The impact of occupational injury reduction on the U.S. economy

BACKGROUND: Preventing occupational injuries reduces labor and fringe benefit costs to employers. The related savings filter through the economy, impacting its performance. This study is a first attempt to measure the impact of occupational injury reduction on national economic output, gross domestic product, national income, and employment by using an input-output model of the U.S. economy. METHODS: Occupational injury costs by industry for 1993 were used as a baseline for an input-output model, and the impact of the 38% injury rate reduction between 1993 and 2002 was measured. All computations are in year 2000 dollars. RESULTS: Declining occupational injury between 1993 and 2002 increased employment by an estimated 550,000 jobs. The increase in gross domestic product (GDP) was 25.5 billion US dollars or 9% of the average annual GDP increase from 1993 to 2002. CONCLUSIONS: These estimates represent the benefits of injury rate reduction but ignore associated prevention costs.     

Economic burden of illness for employees with painful conditions

OBJECTIVE: We sought to compare the medical services utilization and average annual direct (ie, medical and medication) and indirect (ie, work-loss) costs for employees with painful conditions to a random sample ("average employee"). METHODS: An employer administrative claims database (approximately 600,000 insured lives) was used to identify patients with ICD-9 codes for painful conditions. Direct costs were total employer medical and medication costs and indirect costs were associated with medically related absenteeism days and disability claims. RESULTS: Among employees with painful conditions, total costs were 1.5 to 3.5 times as high (P < 0.01) as those of the average employee (ie, 7088 US dollars to 16,874 US dollars compared with 4,849 US dollars) depending on the painful condition. CONCLUSIONS: Painful conditions are costly to employers, and better management/treatment of such conditions may help reduce the associated employer economic burden.     

The cost of diabetes in Latin America and the Caribbean

OBJECTIVE: To measure the economic burden associated with diabetes mellitus in Latin America and the Caribbean. METHODS: Prevalence estimates of diabetes for the year 2000 were used to calculated direct and indirect costs of diabetes mellitus. Direct costs included costs due to drugs, hospitalizations, consultations and management of complications. The human capital approach was used to calculate indirect costs and included calculations of forgone earnings due to premature mortality and disability attributed to diabetes mellitus. Mortality and disability attributed to causes other than diabetes were subtracted from estimates to consider only the excess burden due to diabetes. A 3% discount rate was used to convert future earnings to current value. FINDINGS: The annual number of deaths in 2000 caused by diabetes mellitus was estimated at 339,035. This represented a loss of 757,096 discounted years of productive life among persons younger than 65 years (> billion US dollars). Permanent disability caused a loss of 12,699,087 years and over 50 billion US dollars, and temporary disability caused a loss of 136,701 years in the working population and over 763 million US dollars. Costs associated with insulin and oral medications were 4720 million US dollars, hospitalizations 1012 million US dollars, consultations 2508 million US dollars and care for complications 2,480 million US dollars. The total annual cost associated with diabetes was estimated as 65,216 million US dollars (direct 10,721 US dollars; indirect 54,496 US dollars). CONCLUSION: Despite limitations of the data, diabetes imposes a high economic burden to individuals and society in all countries and to Latin American and the Caribbean as whole.     

Cost of work-related injuries in insured workplaces in Lebanon

OBJECTIVE: To estimate the medical and compensation costs of work-related injuries in insured workplaces in Lebanon and to examine cost distributions by worker and injury characteristics. METHODS: A total of 3748 claims for work injuries processed in 1998 by five major insurance companies in Lebanon were reviewed. Medical costs (related to emergency room fees, physician consultations, tests, and medications) and wage and indemnity compensation costs were identified from the claims. FINDINGS: The median cost per injury was US dollars 83 (mean, US dollars 198; range, US dollars 0-16,401). The overall cost for all 3748 injuries was US dollars 742,100 (76% of this was medical costs). Extrapolated to all injuries within insured workplaces, the overall cost was US dollars 4.5 million a year; this increased to US dollars 10 million-13 million when human value cost (pain and suffering) was accounted for. Fatal injuries (three, 0.1%) and those that caused permanent disabilities (nine, 0.2%) accounted for 10.4% of the overall costs and hospitalized injuries (245, 6.5%) for 45%. Cost per injury was highest among older workers and for injuries that involved falls and vehicle incidents. Medical, but not compensation, costs were higher among female workers. CONCLUSION: The computed costs of work injuries--a fraction of the real burden of occupational injuries in Lebanon--represent a considerable economic loss. This calls for a national policy to prevent work injuries, with a focus on preventing the most serious injuries. Options for intervention and research are discussed.     

Measuring the relationship between employees' health risk factors and corporate pharmaceutical expenditures

This study demonstrates the relationship between self-reported health risk factors on a health risk appraisal and pharmaceutical expenditures for a large employer. A total of 3554 employees who were participants in a pharmacy benefit plan for the entire year of 2000 completed a health risk appraisal. As the number of self-reported health risk factors increased from zero to six or more, corporate pharmaceutical costs increased in a stepwise manner: US dollars 345, 443, 526, 567, 750, 754, and 1121 US dollars, respectively. After controlling for age, gender, and the number of self-reported diseases, each additional risk factor was associated with an average annual increase in pharmacy claims costs of 76 US dollars per employee. Specific health risks were associated with significantly higher expenditures. The results provide estimates of incremental expenditures associated with common, potentially modifiable risk factors. Pharmaceutical expenditures should be considered by corporations in their estimates of total health-related costs and in prioritizing disease management initiatives based on health risk appraisal data.     

Occupational disease and workers' compensation: coverage, costs, and consequences

Most of the costs of occupational disease are not covered by workers' compensation. First, the authors estimated the deaths and costs for all occupational disease in 1999, using epidemiological studies. Among the greatest contributors were job-related cancer, chronic respiratory disease, and circulatory disease. Second, the authors estimated the number of workers' compensation cases, costs, and deaths for 1999, using data from up to 16 states representing all regions of the country. Unlike the epidemiological studies that emphasized fatal diseases, the workers' compensation estimates emphasized nonfatal diseases and conditions like tendonitis and hernia. Comparisons of the epidemiological and workers' compensation estimates suggest that in 1999, workers' compensation missed roughly 46,000 to 93,000 deaths and 8 billion US dollars to 23 billion US dollars in medical costs. These deaths and costs represented substantial cost shifting from workers' compensation systems to individual workers, their families, private medical insurance, and taxpayers (through Medicare and Medicaid). Designing policies to reduce the cost shifting and its associated inefficiency will be challenging.     

Costs of occupational injuries and illnesses in California

OBJECTIVES: The purpose of this study was to estimate the annual incidence, the mortality, and the direct and indirect costs associated with occupational injuries and illnesses in California in 1992. To achieve this, we performed aggregation and analysis of national and California data sets collected by the U.S. Bureau of Labor Statistics, California Workers' Compensation Insurance Rating Bureau, California Division of Industrial Relations, the National Center for Health Statistics, and the U.S. Health Care Financing Administration. METHODS: To assess incidence of and mortality from occupational injuries and illnesses, we reviewed data from state and national surveys and applied an attributable risk proportion method. To assess costs, we used the cost-of-illness, human capital, method that decomposes costs into direct categories such as medical expenses and insurance administration expenses as well as indirect categories such as lost earnings, lost home production, and lost fringe benefits. Some cost estimates were drawn from California data, whereas others were drawn from a national study but were adjusted to reflect California's differences. Cost estimates for injuries were calculated by multiplying average costs by the number of injuries. For the majority of diseases, cost estimates relied on the attributable risk proportion method. RESULTS: Approximately 660 job-related deaths from injury, 1.645 million nonfatal injuries, 7,079 deaths from diseases, and 0.133 million illnesses are estimated to occur annually in the civilian California workforce. The direct ($7.04 billion, 34%) plus indirect ($13.62 billion, 66%) costs were estimated to be $20.7 billion. Injuries cost $17.8 billion (86%) and illnesses $2.9 billion (14%). These estimates are likely to be low because: (1) they ignore costs associated with pain and suffering, (2) they ignore home care provided by family members, and (3) the numbers of occupational injuries and illnesses are likely to be undercounted. CONCLUSION: Occupational injuries and illnesses are a major contributor to the total cost of health care and lost productivity in California. These costs are on a par with those of all cancers combined and only slightly less than the cost of heart disease and stroke in California. Workers' compensation covers less than one-half of the costs of occupational injury and illness.     

Costs of medically treated craniofacial conditions

OBJECTIVES: Determining the magnitude of the burden of diseases and health disorders on the U.S. population is a high priority for health policy makers. Conditions such as malignant neoplasms and injuries from craniofacial trauma contribute to adverse oral health. This study estimates the number of cases of diseases and disorders relevant to oral health that are treated annually in the medical care, as opposed to the dental care, system and associated costs. Policy makers can use this cost model to compare the impact of different conditions, to target areas for reducing costs, and to allocate appropriate health resources. METHODS: Data from four national and two state data systems were used to estimate the number of cases of selected dental, oral, and craniofacial diseases and conditions treated in the medical system annually and associated medical and wage/household work loss costs. RESULTS: Per case, the most costly conditions were estimated to be malignant neoplasms at 83,080 US dollars annually (in 1999 dollars), diabetes-related oral conditions at 51,030 US dollars, endocarditis at 48,610 US dollars, and chlamydiae at 41,100 US dollars. Total estimated costs for oral conditions treated in the medical care system in 1996 were approximately 95.9 billion US dollars, including 21.4 billion US dollars in medical costs and 74.4 US dollars billion in wage/household work loss costs. CONCLUSIONS: Conditions treated outside the dental care system are major contributors to oral health costs. They should be an important focus for the National Institute of Dental and Craniofacial Research.     

Incidence and cost of nonfatal farm youth injury, United States, 2001-2006

The objective of this study was to estimate the annual incidence and cost of nonfatal farm youth injury in the United States for the period 2001-2006. The authors used 2001-2006 Childhood Agricultural Injury Survey data to estimate the annual incidence of farm youth nonfatal injury. To estimate the costs for injuries suffered by youth working/living on the farm, the number of injuries was multiplied by published unit costs by body part, nature of injury, and age group. The annual number of nonfatal injuries to youth (ages 0-19) on farms in 2001-2006 was 26,570. The annual cost of nonfatal farm youth injuries was $1 billion (in 2005 dollars), with 26% of costs related to working on the farm and 47% on beef cattle farms. Around 9.3% of the cost was medical costs, 37.2% work and household productivity loss, and 53.5% quality of life loss.     

The costs of unintentional home injuries

BACKGROUND: Unintentional home injuries impose significant, but little reported, costs to society. The most tangible are medical and indirect costs. A less-tangible cost is the value of lost quality of life due to impairment or death. METHODS: A societal perspective was adopted in estimating unintentional home injury costs. All costs associated with the injuries are included in the analysis-costs to victims, families, government, insurers, and taxpayers. The costs are incidence based, meaning all costs that will result from an injury over time are counted in the year that the injury occurs. RESULTS: Unintentional home injuries cost U.S. society at least $217 billion in 1998. The cost of fatal unintentional injuries alone was $34 billion, with nonfatal injuries accounting for the remaining $183 billion. The largest cost was the value of lost quality of life at $162 billion. Medical costs and indirect costs were $22 billion and $33 billion, respectively. CONCLUSIONS: These estimates indicate that unintentional home injuries, especially falls, are a major problem in the United States. Falls are a particular problem in need of more attention.     

Productivity cost benefit to employers of treating migraine with rizatriptan: a specific worksite analysis and model

Employers in the United States might not be aware of the productivity costs of migraine or the extent to which those costs can be reduced by optimal treatment. An economic model was developed to enable employers to estimate the productivity costs of migraine to their company and the savings that will accrue if those patients who suffer from migraine are treated with rizatriptan. Analyses were run for both a major financial services corporation and a representative U.S. company. The major financial services corporation, with 87,821 employees, is projected to lose 538 person-years annually, at an estimated cost of 23.8 million dollars. A representative U.S. company with 10,000 employees is projected to lose 46.0 person-years of productive effort annually as a result of migraine, valued at approximately 1.94 million dollars. The value of the annual work loss avoided if migraine is treated with rizatriptan is projected at 10.3 million dollars for the financial services corporation and 841,000 dollars for the representative U.S. company. There is a substantial productivity cost burden of migraine from a U.S. employer perspective. These productivity costs can be reduced significantly by treating migraine headaches with rizatriptan.     

Incidence and Cost of Nonfatal Farm Youth Injury,United States, 2001–2006

ABSTRACT

The objective of this study was to estimate the annual incidence and cost of nonfatal farm youth injury in the United States for the period 2001–2006. The authors used 2001–2006 Childhood Agricultural Injury Survey data to estimate the annual incidence of farm youth nonfatal injury. To estimate the costs for injuries suffered by youth working/living on the farm, the number of injuries was multiplied by published unit costs by body part, nature of injury, and age group. The annual number of nonfatal injuries to youth (ages 0–19) on farms in 2001–2006 was 26,570. The annual cost of nonfatal farm youth injuries was $1 billion (in 2005 dollars), with 26% of costs related to working on the farm and 47% on beef cattle farms. Around 9.3% of the cost was medical costs, 37.2% work and household productivity loss, and 53.5% quality of life loss.     

Vital Signs: Health Burden and Medical Costs of Nonfatal Injuries to Motor Vehicle Occupants — United States, 2012

Background

Motor vehicle crashes are a leading cause of death and injury in the United States. The purpose of this study was to describe the current health burden and medical and work loss costs of nonfatal crash injuries among vehicle occupants in the United States.

Methods

CDC analyzed data on emergency department (ED) visits resulting from nonfatal crash injuries among vehicle occupants in 2012 using the National Electronic Injury Surveillance System – All Injury Program (NEISS-AIP) and the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS). The number and rate of all ED visits for the treatment of crash injuries that resulted in the patient being released and the number and rate of hospitalizations for the treatment of crash injuries were estimated, as were the associated number of hospital days and lifetime medical and work loss costs.

Results

In 2012, an estimated 2,519,471 ED visits resulted from nonfatal crash injuries, with an estimated lifetime medical cost of $18.4 billion (2012 U.S. dollars). Approximately 7.5% of these visits resulted in hospitalizations that required an estimated 1,057,465 hospital days in 2012.

Conclusions

Nonfatal crash injuries occur frequently and result in substantial costs to individuals, employers, and society. For each motor vehicle crash death in 2012, eight persons were hospitalized, and 100 were treated and released from the ED.

Implications for Public Health

Public health practices and laws, such as primary seat belt laws, child passenger restraint laws, ignition interlocks to prevent alcohol impaired driving, sobriety checkpoints, and graduated driver licensing systems have demonstrated effectiveness for reducing motor vehicle crashes and injuries. They might also substantially reduce associated ED visits, hospitalizations, and medical costs.     

Evaluation of the burden of logging injuries using West Virginia workers' compensation claims data from 1996 to 2001

BACKGROUND: The risks associated with logging are well documented, however little work has been done on estimating the economic impact of injuries among loggers. METHODS: West Virginia Workers' Compensation claims data for the period 1996-2001 was used to assess the economic burden of logging injuries in the state. RESULTS: There were 1,371 claimants during this period with the highest number of claims (39%) in the 25-34 years age category. The total cost of injuries was over US dollars 14 million. The most severe injuries, traumatic brain injuries (TBI), thoracic, cervical, and lumbar, resulted in the highest medical costs, indemnity costs and permanent disability. The average medical cost for logging-related to TBI was US dollars 198,048 compared to US dollars 15,321 for other major industries. CONCLUSIONS: The magnitude of the economic costs underscores the need for active research of injury prevention among loggers and for greater attention to occupational safety and health programs.     

Costs of occupational injuries in agriculture

OBJECTIVE: This study was conducted to estimate the costs of job-related injuries in agriculture in the United States for 1992. METHODS: The authors reviewed data from national surveys to assess the incidence of fatal and non-fatal farm injuries. Numerical adjustments were made for weaknesses in the most reliable data sets. For example, the Bureau of Labor Statistics (BLS) Annual Survey estimate of non-fatal injuries is adjusted upward by a factor of 4.7 to reflect the BLS undercount of farm injuries. To assess costs, the authors used the human capital method that allocates costs to direct categories such as medical expenses, as well as indirect categories such as lost earnings, lost home production, and lost fringe benefits. Cost data were drawn from the Health Care Financing Administration and the National Council on Compensation Insurance. RESULTS: Eight hundred forty-one (841) deaths and 512,539 non-fatal injuries are estimated for 1992. The non-fatal injuries include 281,896 that led to at least one full day of work loss. Agricultural occupational injuries cost an estimated $4.57 billion (range $3.14 billion to $13.99 billion) in 1992. On a per person basis, farming contributes roughly 30% more than the national average to occupational injury costs. Direct costs are estimated to be $1.66 billion and indirect costs, $2.93 billion. CONCLUSIONS: The costs of farm injuries are on a par with the costs of hepatitis C. This high cost is in sharp contrast to the limited public attention and economic resources devoted to prevention and amelioration of farm injuries. Agricultural occupational injuries are an underappreciated contributor to the overall national burden of health and medical costs.     

Conventional development versus managed growth: the costs of sprawl

OBJECTIVES: We examined the effects of sprawl, or conventional development, versus managed (or "smart") growth on land and infrastructure consumption as well as on real estate development and public service costs in the United States. METHODS: Mathematical impact models were used to produce US estimates of differences in resources consumed according to each growth scenario over the period 2000-2025. RESULTS: Sprawl produces a 21% increase in amount of undeveloped land converted to developed land (2.4 million acres) and approximately a 10% increase in local road lane-miles (188 300). Furthermore, sprawl causes about 10% more annual public service (fiscal) deficits ($4.2 billion US dollars) and 8% higher housing occupancy costs ($13 000 US dollars per dwelling unit). CONCLUSIONS: Managed growth can save significant amounts of human and natural resources with limited effects on traditional development procedures.     

Costs differences across demographic groups and types of occupational injuries and illnesses

BACKGROUND: Little is known about cost differences for demographic groups or across occupational injuries and illnesses. METHODS: In this incidence study of nationwide data for 1993, an analysis was conducted on fatal and non-fatal injury and illness data recorded in government data sets. Costs data were from workers' compensation records, estimates of lost wages, and jury awards. RESULTS: The youngest (age < or = 17) and oldest (age > or = 65) workers had exceptionally high fatality costs. Whereas men's costs for non-fatal incidents were nearly double those for women, men's costs for fatal injuries were 10 times the costs for women. The highest ranking occupation for combined fatal and non-fatal costs--farming, forestry, and fishing--had costs-per-worker (5,163 US dollars) over 18 times the lowest ranking occupation-executives and managers (279 US dollars). The occupation of handlers, cleaners, and laborers, ranked highest for non-fatal costs. Gunshot wounds generated especially high fatal costs. Compared to whites, African-Americans had a lower percentage of costs due to carpal tunnel syndrome, circulatory, and digestive diseases. CONCLUSIONS: Costs comparisons can be drawn across age, race, gender, and occupational groups as well as categories of injuries and illnesses.     

The incidence and economic costs of cancer, motor vehicle injuries, coronary heart disease, and stroke: a comparative analysis.

The economic impact of disease and injury has most often been calculated by examining the costs associated with the prevalence of the impairments in the reference year. An alternative accounting approach is to assign all disease costs to the year of incidence, an approach which entails present-valuing to the year of incidence both health care expenditures and lost productivity. The incidence approach is the more appropriate for gauging the economic gains achievable through prevention, immediate rehabilitation, and arresting progression. Incidence-based costs have been estimated for the United States in 1975 for cancer, coronary heart disease, motor vehicle injuries, and stroke. A noteworthy finding is the relative economic importance of motor vehicle injuries, which frequently have been overlooked in the ordering of public health expenditure priorities. After cancer, which generated approximately $23.1 billion in present-valued costs in 1975 (discounted at 6 per cent), motor vehicle injuries and coronary heart disease constitute the next most expensive conditions--having generated estimated annual costs of $14.4 billion and $13.7 billion, respectively. Stroke, at $6.5 billion, follows in economic importance.     

Economic burden of occupational injury and illness in the United States

Context: The allocation of scarce health care resources requires a knowledge of disease costs. Whereas many studies of a variety of diseases are available, few focus on job‐related injuries and illnesses. This article provides estimates of the national costs of occupational injury and illness among civilians in the United States for 2007. Methods: This study provides estimates of both the incidence of fatal and nonfatal injuries and nonfatal illnesses and the prevalence of fatal diseases as well as both medical and indirect (productivity) costs. To generate the estimates, I combined primary and secondary data sources with parameters from the literature and model assumptions. My primary sources were injury, disease, employment, and inflation data from the U.S. Bureau of Labor Statistics (BLS) and the Centers for Disease Control and Prevention (CDC) as well as costs data from the National Council on Compensation Insurance and the Healthcare Cost and Utilization Project. My secondary sources were the National Academy of Social Insurance, literature estimates of Attributable Fractions (AF) of diseases with occupational components, and national estimates for all health care costs. Critical model assumptions were applied to the underreporting of injuries, wage‐replacement rates, and AFs. Total costs were calculated by multiplying the number of cases by the average cost per case. A sensitivity analysis tested for the effects of the most consequential assumptions. Numerous improvements over earlier studies included reliance on BLS data for government workers and ten specific cancer sites rather than only one broad cancer category. Findings: The number of fatal and nonfatal injuries in 2007 was estimated to be more than 5,600 and almost 8,559,000, respectively, at a cost of $6 billion and $186 billion. The number of fatal and nonfatal illnesses was estimated at more than 53,000 and nearly 427,000, respectively, with cost estimates of $46 billion and $12 billion. For injuries and diseases combined, medical cost estimates were $67 billion (27% of the total), and indirect costs were almost $183 billion (73%). Injuries comprised 77 percent of the total, and diseases accounted for 23 percent. The total estimated costs were approximately $250 billion, compared with the inflation‐adjusted cost of $217 billion for 1992. Conclusions: The medical and indirect costs of occupational injuries and illnesses are sizable, at least as large as the cost of cancer. Workers’ compensation covers less than 25 percent of these costs, so all members of society share the burden. The contributions of job‐related injuries and illnesses to the overall cost of medical care and ill health are greater than generally assumed.