Biopsychosocial Law, Health Care Reform, and the Control of Medical Inflation in Colorado
Biopsychosocial Law, Health Care Reform, and the Control of Medical Inflation in Colorado
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DOI：
10.1037/a0028623
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发表时间：
2012-05-01
影响因子：
2.7
通讯作者：
Warren, Pamela A.
中科院分区：
文献类型：
--
作者：
Bruns, Daniel;Mueller, Kathryn;Warren, Pamela A.
目的： 1992 年科罗拉多州工人赔偿改革法案是医疗保健改革方面一项值得注意的尝试，该法案导致了所谓的“生物心理社会法”的制定。这些法律强制要求对受伤或慢性疼痛患者使用治疗指南，提倡生物心理社会康复模式，并渴望使用“最佳实践”方法来控制成本。本研究的目的是检验这一医疗保健改革过程的财务影响，并检验这一假设：这种方法可以成为在提供良好护理的同时控制成本的有效策略。研究方法：本研究使用了 1992 年至 2007 年在美国 45 个州前瞻性收集的数据集，用于监管目的。这些数据总结了科罗拉多州 520,314 名受伤工人以及全国估计 2860 万受伤工人的医疗和伤残费用。由于没有其他州通过类似的法案，科罗拉多州工人赔偿改革法案创造了一个自然实验，根据具有法律效力的医疗指南创建了一个治疗组。结果：改革实施后的 15 年里，科罗拉多州工人赔偿医疗费用的上涨幅度仅为全国平均水平的三分之一，仅 2007 年就为受伤患者节省了约 8.59 亿美元。结论：虽然存在混杂变量，并且无法确定因果关系，但这些数据与以下假设一致：科罗拉多州 1992 年利用生物心理社会模型改革工人赔偿法的立法努力按预期发挥作用，在控制成本的同时提供良好的护理。
Purpose: A noteworthy attempt at health care reform was the 1992 Colorado workers' compensation reform bill, which led to the creation of what has been called "biopsychosocial laws." These laws mandated the use of treatment guidelines for patients with injury or chronic pain, which advocated a biopsychosocial model of rehabilitation, and aspired to use a "best practice" approach to controlling costs. The purpose of this study was to examine the financial impact of this health care reform process, and to test the hypothesis that this approach can be an effective strategy to contain costs while providing good care. Research Method: This study utilized a dataset collected prospectively from 1992 to 2007 in 45 U.S. states for regulatory purposes. These data summarized the medical treatment and disability costs of 520,314 injured workers in Colorado, and an estimated 28.6 million injured workers nationally. As no other state passed a comparable bill, the Colorado worker compensation reform bill created a natural experiment, where a treatment group was created by legally enforceable medical treatment guidelines. Results: In the 15 years following the implementation of the reform, the inflation of medical costs in Colorado workers' compensation was only one third that of the national average, saving an estimated $859 million on patients injured in 2007 alone. Conclusions: Although there were confounding variables, and causality could not be determined, these data are consistent with the hypothesis that Colorado's 1992 legislative efforts to reform workers compensation law using the biopsychosocial model worked as intended to provide good care while controlling costs.