Accident insurance, sickness, and science: New Zealand's no-fault system

Occupational and Environmental Medicine in the United States: A Proposal to Abolish Workers' Compensation and Reestablish the Public Health Model

The workers' compensation model of occupational and environmental medicine should be converted to a public health model. Occupational and environmental medicine, as a part of the public health infrastructure,could play a much more substantive part in bringing about a national program to deal with occupational and environmental health. The workers' compensation insurance system could be discontinued at any time,but it will be vital to do so when national health insurance is adopted in the United States. Abolishing workers' compensation would remove the perverse incentives that currently undermine the practice of occupational medicine. Medical care for workers should be provided by health care professionals who are not subject to influence by employers or insurers. Eligibility for benefits should not be determined by health and safety professionals. Wage-replacement benefits for workers should be determined by guidelines established by government and industry that prevent manipulation of health and safety professionals by employers and insurers. A nationwide comprehensive system to track work-related injury and illness, superior to the current reliance on records provided by employers and collated by government agencies, should be adopted. When unusually high rates of injuries, illnesses,and fatalities occur, government inspectors ought to respond and regulate the industry accordingly. Occupational health and safety professional strained in public health can and should participate in these activities, but not when they are in the employ of industry or insurers.

Preserving workers' dignity in workers' compensation systems: an international perspective

BACKGROUND

Workers' compensation systems are among the most generous disability insurance systems in North America, although they are also known to be potentially adversarial and may have iatrogenic effects on claimants. This article examines issues to be considered to ensure fair compensation provided in a way that respects the dignity of workers.

METHODS

An overview of the literature on characteristics and effects of workers' compensation systems is followed by an analysis based on classic legal methods, including those of comparative law, complemented with interview data to examine three models of disability compensation.

RESULTS

The first part of the article identifies cross cutting issues to be considered in the examination of the equity of compensation systems and the protection of the dignity of claimants. These include three underpinnings of workers' compensation: the links between a "no-fault" system and the adversarial process, the appropriate use of medical and scientific evidence in the determination of compensability and the application of appropriate measures for promoting return to work. The second part looks at accident compensation in New Zealand, where compensation is available regardless of the cause of the accident, and disability insurance in the Netherlands, where compensation is available regardless of the cause of the disability. It then describes a composite of characteristics favorable to equity drawn from the thirteen workers' compensation systems in Canada.

CONCLUSION

Systems that succeed in reducing opportunities for adversarial interactions and that provide substantive protection could better promote the dignity of claimants.

The moral regulation of the workplace: presenteeism and public health

This paper draws on Durkheimian concepts of moral forces, particularly anomie and fatalism, and the forced division of labour, to argue that the current institutional arrangements to protect and compensate workers in hazardous workplaces are insufficient. This argument is illustrated with interview data from workers at a meatworks in New Zealand which examined workers' responses to illness and injury in the workplace. It is suggested that an imbalance in moral forces leads to pathological outcomes for workers - seen in presenteeism - the phenomenon of staying at work when injured or ill - and workplace injustice. There are state institutions such as worker compensation schemes and occupational safely and health regulations, and other intermediary groups such as unions, that can act as a buffer against anomic and fatalistic forces in the workplace, but at present these countervailing regulatory and advocacy forces are not sufficiently protective of vulnerable workers. Public health advocacy and research could fill the current void.

Assessing genetic testing: who are the "lay experts"?

This paper addresses the question of expertise in relation to technology assessments, arguing both that "lay expertise" is necessary and that "lay expertise" should not be interpreted as equivalent to "patient expertise". It presents findings from a prospective study of the social implications of genetic testing for susceptibility to occupational disease and injury. The findings support the view that technologies cannot be adequately assessed in isolation from the socio-political context in which they will be utilised. Interviews with those possessing non-traditional, "lay" expertise in seeking compensation for occupational disease and/or long-term disability identified a range of institutional practices which, unless they are addressed, will significantly increase the dangers of utilizing genetic testing. The paper concludes that adequate assessment of a technology can be impeded by a focus on the technology itself, particularly when the impact of a technology may be to exacerbate already problematic aspects of existing social and political institutions.

‘Choosing’ to work when sick: workplace presenteeism

Presenteeism is a concept used to describe the phenomenon of working through illness and injury. This paper is based on interviews and focus groups undertaken at three different work sites in New Zealand: a small private hospital, a large public hospital and a small factory. The research suggests that presenteeism is a prominent phenomenon in the lives of workers at these different sites, but the way in which it is rationalised and the factors that foster presenteeism are quite distinct. Exploring the way in which presenteeism links to economic and social constraints and workplace cultures provides insights into these rationalisations. The powerful forces promoting presenteeism tempers the research community's concern with absenteeism. A presenteeism discourse needs to be more prominently articulated to oppose both the absenteeism discourse, and to moderate the views taken by some postmodernist theorists on choice in relation to health practices in workplace settings.

Should Australia introduce a vaccine injury compensation scheme?

At least a dozen countries or states in the world have introduced vaccine injury compensation schemes. This paper argues that the Australian Government should introduce such a scheme, which may reduce litigation, and may improve consumer and provider confidence. The most important justification, however, is an ethical argument from justice and equity: introduction of a vaccine injury compensation scheme acknowledges the unique situation that routine childhood immunization is a public health measure, given and accepted in good faith, that may occasionally damage the recipient.