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People who receive financial compensation are less likely to recover well after surgery

At a glance:
If a patient is compensated for their condition, they are considerably less likely to have a good recovery after surgery. 
Perspectives:
Employee
Regardless of the type of condition they have, people who receive financial compensation for their health problem tend not to have as good a recovery. This fact has been known for some time.

Studies have shown that when people blame their employer for their condition they are more unhappy about their situation and less likely to have a satisfactory outcome.

Understanding your situation can help the way you think about things. If you are experiencing communication barriers, or feel resentful about your injury, it might reduce your chances of recovery.

If you can deal positively with these issues, your chance of recovery is likely to improve.
Employer
A number of factors contribute to the poor health outcomes of compensated workers. People who blame their employer tend not to recover as well. Health outcomes could also be affected by delays, frustration, and the increasing reluctance of doctors to treat patients who are claiming compensation.

Improving outcomes for employees and encouraging return to work will improve outcomes for the workplace. This can be achieved by supporting employees who need treatment, minimising delays, addressing any issues of blame and promoting good communication.
Treater
Treating practitioners are well aware that when compensation payments are involved, health outcomes are less satisfactory. It is essential to share these facts with patients.

Contributing factors to the situation may be:

         Blame and resentment resulting in perceptions of poorer outcomes

         Bureaucratic delays that can impede treatment

         Under or over-treatment, due to reduced patient involvement in the decision-making process

         The U.S. rheumatologist Nortin Hadler famously said - It is hard to get well if you have to regularly prove that you are sick.
Insurer
It is important for people undergoing treatment to understand that health outcomes are less satisfactory when compensation is paid. However it is equally important for others to understand the reasons for this and to work towards improving the situation.

Delays in providing treatment can contribute to frustration and resentment, and outcomes can be worse if treatment is delayed. When receiving positive care and support, patients are more likely to respond to treatment positively.

Outcomes can be improved by supporting evidence based-medicine, trying to minimise over-treatment, and ensuring the employer provides positive support.
Original Article, Authors & Publication Details:
I. Harris1, J. Mulford1, M. Solomon2, J. M. van Gelder3, J. Young2 (2005). 

Association between compensation status and outcome after surgery.  Journal of the American Medical Association; 293(13):1644-1652

1Orthopaedic Department, Liverpool Hospital, Liverpool, Australia
2Surgical Outcome Research Centre, Camperdown, Australia
3University of New South Wales, Kensington, Australia
Background, Study Objectives, How It Was Done:
This paper is a review of the effects of financial compensation on patients' recovery after surgery. 

The researchers found 211 relevant studies on this topic. These studies contained “observational” information, meaning that other factors that might affect the results were not controlled.

The researchers observed whether or not patients in each study had received compensation, and classified the patient's recovery after surgery as “satisfactory” or “unsatisfactory.” This was done using measurements of specific injury outcomes, the patient's general health and function, patient satisfaction or pain.
Study Findings:
Of the 211 studies:

         175 studies showed that people who received compensation for their condition were less likely to recover fully than those who didn't

         30 showed that there was no difference in the recovery of compensated and non-compensated groups

         5 didn't comment on the difference in outcomes between the two groups

         1 showed that people who were compensated were more likely to recover fully than those who weren't

The results of the studies were combined using a statistical technique known as meta-analysis.
meta-analysis
A complex statistical analysis that combines the results of a number of studies on the same subject.
 In total there was information on 7244 compensated and 13254 non-compensated patients. Although the studies differed somewhat, the combined results showed an association between receiving compensation and a reduced chance of recovery.

The authors also tried to determine whether other factors were affecting the results. They found that differences in the study type and completeness of follow-up had no effect. The same effect was observed for different types of injury and it made no difference whether the compensation came from litigation or workers' compensation.
Conclusions:
A review of studies investigating patients' recovery from surgery showed that people who are financially compensated for their condition are less likely to recover fully than those who are not.  Overall, compensated patients were several times more likely to have an unsatisfactory recovery after surgery than were non-compensated patients. 

The same association between compensation and poorer recovery outcomes was observed across all types of injury, surgery, compensation, and study methods.  In many studies, compensation status was the most important factor in predicting a poor recovery.
References:
PubMed Abstract
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