The economic and social cost of workplace disease and injury in Australia and New Zealand

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1 The economic and social cost of workplace disease and injury in Australia and New Zealand Access Economics Lynne Pezzullo, Director, Head of Health Economics

2 Overview Background to the 2 studies Methods developed through the Australian study Application in New Zealand the 2 nd study Conclusions

3 Background 2004 NOHSC National Occupational Health and Safety Commission Australia Compensated costs not the whole story Underestimating disease Need a better understanding for cost benefit analysis for regulation 2006 NOHSAC National Occupational Health and Safety Advisory Committee New Zealand

4 Methods - Australia Literature review NOHSC library: Leigh et al 2000 Costs of Occupational Injuries and Illnesses (1992); Miller 1997 Estimating the Costs of Injury to U.S. Employers ; Davies & Teasdale 1999 [Health and Safety Executive UK] The Costs to Britain of Work place Accidents and Work related Ill Health 1995 previous Australian government study sub optimal methods Excluded disease & QoL, double counting (income, production) etc Our job: examine alternative methods and data to support them Agree definitions workplace, humans (not property); In/out bystanders, goodwill, family carers etc

5 Advantages since 1995 NOHSC split compensated incidents into injury and disease codes Jurisdictions (8) developed nationally consistent data coding approach the National Data Set (NDS) More acceptance of QoL (quality of life) metrics such as the disability adjusted life year (DALY) More work on attributable fractions (AF) and disease costing by the Australian Institute of Health and Welfare (AIHW)

6 Themes and issues Perspective individual/worker, employer, society Cost categories ex ante vs ex post; direct vs indirect; costs of prevention real vs transfer costs deadweight losses (DWLs) Productivity losses friction or human capital approaches Willingness to pay valuing disability and premature death value of a statistical life year (VSLY) discount rate 3.3% real, 1.55% real for production streams

7 The incidence of incidents Time dimension for analysis (latency): incidence vs. prevalence approach to costs

8 Severity categorisation Severity of incident 5 categories NDS 1. Full return to work after absence <1 week 2. Full return to work after absence >1 week 3. Permanent disability partial return to work 4. Permanent disability no return to work 5. Death/fatality

9 Matrix approach Number of incidents * average cost of incident ( bottom up ); Some costs top down Cost category * who bears the cost Severity splits (not male/female or other cross tabs) Production disturbance costs Human capital costs Medical & rehabilitation costs Administrative costs Transfer costs Other costs Total cost categories Total Firm Worker Society

10

11 Number of incidents Fatalities 2003 study: n=2,620; with disease increase to 5,420 Injuries from Australian Bureau of Statistics Work related injuries # ,286 non fatal compensated + uncompensated (adjusted) inc. disease 349,706 all incidents (including fatalities and disease) National Data Set (NOHSC) for compensated incidents by severity Assumptions that some uncompensated severity splits same as compensated

12

13 Production disturbance costs Value of production (VOP) = weeks lost per incident*average weekly earnings*0.4 40% loading for overtime required to maintain production Staff turnover cost (STC) = 26 weeks*average weekly ordinary time earnings minus (26 weeks * average weekly ordinary time earnings)/(1+r)^3 Assumes 3 years till next job change (based on turnover rates) Then PDC = VOP (1 5) + STC (1 5) Then employer, worker and social components estimated. Employer pays the fist 3.3 days excess, uncompensated workers use sick leave, society bears compensation cost, lost taxation revenue and welfare payments.

14 Human capital costs HKC = present value of earning before incident minus PV of earnings after Requires estimate of average retirement age (62 years) and the average aged that a worker returns to work after an incident (43 years) Workers not returning to work (category 4 & 5), earnings after = 0 Those returning part time (category 3), earnings after = 0.64 * earnings before No HKC is borne by firm. Shared between worker (loss of income) and society (compensation payments, lost taxation revenue, welfare payments).

15 Medical costs Employers pay the first $290 (only $145 for category 1 though, on average) Then costs split between compensation system (NDS data), private health insurance, the public health system, and out of pocket payments by individuals. Data from AIHW used for the non compensated cost splits and totals. Uncompensated assumed only 75% of compensated. Compensated shown below.

16 Rehabilitation costs Society bears rehabilitation costs relates to severity categories 3 & 4 only. Data from Department of Family and Community Services (FACS) Shows uncompensated rehabilitation costs higher than compensated

17 Administrative costs Legal costs average cost per dispute by severity from compensation data; 1 in 8 disputed; shared between individual & society. Up to $11,972 per case on average. Also penalties and fines borne by employers. Around $10m total. Investigation costs average by severity from compensation data (for employers); ranges $28 to $2840/incident (Cat 5). Plus the compensation scheme s investigations ($390m total). Travel costs average by severity from compensation data; ranges $3 to $513/incident (Cat 4). Funeral costs compensation data; treated as a bring forward.

18 Transfer costs Transfers from society to worker = welfare payments include sickness allowance (short term), disability support pension (long term), lost taxation revenue.

19 Transfer costs Average welfare payments range up to $62,000 for uncompensated Category 4. Tax revenue forgone: over $100,000 for uncompensated disease Category 5. Deadweight losses calculated as 28.75% of the value of the transfer (Productivity Commission).

20 Other costs Loss of healthy life (pain, suffering and premature death) Disability weights from Global Burden of Disease Study (WHO, AIHW) VLY = $150,000 ($112,500 $225,000) gross; net subtracts costs to workers

21 Other costs Carers and aids, equipment and home modifications Category 4 workers Costs derived from FACS data Cost of informal care = $33,074/worker; Cost of aids etc = $10,396/worker

22 Total costs - Australia $33bn + $57bn loss of healthy life ($90bn) Split of $33bn in pie chart Employers $1bn (3%), Workers $14bn (42%) (+$57bn), Society $18bn (55%) $2.0, 6% $1.5, 5% $1.2, 4% $1.4, 4% $1.4, 4% $25.7, 77% Production disturbance Human capital Medical and rehabilitation Administrative Transfers Other

23 New Zealand study NZ 4m people cf. 20m people in Australia in More of a no fault system in NZ Excellent data from Accident and Compensation Commission (ACC) enabled additional cost splits: by ICD 10, industry, cause, ethnicity, age, gender 7 severity categories: Category 3 split into staged & partial return. Also other. Driscoll et al 2004 The burden of occupational disease and injury in NZ gave 305,150 incidents in total: 253,812 (83%) compensated and 51,338 (17%) uncompensated 239,894 (94%) injuries and 13,918 (6%) disease (+ disease splits)

24 New Zealand methods Identical methods and matrix approach to Australia; just NZ data e.g. discount rate 3.8% VSLY NZ$184,216 System leads to more incidents of shorter duration.

25 Total costs New Zealand $4.9bn + $16.0bn loss of healthy life ($20.9bn) Split of $4.9bn in pie chart Employers $287m (6%), Workers $2.28bn (46%) (+$16bn), Society $2.34bn (48%) NZ (LHS) lower HKC compared to Australia (RHS) $238, 5% $55, 1% $293, 6% $573, 12% Production disturbance $2.0, 6% $1.5, 5% $1.2, 4% $1.4, 4% $1.4, 4% $694, 14% Human capital Medical and rehabilitation $3,050, 62% Administrative Transfers Other $25.7, 77%

26 Costs by severity Stage return >½ financial costs ($2.6bn); then fatal, then other. Average cost/case $16,066 & $68,437 including suffering Permanent disabilities highest financial ($1.1m), deaths highest overall ($4.1m)

27 Costs by ICD-10 Cancer highest cost/case Sprains & strains most in total $m o $1.8bn financial o $7.6bn total o 36% total

28 Costs by industry ($m)

29 Costs by cause ($m)

30 Cost/case by ethnicity

31 Cost/case by age

32 Cost/case by gender

33 Conclusions Occupational injuries and disease affect around 4% workforce per annum in Australia and New Zealand Total financial costs are around 4% (NZ) to 5% (Australia) GDP Costs are largely lost production and the loss of healthy life Early intervention and a no fault system (as per NZ) may assist in reducing the long run human capital and QoL costs, while increasing the up front compensible medical/rehab cost component

34 Thank You While every effort has been made to ensure the accuracy of this document, the uncertain nature of economic data, forecasting and analysis means that Access Economics Pty Limited is unable to make any warranties in relation to the information contained herein. Access Economics Pty Limited, its employees and agents disclaim liability for any loss or damage which may arise as a consequence of any person relying on the information contained in this document. Access Economics Lynne Pezzullo, Director, Head of Health Economics

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