Do private clinics or expedited fees reduce disability duration for injured workers following knee surgery?

Objective: To investigate the effect of workers' compensation policies related to expedited surgical fees and private clinic surgical setting on disability duration among injured workers. Methods: The study included 1,380 injured workers with knee meniscectomy between 2001 and 2005 in British Columbia. Using linked workers' compensation claim and surgery/clinical records, wait time for surgery (time from last surgical consult to surgery) and time from surgery to return to work were computed and compared for workers who received care in public versus private facilities, and according to whether their surgeons received fees intended to expedite care. Results: The public expedited group had the shortest disability duration from surgical consult to return to work; the expedited fee reduced the surgery wait time (~2 work weeks), and surgeries performed in public hospitals had a shorter return-to-work time (~1 work week). Discussion: An overall difference of approximately three work weeks in disability duration may have meaningful clinical and quality-of-life implications for injured workers. However, minimal differences in expedited surgical wait times by private clinics versus public hospitals, and small differences in return-to-work outcomes favouring the public hospital group, suggest that a future economic evaluation of workers' compensation policies related to surgical setting is warranted