How does worker's compensation and other forms of liability insurance work in a single-payer system?

Factual Questions
21

You might also surmise that TAC funded patients get sent for more unnecessary tests and are kept in longer to bump up the bill.

In the UK, the biggest cost to insurers is injury claims. The repairs will never exceed the value of the car, but compensation for injuries, not all of them real, can be many times that. The advent of no-win-no-fee lawyers, sometimes in collusion with less than scrupulous doctors, has turned this into quite an industry. After a collision, even a minor one, many drivers are bombarded with telephone calls suggesting, sometimes not even all that subtly, that they can make a claim for whiplash, which is hard to refute.

22

Yes, no, yes.

That is, the insurance company selects the doctor/hospital (except for emergency treatment) rather than just paying whoever the patient selects. And not every state has the same system. A few have state workers’ compensation funds which employers pay into rather than paying for private insurance, and many large employers are self-insured.

No, at least that’s not the whole story. No-fault insurance means that injured parties claim against their own coverage. It doesn’t mean that the other party has no financial responsibility; the injured party’s insurer will seek reimbursement from the other party/insurer, and the injured party will seek reimbursement for costs over and above his own policy limits.

23

Because I am a public school teacher, I am a government employee. My employer is a local school district. My district gets its worker’s comp, motor vehicle, liability, and fire insurance from an organization school districts join (the Texas Association of School Boards). I cannot go to any doctor, however. TASB belongs to a government alliance with a list of approved doctors (like any other insurance network). I had to choose from them – and none are in my town, of course.

I believe the TASB Risk Management Fund is actually a self-insured pile of money. There doesn’t seem to be any traditional servicer or vendor for it. The closest I can find is this inter-governmental alliance.

24

Not exactly no consequences. The driver was charged with careless driving causing injury, fined $300 and licence suspended for 3 months. Also, her insurance company paid for the write off of my motorcycle. She was only 18 and driving Dad’s car, so I imagine there was some push back from Dad next time she wanted to borrow it.

Certainly, I can’t sue her for compensation or payment of treatment.

25

Forgot to add:
I also didn’t describe a case where the injury is not severe enough to need hospital treatment. If I hurt myself at home or work, I can visit my own GP. ACC will pay part of his fee and I pay the balance. usually around $16-20. There is no tie to certain providers at the GP level. Some specialist services may require you to go to a certain ACC approved provider.

26

Just to clarify, for Canada - (IANAL)

Canadian provinces have single-payer systems that cover just about everything not elective. There is generally no bill for such treatments. You go to the doctor, or get admitted to hospital, and get the necessary treatment. The only bills you have are things like ambulance ride, prescriptions (unless in the hospital as part of treatment), non-hospital dental, and some extras afterwards, like a fancy wheelchair. These are the sorts of things “health insurance” as an employer benefit might cover if you have good benefits. Some treatments like physiotherapy may have annual limits.

Workers’ Comp - every province also has a workers’ compensation plan. Pretty much every employer must participate. Rates are set by the category of work, so retail store payments would be a lot less than say, a big warehouse or a steel plant or a construction site. Some very large employers are in their own category, basically paying what their employees cost the system. The WCB’s (workers Compensation Boards) are generally pretty anal about ensuring all accidents even minor ones are reported. Big industrial employers tend to be anal about safety - or they quickly learn to be. WCB also has inspectors for industrial sites.

So this is the response to the OP - if you go to a doctor, one of the questions will be “did this happen at work?” even if it’s a pulled muscle or a sore back. If the answer is “yes” then the doctor bills the WCB instead of the provincial health plan. (The major exception to the “single payer” principle). If you and/or the employer did not report this then there will be a bureaucratic shitstorm over failure to report within 24 hours. No fun being a boss. All subsequent treatment for that complaint will be billed to the WCB so they can track the true cost of workplace injuries. WCB also pays lost wages and even disability pensions or partial pensions. The major benefit to the employer, is it precludes almost any lawsuits over the accident. (IIRC, unless it involves criminal negligence)

Depending on your political bent, and that of the current government, the WCB is either too lenient or too strict. I know of one fellow who cracked his ankle (at work) and then, according to coworkers, walked on it frequently to ensure he stayed off work collecting pay for over 8 months… Except for the time after the new contract kicked in, where he went back to work for a day before deciding he was too sore and went back home collecting compensation based the new contract rate. Of course, while you are off sick - some insurance schemes were badly written and for example, paid your mortgage or car payments while the person was also collecting 80% of their wage, tax free. (It’s insurance payment). He resisted as hard as he could coming back on a make-work project painting railings. Another woman I heard of “snagged her bra strap” on a fire extinguisher hook, causing no visible injuries except leaving her with a “painful deep tissue injury” that she collected on for 5 months. Horror stories abound.

I had a friend in college when Ontario first published the list of doctors who made over $100,000 in a year. (Mid-70’s - Back when that was serious bucks). He explained his dad wasn’t on the list because it only listed the health plan, and not WCB payments; his dad made more than half his billings to the WCB.

For other incidents - well, unless you want to set up the equivalent of death panels - say, “Darwin panels” - how do you determine what to bill back to a patient? Is skydiving or hang-gliding so dangerous you should be responsible for your own medical bills? How about skiing - notorious for broken limbs? how about skateboarding? How about just doing really stupid stuff, like trying to get the barbeque ready faster by pouring on more starter fluid? The thing is, people don’t set out to injure themselves. besides, the hard-of-thinking tend not to have enough to cover their medical bills anyway. So whatever happens, stupid or accidental or whatever, the health plan pays for anything not work related; and compensation pays for anything that happens on the jobsite.

That’s probably a major plus - there are a helluva lot less lawsuits in Canada, because nobody is looking for $300,000 to cover the medical bills for their broken leg. Auto insurance will cover third-party for some stuff like physiotherapy out of the hospital and lost wages - if you are not at fault (and the driver was sober). If their insurance won’t cover it and they are at fault, probably yours will.

I’ve had experience out west with a single-payer auto insurance. It’s just like real auto insurance, except much cheaper unless you own a minimally insured POS. Their adjuster decides whose at fault, and the not-at-fault does not pay a deductible. At fault, your rates go up for a few years. I heard one province went to no-fault, where the only dispute was the deductible and all decisions were made by the auto commission’s tribunal or something - “you get $20,000 for all future physiotherapy needed.” Even if it wasn’t your fault, unless you bought the premium coverage, they don’t pay your car rental. (This is all second hand, so not sure…)

So with or without single-payer auto insurance, there’s a lot less lawsuits. Ditto for negligence; I slip on your icy sidewalk - no medical bills to sue for, so you have to convince a judge that you were so badly injured you need to collect months or years of lost wages, pain and suffering, etc.

27

Thanks for the clarification, Really Not All That Bright. There seems to be a wide range in how workers’ comp is handled in different countries (and even in different states in the case of the US), so generalization is difficult.

28

This is a huge difference from the Canadian system. Because all doctors are paid through the same medicare/Workers’ comp systems, there are no lists of approved doctors for general practice. An injured person goes to whatever doctor they choose, subject to availability. Doctors are self-employed, not government employed, and GPs can take anyone who walks through the doors.

Specialists are a bit different. They’re all paid through the same systems, so no restrictions imposed as to which specialist you can see. But, the GPs act as the gatekeepers: you generally need a GP referral to see a specialist.

When I had an issue a couple of years ago that required a specialist, my GP gave me the names of two specialists in the city who dealt with that issue. I had heard their names before, and I said which one I wanted. My doc then set up the appointment. Easy peezy.

29

If I’m correct that Kiwi Fruit is posting from New Zealand, there is a twist there that is unique to New Zealand. In the early 1970s, New Zealand abolished torts for personal injury, and replaced them with a no-fault Accident Compensation Commission (the “ACC” Kiwi Fruit mentions). So all accidents are covered by the Commission on a no-fault basis, plus no-fault auto insurance, plus UHC, so the NZ experience doesn’t translate easily to other common law jurisdictions, even those with UHC, like Canada. You can’t sue someone in New Zealand for having negligently injured you.

In Canada, only the federal and provincial governments can invoke sovereign immunity, and even then, it’s been almost done away with in personal injury situations by statutes, typically called The Crown Proceedings Act, allowing actions in tort against the Crown. Cities can be sued like any other corporate body, although there are shorter limitation periods for actions that relate to the condition of city roads and sidewalks. The reason for the shorter limitation periods is that the city needs to be given notice of the injury so they can go and look at the location and the conditions, before it changes because of weather, passage of more vehicles and pedestrians, etc.

But, for most minor accidents, like a slip and fall, the only impact on the injured person is the medical care and time off work. Since there are no medical bills, and most employers give sick time to their employees, there isn’t any incentive to sue: you’re not out of pocket.

This is the point that MD2000 is making. People in the States sometimes talk about the need to reduce litigation because of the costs it has on the health care system. To my mind, that’s approaching the problem from the wrong end: people in the US are more likely to sue for health costs because they don’t have universal health coverage, and therefore need to sue someone to try to make up the cost of the health bills they’ve paid.

Canadians don’t need to sue for health costs, so usually court actions are only brought if the injury has caused a permanent disability or loss of income: in other words, more serious cases. It’s not that lawsuits in the US are driving up health costs; it’s that the lack of UHC in the US is driving people to litigation.

30

[quote=“bob_2, post:21, topic:783660”]

You might also surmise that TAC funded patients get sent for more unnecessary tests and are kept in longer to bump up the bill.
[/QUOTE

Although in theory that’s a potential problem, in practice it’s not a big issue here. Aus Public Hospital policies are dominated by the government funding, which is fixed (‘caseload’). So they just aren’t in the habit of thinking how to boost costs. And most patentients want to get out of hospital and get on with their life.

Contention between patient and insurer arises over chronic injuries, but hospitals and doctors aren’t interested parties in those disputes.

It’s a contentious issue in Aus, but not as bad as you descrbe for the UK. For Transport inuries, “Common Law” claims are only allowed for “serious injuries” in Vic.Aus. Don’t think similar limitiations apply to workplace, but I think if you win, you have to pay back what you got from the insurance. Lawyers really like this kind of claim, and have fought all efforts to fix it.

31

And of course, if it comes to a court fight, then that US$100,000 in medical bills becomes $150,000 because the lawyer usually operates on contingency and gets their share. Plus, the loser has to pay their own lawyers too. The whole US system gets more expensive, the only upside is for the lawyers.

I forgot about mentioning the “which doctor” scenario, because in many places in Canada, the trick is finding a doctor that has an opening, not one that is party to your plan; they all are on the same plan. Specialists, depending on specialty and location, can have long wait lists. This is the downside of UHC - people actually use it when they need to.

32

In Japan, they have workman’s comp and I believe that it covers expenses not covered by the single-payer insurer.

It also provides a door-to-door coverage, from when you leave your house in the morning until you return, unless you stop off for an errand.

33

WCB in Canada typically covers injuries on the job site. they even cover heart attacks, chronic diseases and conditions attributable to work such as hearing loss for loud environments. It was a joke where I live, tell the wives or co-workers - “if I have a heart attack, drive to the plant and throw me over the fence”.

I don’t think it counts if you re commuting… except:

One fellow was cycling to work, full tilt, head down. So he didn’t see the rail crossing had been dug up for road repairs until too late and hit the 4-inch high rail, flipped and broke his pelvis. WCB covered him because the rail line was just inside company property although a few hundred yards from the fence.

One fellow was boosting his battery to go to work at a recreational facility well out of town; it blew up in his face, injuring one eye. He got WCB because part of his job description was to pick up the other workers so technically starting his vehicle was “on the job”.

34

No. That’s the downside of an insufficiently funded UHC.

35

And md2000’s experience is not necessarily the same across the country. The clinic I go to gas recently had a big sign out front, advertising that they have 3 new doctors joining them, and they’re looking for patients.

36

There’s no such thing as “sufficiently funded”, the system can always use more money. (And there’s always allegations they specifically budget hospitals to limit things like the number of hip replacements per year, to keep the cost down.) From what I’ve heard, rural areas and up north have a real problem getting doctors to stay and practice, but I have heard news stories about bigger cities also having a problem. Of course, for Canada, one of the problems is that there’s a huge (but more complicated) market down south where health professionals can make a lot more money. Plus, Canadian doctors are independent workers on the same model as US doctors, billing per patient treatment - usually* - so the government can’t tell them where to practice. Desirable locations with have plenty of doctors, others less so.

One trick is that some medical schools give consideration to applicants from small towns, in the hope they will not be averse to working in small towns when they graduate.

*IIRC, IANAD, some positions like Emergency are hired positions, but still some piecework.

37

Thank y’all for the nice conversation and the information. My biggest takeaway is that, in single-payer situations, one gets sick/hurt, goes to the doctor or hospital, and gets treatment. The financial parts of this relies on information from the patient, but otherwise takes place “behind the scenes”, without much intervention from the patient himself.

Sounds like a dream. Get hurt? Go to the hospital. What a concept.

38

That’s about it, yep. Except we go to hospital up here. :slight_smile:

39

I go to THE hospital. :wink:

40

Yes, once in a while the doctor’s receptionist will ask to see my health card; but generally, just go see the doctor or go to the emergency room if it’s urgent and/or after hours. If admitted to hospital, in you go - there may be forms to sign, I wouldn’t know, I’ve never been admitted to a hospital. Don’t even have to sign anything about costs. Billing happens behind the scenes, I haven’t a clue what the costs were or could be.

I was involved in a discussion about investing once that included a GP. He didn’t specifically say, but I got the impression that a GP (as opposed to a specialist) does not make a lot of money. Sure, they are probably in the top end of middle class, but not “rich”. OTOH, I have heard the same about GP’s in the USA - and my impression is that a GP in Canada has a lot fewer paperwork and billing hassles.