It is vital both the Government and insurers invest more heavily in rehabilitation if the cost of long-term illness is to be reduced, says Helen Merfield
It is well recognised that rehab-ilitation and early intervention are effective mechanisms to help ensure a healthy, safe and durable recovery for sick or injured individuals. The challenge for the Government and business is to develop an effective overall rehabilitation infrastructure in the UK and get the most out of the resources available.
The Trade Union Congress (TUC) and Association of British Insurers (ABI) have jointly called on the Government to take a clear lead on rehabilitation, and develop a national action plan to develop faster and better services. The reasons for their actions are clear: if the UK is prepared to invest the money up front, at all levels in rehabilitation, society as a whole will benefit. At the national level there will be a decrease in demand for Incapacity Benefit, NHS beds will be freed up faster as patients' recovery time is reduced and employers benefit from increased return-to-work rates.
Absence from the workplace following injury or illness has been estimated to cost British companies a staggering £11bn per year and this is rising. This already equates to up to 9% of the annual salary expenditure for a large employer. A total of 2.7 million people currently receive Incapacity Benefit, yet only 1% return to the workforce each week.
Early intervention
This return-to-work rate could be greatly improved by the widespread adoption of early intervention and rehabilitation case management in cases of personal injury. Effective rehabilitation case management helps to ensure a safe, suitable and durable return-to-work programme for injured employees. This in turn will help insurers and employers to mitigate the economic burden of sick pay, the associated costs of hiring replacement workers and time wastage caused by transferring an employee's workload to another member of the company.
The insurance industry can no longer ignore the benefits associated with introducing rehabilitation case managers (RCMs) into the claims and treatments process. This is emphasised by statistics from the International Underwriter's Association's (IUA) Third Bodily Injury Study (2003), which states that the cost of bodily injury claims to UK insurers has risen by almost 10% per annum in the last decade - nearly three times the rate of national average earnings.
Related to this, employers' liability (EL) insurance costs are soaring and for some employers, cover is becoming difficult to obtain at any price. It was recently reported that some companies, particularly small to medium-sized enterprises (SMEs), could not afford EL premiums. Some have already gone out of business because UK employers are compelled by law to obtain this cover. The potential for a reduction or maintenance of insurance premiums is extremely welcome in this current challenging market. Rehabilitation case management and the provision of proactive occupational health programmes can help achieve this. This enables insurers to bear the costs associated with workplace accidents and, in turn, offer realistic premiums for companies obtaining compulsory EL insurance.
Currently, only 5% of insurers' claimants are offered rehabilitation. However, this figure is expected to increase dramatically over the next few years as insurers seek to contain the spiralling costs of bodily injury claims. Insurers introducing RCMs early into the claims process benefit from increased predictability in pricing and the estimation of payouts.
More investment
Unfortunately for insurers and employers, current budget allocations in the NHS are not predicated towards the establishment of an effective rehabilitation infrastructure. While NHS budgets have increased in recent years, which is undoubtedly a positive step, the UK still lags behind its counterparts in the developed world when it comes to healthcare spending.
The NHS's budget is anticipated to be in the region of £65.4bn in 2002-2003, ranking second only to the social security budget in terms of the Government's expenditure. NHS spending currently amounts to approximately 6.6% of national income. However, in Germany 10.7% of national income is spent on healthcare provision and in the US this figure rises to 13.9%.
More than half the money spent in the UK on community health projects and hospitals is devoted to acute medical treatment. However, there is a need for increased provision and expenditure on rehabilitation services. Increased spending on rehabilitation and after-care services can actually help lower overall costs.
For example, many hospitals are under pressure to cut waiting lists for operations, but are prevented from doing so by a shortage of available beds. This typically leads to short-term, higher cost solutions. Rehab-ilitation can help speed a patient's recovery, consequently allowing them to return home sooner and freeing up a bed.
Victims of accident and injury would also benefit from the NHS devoting capital expenditure for the establishment of specialist rehabilitation centres, like those utilised by athletes to assist their return from injury. It is generally accepted that when a sports professional is injured they will require rehabilitation to return to full fitness. The same rationale should be applied to any victim of an accident or injury. Rehabilitation is crucial to ensure a durable and sustainable return to work not only for elite athletes, but for any individual who suffers an injury.
Adopting a 'best practice' approach to rehabilitation in the UK that ensures the highest possible standards will reap dividends for all concerned. Organisations including the Case Management Society of the UK (CMS UK) have been working hard to ensure this best practice approach becomes a reality.
CMS UK is operated by case managers who have established set membership standards, assessments for those seeking to join, quality standards of practice, and developed continuing education requirements. Related to this is Bodily Injury Claims Management Association (BICMA) and the ABI Rehabilitation Working Party which has developed The Code of Best Practice on Rehabilitation, targeted at insurers and legal representatives.
Reducing costs
The Code's primary purpose is to emphasise the importance of early intervention and treatment of personal injury cases. This not only reduces the costs of medical care and those of the insurer, but also reduces the costs to society by helping to ensure a healthy, productive workforce.
Effective rehabilitation case management involves post-injury assessment, evaluation and rehabilitation programme co- ordination, providing specialist assistance to aid the medical recovery and return to work of an injured individual. RCMs should be client-focused and outcome-based, eliciting team work with all key parties including the employer, solicitor, GP and insurer to expedite recovery, minimise the life of a claim and facilitate a return to optimum health and suitable employment. For the rehabilitation process to be effective, the RCM needs to ensure that a team approach is adopted. Most importantly, the injured individual needs to be actively involved in the planning and implementation of their rehabilitation programme, remaining the central focus at all times.
Private alliances
Within the UK, a partnership between public and private enterprise in the field of rehabilitation is already emerging. An increasing number of privately financed RCMs already operate alongside NHS professionals to ensure the very best treatment and rehabilitation for injured or ill individuals can be made available. What is needed in the future is the development of a co-ordinated and sustainable infrastructure for rehabilitation in the UK.
If the Government increases capital expenditure on specialist rehab-ilitation centres, while insurance companies invest in rehabilitation case management and employers concentrate on preventative occupational health services - the costs and burden associated with personal injuries would be greatly reduced. A co-ordinated approach would result in a better quality of life enjoyed by those who would otherwise be destined for long-term illness and unemployment, resulting in economic and social benefits for society as a whole.
Helen Merfield is managing director at HCML
COVER notes
• The cost of bodily injury claims to insurers has risen 10% each year over the last decade.
• Just 5% of claimants are currently offered rehab-ilitation services by insurers.
• More investment in rehabilitation services by both the NHS and insurers would help cut long-term costs, free up NHS beds and get people back to health quicker.
