Cost shifting in health care: A pilot study explores the relationships between cost shifting, repetitive strain injury, the Workplace Safety and Insurance Board of Ontario, and publicly funded health care

Cost shifting in health care occurs when one of the participants, whether public or private, attempts to shift the burden of the health care cost to another participant. Overuse types of injuries, often referred to as repetitive strain injuries, may occur during work or leisure and present an opportunity to cost shift. A survey was designed to identify potential cost shifting activities involving overuse types of injuries affecting the upper limbs. A sample size of 100 family physicians was randomly chosen from a sampling frame composed of number of communities in Ontario. A total of 56 physicians agreed to participate and completed the questionnaire. Results indicated that respondents identified some 384 known, or suspected, cases of work-related injury. Respondents indicated that 208.5 of the 384 cases were billed to public medicare and not to workers' compensation. Selected variables showed statistically significant correlations suggestive of cost shifting activities. Further study is required to clarify the extent and dollar value of cost shifting activity both provincially and nationally.