The International Association of Industrial Accident Boards and Commissions (IAIABC) held their 76th annual convention on September 9 - 12, 1990, in New York. The active members of the IAIABC are the Workers' Compensation Boards or Industrial Accident Boards or Commissions worldwide. Those attending this convention also included representatives from the insurance industry, the labor and business communities and other national and international organizations.
Obviously, the information and opinions shared by the members of this organization will have a great influence on the policies and regulations that are ultimately adopted throughout the world. These regulations can not help but greatly influence the delivery, payment/cost and accessibility of chiropractic care.
One of the most important events of the convention (from a chiropractic point-of-view) was the IAIABC Medical Committee's presentation of a paper entitled "The Role of Managed Care in Workers' Compensation."
The Medical Committee is chaired by Judith Greenwood,Ph.D., who is the researcher that released the April 1989 "study" which attempted to show that chiropractors charge three and one-half times more than MDs or DOs while treating workers' compensation claimants (please see "West Virginia Society Resists Attacks" in the July 18, 1990 issue, Dr. Greenwood played a very significant part in those attacks).
Fortunately, the committee also contains a chiropractic member: Charles Herring,D.C., who represents the ACA. (please see "The Future of Chiropractic Within Workers' Compensation" in the August 18, 1990 issue). Dr. Herring is the only chiropractic member of the IAIABC.
The purpose for this paper was "to discuss managed care as an option for workers compensation: an option to both improve the quality of care and to reduce medical costs." While these are very desirable efforts, one can not help but be suspect of the methodology recommended.
One of the areas that may be of concern is the definition of "managed care":
"For the purposes of this paper, managed care is defined as a health care delivery organization or system with the following key elements:
"A physician gate keeper or other care director responsible for ensuring access to, and provision of, appropriate and good quality health care services;
"A network of necessary primary and ancillary services, with mechanisms to control and monitor access and utilization;
"Financial incentives between the health care delivery organization or system and the payer, that reinforce, or at least do not impede, the cost effective provision of necessary services.
"An awareness by care givers of the complexities of work injuries and illnesses, a recognition of the role and responsibilities of the workers' compensation system, an understanding of the return to work goal of workers' compensation and an ability to mobilize health care resources towards that goal."
The paper goes on to suggest that managed care should be considered for "two kinds of cases." The first is for "catastrophic injuries." The second type of case is "the relative minor injury that turns from acute to chronic, such as happens on occasion with back strains and sprains. Here an injured worker may find him or herself, after many months, embedded in a disability process that involves excessive prescription of drugs, excessive or unnecessary surgeries, loss of social connection to friends and work associates, erosion of family roles, and financial impoverishment. In such situations, early institution of a managed care approach might well result in a far better outcome."
Others issues discussed are:
"Freedom of Choice of Attending Physician"
"Employer/Insurer Choice"
"Utilization"
"Quality"
"Return to Work"
The paper concludes with a description of the roles of labor, management, insurers, health care professionals and regulators in workers' compensation. The Health Care Professionals' Role is stated as:
"Health Care Professionals should support the development of protocols and treatment guidelines for the effective care of work injuries and diseases, and in particular, non-surgical treatment of problematic soft tissue injuries."
Every new development brings challenges and opportunities. Managed care is no different. If the chiropractic profession can demonstrate the cost-effectiveness of chiropractic care (as demonstrated in the Meade et al study published in the British Medical Journal, please see "British Researchers Show Chiropractic More Effective" in the July 4, 1990 issue), then managed care may 'hurl chiropractic into the main stream.' If not ...
Interestingly enough, the medical care committee vetoed this managed care report and thus kept the report from being recommended to the general assembly of the IAIABC for a vote. If this paper is adopted by the general assembly, this report would become the policy statement of the IAIABC and all state policy makers/administrators would be encouraged to pass laws to implement the concept.
The ever changing health care environment must be closely monitored to insure chiropractic's place in the health care of the world.
