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W1.5

Title:  Do insurance policies affect back pain?

Authors and affiliation: J. David Cassidy 1, Pierre Côté 2, Willem van Mechelen 3, Ton  Schellart 3, Han Anema 3, Glenn Pransky 4, William Johnson 5, L. Rachid Salmi 6, Lena Holm 7, Inger Scheel 8, Mary Wyatt 9, and Paul J. Watson 10

1 Outcomes and Population Health, University Health Network and Public Health Sciences, University of Toronto, Canada
2 Institute for Work & Health and Public Health Sciences, University of Toronto, Canada
3 EMGO Institute, VU University Medical Center, The Netherlands
4 Liberty Mutual Research Institute for Safety; USA
5 Arizona State University, USA
6 Institut de Santé Publique, d’Epidémiologie et de Développement, Université Victor Segalen Bordeaux 2, France
7 Institute of Environmental Medicine, Karolinska Institutet, Sweden
8 SINTEF Health Research, Oslo, Norway
9 Monash University, Australia
10 Pain Management and Rehabilitation, University of Leicester, UK.

Email address: david.cassidy@uhn.on.ca

Introduction: In most developed nations health care for back pain is paid by various types of insurance programs, including public, private, workers’ compensation, motor vehicle insurance and combinations of these. These programs have regulations that affect the type of care (e.g., professions, therapies, pharmaceuticals, etc.), amount and delivery of care (e.g., number of treatment sessions, etc.), method of funding (e.g., salaried and/or fee-for-service practitioners), or (work) disability. There is some evidence that the amount and type of compensation benefits available to those with occupational or traffic-related back injuries affects the number of insurance claims, the recovery times and therefore the associated costs. Even though insurance systems can have a profound effect on back pain, there are few formal studies of this. Furthermore, different countries offer different permutations of these insurance systems, yet international comparisons are lacking.

Objective: To compare and contrast international insurance systems for occupational and traffic related back injuries by identifying services, benefits and policies that impact on the incidence, treatment, prognosis and disability of back pain.

Methods / content: The workshop will bring together clinicians and scientists that provide care within and/or study and have knowledge of these systems. Participant speakers will be solicited from several jurisdictions to 1) describe and compare insurance systems in terms of benefits and related insurance health policies (incentives and disincentives) that impact on patients with occupational and traffic related back pain; 2) report on past key studies that have investigated the effects of these systems on back pain patients and populations; 3) identify the strengths and weaknesses within these systems in terms of their positive and negative effects on the incidence, treatment, prognosis and disability of back pain; and 4) consider the generalizability of key study results from one jurisdiction to another.This description of various insurance systems and their effect on back pain, and the initial survey of key studies, will form the basis for an international collaboration on insurance and back pain. The initial goal of this collaboration will be to identify the best and worst insurance policies for patients with back pain and describe them in a paper to be submitted for publication. This will form the basis for an international collaboration on the effects of insurance systems on back pain and will help to identify a research agenda to address these issues. If successful, this workshop might become a continuing feature of the Back Forum with the emphasis on the local host jurisdiction.