followed by Leslie I. Boden, PhD, who provides an analysis of why workers' compensation is a "special case" in medical costs--and medical cost containment. Alfred Taricco, MD, FACS, coeditor, follows with an overview of the variety of cost containment measures in effect, including an assessment of PROs, managed care, peer review, and health care professionals other than physicians, some of whom are supplements to physicians. His chapter is an overview of the field, on a macro or broad policy level.

The contributions range from very specific topics, such as management of low back pain, a major workers' compensation issue, to a related analysis of chiropractic cost in workers' compensation. They also cover the variety of political and social viewpoints, from the labor perspective to the concept of 24-four hour coverage. One of the best chapters, by John F. Burton, provides an excellent overview of alternatives to deal with workers' compensation. His approach is balanced and rational, and his chapter reflects well the emphasis on balance shown throughout the volume.

Other authors make significant contributions as well. There are chapters dealing with national health care policy, barriers to health care reform, and, of course, the ethical issues, the latter presented by Dan Callahan.

For many readers, the basic motivation for interest in the book will be their involvement in attempts to manage the health care costs related to workers' compensation. That subject receives specific treatment in the chapter on managed care by Robert L. Simons and Joseph C.H. Smith. As in other settings, there are no simple answers.

What the book does best is to place this entire, complex issue into a balanced perspective. Unless one understands the historical, legal, and social context of the subject, it is impossible to deal effectively with the medical or economic consequences. That need is met fully and clearly.

Workers' compensation could be thought of as the "tip of the iceberg" or, better yet, as a window into the challenge of managing health care costs today. It seems that every problem, every issue, is encapsulated and magnified in workers' compensation, be it cost control, equity, or efficient delivery; workers' compensation is a microcosm for study and understanding of the larger issue of health care costs in our society. Whether the reader is a professional in the field of workers' compensation, a graduate student, or an executive attempting to gain insight into the issue of workers' compensation, this volume should be immensely useful. The dynamics of the issue reflect the major problem this nation faces in getting health care costs under control in any sector.

This is not a book one reads in a single sitting. Yet, it is more than a reference book. It treats the subject in a thorough, balanced, and comprehensive manner, looking forward as well as addressing the history of workers' compensation. For anyone interested in the subject, either being introduced to it or seeking different perspectives on major issues, this work will provide valuable insight to and understanding of a complex subject.--John J. Connolly, EdD, President, Castle, Connolly Medical Ltd., New York, N.Y.

COPYRIGHT 1993 American College of Physician Executives
COPYRIGHT 2004 Gale Group