A study of work related injury and disease in General Practice in Australia. Presented to the Canadian Association of Work and Health 2011.

1. Coverage of work-related problems by
workers’ compensation in primary care
Alex Collie1,2
, Joan Henderson3
, Helena Britt3
& Ying Pan3
.
1.Institute for Safety Compensation and Recovery Research, Melbourne, Australia
2.Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
3.University of Sydney, Sydney, Australia
Presentation to the Canadian Association of Research on Work and Health
Vancouver, 2nd
June 2012

2. Outline
• Treatment of work-related problems in General Practice
• Australian workers’ compensation arrangements
• The BEACH study
• Coverage of work-related problems by GPs in Australia
• Discussion and Conclusions

3. Work-related problems in General Practice
• GP treated injuries in Australia:
• 74% musculoskeletal
• 11% wounds
• 8% crush/burn
• 5% eye
• 2% other
• GP treated diseases in Australia:
• 49% musculoskeletal
• 14% psychological
• 10% skin
• 6% neurological
• 2% respiratory
Driscoll T, Hendrie AL. Aust NZ J Pub Health, 2002: 26(4); 346-351.

4. Work-related problems in General Practice
• 3-5% of all work-related injures result in hospitalisation (Allard E Dembe et al,
(2003) 44 Am J Ind Med 331.)
• In Victoria, Australia during the period 2000 to 2010:
• 34% of injured workers see a GP on the day of the accident.
• 76% of workers compensation clients in Victoria visited a GP.
• Of those, the mean number of GP visits during the course of a claim
was 17.4 (SD 30.1).
• The workers compensation regulator spent $1.76 billion on GP services
(Collie A, unpublished data)
General Practitioners have a critical role in treatment and
rehabilitation of injured workers.

5. Australian workers’ compensation
jurisdictions
• 12 workers compensation jurisdictions
• 6 states, 2 territories, Comcare, Seacare, Dept of
Veterans’ Affairs, Dept of Defence
• Regulatory differences between
jurisdictions
• Eligibility
• Entitlements
• Societal differences between jurisdictions
• Industry mix
• Access to healthcare services (geography)

6. Aims
• To compare the proportion and nature of GP treated occupational health
problems in Australia that are claimed through workers’ compensation with
those not claimed.
• To determine the coverage of GP treated occupational health conditions by
workers’ compensation schemes between jurisdictions.

7. The Bettering the Evaluation And Care of Health
(BEACH) study
• Continuous national study of GP clinical activity, began 1998
• Random sample of 1000 GPs across Australia per annum
• Each GP records details of 100 consecutive patient encounters
• Data recorded:
• Reasons for encounter
• Problems managed
• Referrals / prescriptions
• Funding source (workers compensation, medicare, private etc..)
• Work-related
Britt H, Miller GC, Charles J, Henderson J, Bayram C, Pan Y: General practice activity in Australia, 2008-09. Canberra: Australian Institute of Health and
Welfare; 2009. (AIHW Cat. No. GEP 25.)

8. Method - overview
Work-related encounters
N=12,580 (2.6%)
All GP encounters on BEACH
Apr 2004 to Mar 2009
N=486,400
Other encounters
N=473,820 (97.4%)
Claimed on workers
compensation
N=9,743 (77.4%)
Claimed on workers
compensation
N=2,837 (22.6%)
Between groups analysis of problems
managed.
Analysis of geographic distribution of
encounters.
excluded

9. Top 10 problem categories
Rank
Claimed on workers compensation Not claimed on workers compensation
Problem
Rate per 100 GP
encounters
Problem
Rate per 100
GP encounters
1 Musculoskeletal 69.0 (67.8-70.2) Musculoskeletal 46.4 (43.9-48.9)
2 Skin 12.2 (11.4-13.0) Psychological 21.7 (19.2-24.2)
3 Psychological 8.3 (7.4-9.1) General & unspecified 10.6 (9.2-12.0)
4 General & unspecified 5.9 (5.3-6.4) Skin 10.1 (8.9-11.4)
5 Neurological 3.9 (3.5-4.3) Neurological 3.3 (2.7-4.0)
6 Eye 1.4 (1.1-1.7) Respiratory 2.7 (2.0-3.5)
7 Digestive 0.9 (0.7-1.1) Eye 2.0 (1.5-2.6)
8 Circulatory 0.7 (0.6-0.9) Circulatory 1.7 (1.2-2.2)
9 Respiratory 0.4 (0.3-0.5) Digestive 1.6 (1.1-2.0)
10
Endocrine &
metabolic
0.3 (0.2-0.4) Social 1.2 (0.8-1.6)
Subtotal 103 Subtotal 101.3

10. Top 10 problems managed
Rank
Claimed on workers’ compensation Not claimed on workers’ compensation
Problem
Rate per 100
encounters
Problem
Rate per 100
encounters
1 Back complaint 17.5 (16.6-18.4) Back complaint 12.8 (11.4-14.1)
2 Sprain/Strain 12.8 (11.9-13.6) Acute stress reaction 7.1 (5.9-8.3)
3
Musculoskeletal
NOS
10.5 (9.7-11.3) Depression 6.4 (5.2-7.6)
4 Injury skin, other 4.5 (4.1-5.0) Sprain/Strain 6.2 (5.1-7.4)
5 Fracture 4.1 (3.7-4.6) Musculoskeletal NOS 5.0 (4.2-5.9)
6 Laceration / cut 3.7 (3.3-4.1) Anxiety 4.7 (3.7-5.6)
7 Depression 3.7 (3.2-4.1) Fracture 2.6 (2.0-3.3)
8 Shoulder syndrome 2.9 (2.6-3.3) Osteoarthritis 2.3 (1.8-2.9)
9
Bursitis/tendonitis/s
ynovitis NOS
2.8 (2.5-3.2)
Bursitis/tendonitis/sy
novitis NOS
2.2 (1.6-2.7)
10
Acute internal
damage knee
2.5 (2.2-2.9) Injury skin, other 2.1 (1.6-2.7)
Subtotal 65.2 Subtotal 51.5

11. Percentage of encounters not claimed by
state/territory

12. Percentage of encounters not claimed by
geographic region

13. Nearly a quarter of work-related problems
managed by GPs are not claimed
• In Australia, 22.4% of problems managed by GPs are not claimed on
workers’ compensation.
• Consistent with prior studies:
• 57% of work-related fatalities were included in workers’ compensation
datasets (Driscoll T, et al. OEM 2003, 60; 195-201)
• 62% of surveyed Australians with work-related injury did not apply for
workers’ compensation (SafeWork Australia, 2009)
• Up to 40% of work-related injury and disease appearing on health
datasets do not arise on workers’ compensation datasets. (Driscoll T, et al. OEM
2003, 60; 195-201; Boufous A, Williamson A. Aust NZ J Pub Health 2003; 27: 352-356)

14. “Invisible” problems are less likely to be
claimed on workers compensation
• Encounters at which physically evident problems are managed are more
likely to be claimed on workers compensation.
So-called “invisible” problems are less likely to be claimed.
• Possible reasons
• Perceived negative impact of claiming
• Eligibility restrictions
• Awareness of eligibility
• Australian Work-Related Injury Survey (WRIS) 2005-06:
• Reasons for not applying for workers compensation:
• 8% - identified potential negative impact on current or future employment
• 5% - stated they were not covered by workers compensation (e.g., sole traders)
• 9% - did not think condition was eligible

15. There are jurisdictional and geographic
variations in claiming behaviour
• Significant differences between states and geographic regions.
• Queensland and the Northern Territory had the highest percent of unclaimed
encounters / Tasmania the lowest.
• Regional and remote workers less likely to claim.
• Possible reasons:
• Eligibility differences between jurisdictions
• Access to compensation systems in remote areas
• Paradox?
• “Risky” industries (e.g., forestry, agriculture, mining) are concentrated in regional /
remote areas yet GP encounters in these areas are less likely to result in a workers
compensation claim.

16. Conclusions
• GPs are an important ‘gatekeeper’ in workers compensation cases.
• Nearly a quarter of GP treated work-related problems do not result in a
workers compensation claim.
• “Invisible” problems managed by GPs are less likely to be claimed on
workers’ compensation.
• Jurisdictional and geographic differences have an impact on claiming
behaviour.

17. For more information
Dr Alex Collie
Chief Research Officer,
Institute for Safety Compensation and Recovery Research
Monash University
Email - alex.collie@monash.edu
Phone - (03) 9097 0604
Web – www.iscrr.com.au