Applicability of the gap analysis methodology in measuring service quality in workers compensation managed care health programs

This research provides a quantitative approach to analyzing the impact of the preferred provider organization (PPO) program, an alternative directed health care program into the Workers' Compensation System, on the quality of medical service, return to work and costs. In 2001, the New York State Workers' Compensation Board incurred {dollar}1.05 billion and {dollar}2.22 billion in workers' compensation medical and indemnity costs, respectively. This research methodology will augment workers compensation research in measuring service quality determinants and assessing programmatic success/failure of managed care programs in workers compensation. This research contrasts the PPO program and the traditional fee-for-service operation. The analyses compared service quality constructs—service outcomes, medical process, service delivery, service specifications and service costs against standard benchmarks used in the workers' compensation environment. Three types of analyses were performed: reliability and validity analyses of the SERVQUAL survey instrument, comparative analyses between the PPO program and the fee-for-service program with standardized benchmarks using the service quality construct/gap analyses methodology, and logistic regression analyses to determine the cause-and-effect relationship between SERVQUAL scores and the service quality constructs. The results indicate the applicability of the gap analysis methodology in the workers' compensation environment. This methodology provides a framework of service quality measurable constructs that can be expanded and enhanced. The methodology is also applicable in any service quality environment that produces benchmarks and outcomes. The methodology is diagnostic in its application and useful in a programmatic perspective. The use of the service quality model was appropriate to show a relationship between the service quality (SERVQUAL) or patient satisfaction scores with the service quality constructs/gaps. The research also shows evidence that the PPO program exhibits faster return to work and incurs fewer days away from work. Duration of medical care treatment is also shorter, with more extensive use of medical treatments. Although accessibility to health care providers was a problem, the PPO program does ensure that access is granted to a within PPO network medical specialist. Medical costs and indemnity were significantly lower than the fee-for-service model. Indemnity costs were also less than half of the fee-for-service model. Policy implications to the State of New York are also discussed.