Social Epidemiology Insights

Into The Drivers of Change in

ACC Claims Rates

The Social Production of ACC

Claim Rates
John Wren
Principal Advisor ACC Research

Grant Pittams
ACC Research Manager

Key premises
Well founded sociological and economic behavioural
theories and evidence are available to inform
understanding of the drivers of ACC Claims rates

The Scheme is a social and political construct rooted in

New Zealands social dynamics
Understanding this helps to understand drivers of
claims rates

What are Sociological

Insights?
Systematic ideas about:
How social relationships influence peoples attitudes and
behaviour
How major social institutions affect us
How we affect other individuals, groups, and
organisations

Involves the use of the sociological perspective and

imagination respectively Alan Berger (2006 & 2010). Sociology.

Insights may emphasise

Patterns and Predictability in social order
Social Systems or Individual Actions

Source of Motivation of individuals and social groups

Why people / social groups act

Macro or Micro social effects / interactions

Patterns of Power / Resistance

e.g. Economic differences, Use of Language, Gender Politics,
Class Politics, Group Dynamics

Everything in between

System and Individual Action

Effects Co-payments example:

Impact of Policy, Legal or Operational Entitlement Decisions On

Claims Volumes

Least
Clear
Line moves up if providers and
clients perceive claims are more
likely to be accepted
Extent
Type of Injury
Cover

Med Fees

Potential Scope Injury / Occ Health

Cover
Number of Claims

Weekly Comp &

Serious Injury Claims
respectively

a
ctu

l&

Po

te

al
nti

m
lai

m
olu

Line moves right as clients

access treatment or providers
register more claims

Most
Clear

Least
Clear
Extent Treatment, Rehab Services and Compensation
Cover

Fundamental insights
informing model
Consistent:
seasonal fluctuations
long-term patterns by type of Claim
patterns vary by type of Claim
macro and micro economic behavioural effects impact
differently upon Type of Claim

Med Fees Only

Weekly Comp
Other Entitlement Claims

Fundamental insights
informing model
Significant differences between the Scheme Accounts in terms of:
claim volume
claim proportion
cost
types of injury claim
Small % changes can = large volumes and costs in some
accounts
Scheme Accounts comprise:
Work
Motor Vehicle

Earner
Non-Earner
Self-employed

Fund Type
1,000,000

Non Earners
800,000

600,000

Earners

400,000

Work

200,000

MV
10
20

09
20

08
20

07
20

06
20

05
20

04
20

03
20

02
20

20

01

Basic Structure of ACC Claims

Basic Structure of ACC Claims:

Cost vrs Volume
Example: 2010 Expenditure by Claim Type
$1,600
$1,400
$1,200
$1,000

Expenditure on Weekly
Compensation
Expenditure on Entitlements
$850

Expenditure on Med Fees

$M $800
$600
$400
$444

$479

$200
$0

$324
$94

$76

Weekly Comp Claims

Entitlements other than

WC

Med Fees Only

WC Claims per 10,000 workers

Implementation
of 'Giltrap'

ES Changes

110
100
90
80
70

-1
0
M
ar

-0
9
M
ar

-0
8
M
ar

-0
7
M
ar

-0
6
M
ar

-0
5
M
ar

-0
4
M
ar

-0
3
M
ar

-0
2
M
ar

-0
1

60

M
ar

WC Claims per 10,000 workers

Unemployment Rises

Social Dynamics
ACC Research commissioned research among GPs to explore whether
they had changed their behaviour in any way that may account for the
reduction in GP initiated Med Fee claims. GPs were asked:
Did they have an opinion as to why claim numbers may have dropped?
Had they changed the way they decide whether a claim should be lodged
with ACC or not?
Had they noticed whether injured workers are more or less likely to take
time off work on ACC and why?

Had GPs changed the way they certified

time-off for their patients and in what ways?
GP responses:
18% of GPs said they had changed the way they decide whether a claim
should be lodged with ACC most attributed this to ACC tightening up
on which claims are accepted and which are declined particularly those
related to gradual process
so why lodge a claim if it may not be accepted?

The recession has impacted access to health services (due to the cost)
and people are more reluctant to take time off work in case it jeopardises
their job

Some GPs commented that with minor injuries it wasnt worth the time
or hassle filling in the paperwork

Social dynamics
33% felt that their patients were taking less time off work due to
injury largely attributed to financial restraints and concerns about
loss of jobs.
27% of GPs stated that they have changed the way they certify time
off this generally reflected a shift towards encouraging gradual
return to work.

Summary
Claim rates are the same now as they were in 2001 i.e. the net growth in
claims over the decade is explained by the increase in population.
Changes in strategic direction are observed to be associated with changes
in claim rates. Claim rates rose from 2005 until 2008 falling back to
previous levels by 2010. From 2005 the focus was improved access, then
from 2009 it changed to value for money.

The downward trend in claim numbers has now levelled off, and in the
absence of significant changes in funding or policy settings, new claims
can be expected to increase gradually over time in line with population
change.

Summary

There is a time lag between turning points in economic series and claim
numbers claims turned before economy in 2008
no clear economic association for some types of claims
for work claims there is international evidence that lower employment leads to
fewer claims
Clear policy effects associated with some types of claims but not all
Need to treat Med Fees differently from Weekly Comp Claims in terms of
drivers of change.
Plausible drivers of Med Fees Provider and Claimant Behaviour in
short-term. Long term Health System change in role of service delivery
Plausible Drivers of Weekly Comp are:
Risk
Exposure (Hours Worked)
Entitlement (Policy and Legal cover decisions)

From Model to Policy Implication

Firstly

Policy-makers have to weigh two opposite effects according

to their priorities.
If accident prevention or better insurance coverage is a primary
goal, one could increase benefits, while evaluating claims for
minor and hard-to-diagnose injuries more vigorously to alleviate
moral hazard effects and control costs
If financial constraints are binding, policy-makers should be
aware of the empirical evidencethat higher benefits lead to an
increase in total compensation costs (and moral hazard effects or
increased inequity in entitlement access).
(Lanoie. 1992:66).

From Model to Policy Implication

Secondly
investment in effective injury prevention interventions is
necessary to improve the sustainability of the Scheme in the long
term

Thirdly
operational efficiencies have a role in contributing to the cost of
services and efficacy of outcome.