Skip to Content, Skip to Navigation

Safeguard OSH Solutions - Thomson Reuters

Safeguard OSH Solutions - Thomson Reuters

Alert24 - Safeguard Update

Injury vs illness

Injury vs illness
Article Type:
Publication Date:
New Zealand

ACC's system of case management has received a surprising endorsement from an Otago University research project, which compared the socioeconomic outcomes of injuries and strokes.

In a finding at odds with studies from other parts of the world, research fellow Dr Sue McAllister found that New Zealanders who had suffered disabling injuries not only received better financial support, but were also significantly more likely to return to work within a year than those who had similar disabilities caused by strokes.

"We were surprised by the evidence around return-to-work," McAllister says. "The evidence [from overseas] is that people who receive compensation payments are less likely to return to work because they are being supported financially.

"We expected the stroke group, who were not getting as much monetary support, would have to get back to work more quickly, but that wasn't the case. The only thing we can put this down to is the overall package provided by ACC. Each person has a case manager - someone looking out for them - whereas in the stroke group there may be physio or occupational therapy, but not the complete package."

McAllister's team, from the Department of Preventive and Social Medicine at Dunedin Medical School, says the project, Do different types of financial support after illness or injury affect socio-economic outcomes?, was the first to put New Zealand's "natural experiment" of using contrasting systems to manage illness and injury under scrutiny.

"The recommendation in 1967 was to include both illness and injury under the ACC scheme, but this never occurred," she says. "The apparent unfairness of the situation has been subject to considerable controversy, yet remarkably no one has previously attempted to measure the socioeconomic consequences of the anomaly."

Researchers recruited 109 stroke patients from five DHBs across the country, matching each one to a person of the same age, gender, and impairment profile from among the 2500 participants in the longitudinal Prospective Outcomes of Injury Study being conducted by Otago University's Injury Prevention Research Unit.

In interviews conducted three-and-a-half months and 12 months after the initial stroke or injury, participants were asked about their physical recovery, financial and work situations. The stroke patients fared less well in all areas, reporting more problems with mobility, self-care and cognitive ability, along with a median decline in personal income of 60%, and a return to work rate of only 49% at the one year mark. The injury group also recorded an overall decline in income, but the median was only 13%, and 79% of those in the group were back at work after a year. Those in the stroke group were off work for a mean of 103 days, compared to 60 days for the injury group.

Further analysis comparing only the return to work rates of those from both groups who reported no cognitive impairment at the initial interview produced an adjusted odds ratio of 5.2 in favour of the injury group.

While previous research has linked compensation payments to reduced rates of return to work, McAllister says this may be because the fault-based compensation systems used elsewhere in the world are slower, more stressful, and require the victim to maintain symptoms if they are to receive payment.

"Given our findings, the particular features of the ACC scheme that may encourage return to work are its true no-fault nature, and its deliberate focus on rehabilitation to work. The implication is that an extension of the ACC scheme to illness would result in a fairer system in accord with the original principles. It would also remove the interminable difficulty of distinguishing an accident from a disease process."

A second research project, which will compare the socioeconomic consequences of spinal cord damage caused by injury and by illness, over a two-year period, is about to begin.

"While we took a lot of care to match participants, the previous study was not comparing conditions with identical effects. This study, however, will be looking at the same disability associated with traumatic and non-traumatic causes."

People Mentioned:
Sue McAllister
Organisations Mentioned:
Otago University
Reference No:

From Alert24 - Safeguard Update

Table of Contents