How to reduce ACC costs without cutting cover

Written By: - Date published: 1:10 pm, March 11th, 2009 - 32 comments
Categories: ACC, health - Tags:

The sensationalist tone of media releases regarding the financial situation at ACC has ignored the causes behind this so called ‘blow out’. The investment losses have been a big part of it but there is also a rising accident rate stemming from our ageing population and climbing obesity rates, which has been foreseen by medical experts for some time. We cannot do much about an aging population really, but obesity is wholly avoidable with smart policy that has some guts behind it.

Why should we focus on obesity? Obese workers have a higher accident rate, take longer to recover, cost more treat and are out of work for a longer period of time. A 2007 Duke University study found that ‘obese workers filed twice the number of workers’ compensation claims, had seven times higher medical costs from those claims and lost 13 times more days of work from work injury or work illness than did nonobese workers’. This in itself is worrisome but coupled with the ancillary and wider social costs of obesity, the economic implications are staggering. We have heard about the physiotherapy account being particularly affected, this also fits in line with the study from Duke who discovered that the most common injuries sustained were to lower extremities ,the wrist or hand, and the back. They conclude that ‘the most common causes of these injuries were falls or slips, and lifting’.

Obesity is going to become a leading health care cost for the next 50 years and this government has signaled that it does not care, by focusing purely on the costs of ACC rather than the root causes they are doing the public a massive disservice. What actions they have taken have been a step backwards, like the repealing of legislation to force schools to provide healthy options.

32 comments on “How to reduce ACC costs without cutting cover ”

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  1. mickysavage 1
    11 March 2009 at 1:30 pm

    But to do anything to persuade people to live healthier so that the costs of obesity is reduced and so that personal quality of life is increased is nanny state isn’t it?

  2. gingercrush 2
    11 March 2009 at 1:41 pm

    Great Obesity is a problem. Too bad this article does nothing to actually suggest how you stop such obesity.

    • Matthew Pilott 2.1
      11 March 2009 at 1:46 pm

      I’d have thought out pointing out where steps hvae been taken that are likely to exacerbate the problem would count, don’t you?

      But, to satisfiy you, GC, I’ll pass in this wee gem from Billy Connolly:

      “Eat less. Do more.” (spoken after mocking those who take dieting advice from someone who died a fat [harsh obscenity], viz. Atkins.)

      • Psycho Milt 2.1.1
        11 March 2009 at 2:38 pm

        According to Snopes.com, Atkins was 6 feet tall and 195 pounds when admitted to hospital in a coma from a head injury in April 2003. That’s 1.8 meters and 89 kilos, ie pretty normal. He eventually died at 258 pounds (117 kilos) due to fluid retention and bloating from progressive organ failure leading to death. So yes, he did “die fat” – fairly typical of the lying spin that diet disputes seem to generate.

        • Matthew Pilott 2.1.1.1
          11 March 2009 at 5:02 pm

          Crickey. Send Billy that link quick smart (the text in brackets was a summary of his routine, not my observations)!

          However, I agree with the Connolly approach to preventing obesity.

        • Psycho Milt 2.1.1.2
          11 March 2009 at 6:32 pm

          Apologies – I read the bit in brackets as your own comment.

    • BLiP 2.2
      11 March 2009 at 2:16 pm

      You mean things like insisting school tuck shops carry only healthy food so that children develop a taste for it?

      • Tim Ellis 2.2.1
        11 March 2009 at 2:33 pm

        BLiP, have you got any evidence that such intervention actually works?

        • BLiP 2.2.1.1
          11 March 2009 at 2:45 pm

          Why’s that, do you have evidence that feeding children pies and coke at school reduces obesity?

          • Tim Ellis 2.2.1.1.1
            11 March 2009 at 3:26 pm

            BLiP, I didn’t ply my kids with pies and coke. Certainly I never had coke in the house when my children were young. They grew up with healthy eating habits, not because they couldn’t have a pie at the tuck shop each day, but because they were given nutritional and healthy food at home, each day.

            There is some evidence coming through saying that intervention to control what food is served at school has no effect on the eating habits or obesity rates in children.

            So yes, if you’re going to propose an intervention that is more than just a trial, then I think you need to show evidence that it’s going to work rather than just rolling out social engineering at huge cost without any reason to suggest it is going to work.

            This is a far distance from the ACC discussion however. I don’t see any evidence of a massive increase in obesity or ageing rates over the last five years that would significantly explain the increase in ACC injuries and costs.

            In any case obesity is a public health issue which taxpayers should address through the public health system, not through the ACC system.

          • BLiP 2.2.1.1.2
            11 March 2009 at 4:02 pm

            I hate to say this – but I tend to agree with you. However, I believe National’s decision to reintroduce crap food into schools was made with not even one tenth of the thought and consideration that has gone into this post and attendant comments. It was a nasty emotional reaction to what they have coined “social engineering” – as if trying to improve the diet of children is a bad thing.

            I’m also of the view that the Government policy has an impact on wider society as well as those directly affected. The provision of only “healthy” food in schools must have indicated to unskilled parents that eating healthily is important, especially for children, and that it might be an idea to insist on eating well at home as well. Also, I believe that when children are in the care of the scool, the school should model healthy behaviour and not be a place where children can duck the restrictions of their parents. My parents insisted on healthy food at home and I remember the only good thing about Mondays was access to the school tuck shop nosh. Fortunately for me, my parents were relatively skilled – alas, not all New Zealand chldren have that luxury.

          • Tim Ellis 2.2.1.1.3
            11 March 2009 at 4:46 pm

            However, I believe National’s decision to reintroduce crap food into schools was made with not even one tenth of the thought and consideration that has gone into this post and attendant comments. It was a nasty emotional reaction to what they have coined “social engineering’ – as if trying to improve the diet of children is a bad thing.

            BLiP, I have no knowledge what process the Ministry of Education followed when the last government decided to roll out this policy. I would have thought, however, that before rolling it out nationwide you would set up a few pilot schools for a period of time, measure their performance in reducing obesity against schools without obesity reduction programmes, and be able to clearly demonstrate positive results before applying it nationwide. Alternatively, you should be able to draw on international research showing that such policies actually work.

            You seem to think it should work, and I think everyone would hope that it might work, but I think social policy changes should provide evidence evidence that it will probably work. I haven’t seen the research that says such moves work. I have seen evidence that they don’t work.

            I don’t have any expertise in social policy or education, other than as a parent. My instinct is that school-based social policy engineering doesn’t work, because the habits you try to teach children at school can’t break from the habits they learn at home. I haven’t heard Labour MPs provide evidence that removing unhealthy food from tuck shops reduces obesity in children. If they’ve got the evidence, great. Let’s do it. But if they haven’t, then it seems like a fairly unnecessary move just to justify the employment of a few social policy boffins in Wellington.

  3. infused 3
    11 March 2009 at 1:41 pm

    Where are all these so called stats?

  4. Ianmac 4
    11 March 2009 at 1:49 pm

    Gingercrush:”Great Obesity is a problem. Too bad this article does nothing to actually suggest how you stop such obesity.”
    Do not dare to tell me how to deal with obesity! This is a symptom of Nanny State gone mad! Next soon you will be calling for action in schools and advertising restriction and so on!
    Actually obesity is a real problem but apart from tinkering no-one seems able to manage it as a national problem anywhere. Except in Darfur.

    • higherstandard 4.1
      11 March 2009 at 4:48 pm

      Not true I saw a retrospective study there were remarkable reductions in obesity related illnesses in Cuba during the unravelling of the Soviet Union between 1991-95 which caused significant food and fuel shortages.

      In subsequent years, rates of death decreased markedly from 1997 to 2002: by 51% for diabetes, 35% for CAD, 20% for stroke and 18% for all-cause mortality.

      The question is whether there’s a less extreme way to get people off their backsides and eating less/more healthily than having a food and fuel shortage – I certainly hope so.

  5. Tim Ellis 5
    11 March 2009 at 1:58 pm

    I haven’t seen any evidence of obesity being a major cause of increased ACC costs. I very much doubt it is a significant cause.

    One of the major causes of increased costs has been the performance of ACC itself. The turn-around rates for injury rehabilitation after three, six, and twelve months has declined dramatically in the past five years. Lower turn-around rates mean longer rehabilitation times, more time off work, and higher treatment costs. With all due respect, neither ageing population nor rising obesity explains the dramatic increase in new claims, dramatic increases in claims managed by ACC, or the slower turn-around rates. Obesity and an ageing population are not a new phenomenon that has just happened in the last five years.

    • L Jae 5.1
      12 March 2009 at 8:51 am

      Ah here is where we differ in opinion. Yes you are correct obesity and an ageing population are not new. That is true. However we are seeing a critical mass of these two social phenomona in the western world and in developing nations we will see the impact of obesity start to take effect soon.

      Look ACC is under extraordinary pressure from its investments not returning a profit, but all Nick Smith seems to be concerned with is that entitlements and costs have increased, but not why. Thats what the important question is. WHY. It is not some socialist agenda, it is reaping the whirlwind of 15 years of bad public health policy regarding obesity and diabetes.

      This is one study across many years (1994-2007) at a large institution of 12000 workers. I believe the trends can be applied to NZ, it is not unfeasible.

      http://cfm.mc.duke.edu/wysiwyg/downloads/ObesityandWorkersComp.pdf

  6. gingercrush 6
    11 March 2009 at 2:01 pm

    Well many would say that we need to go back to basics. That so much of our food is over produced, over commercialised that not many of us buy the basics anymore. Which is true to an extent. How many of us buy mixed veges rather than buy fresh? Have you looked the ingredients in our food. Hell grab a random canned food and see the ingredients in them. Years ago, such canned food would look very basic. In building apartments and townhouses there is no room to grow vegetables and fruits.

    Now that in itself isn’t a solution. But neither is tinkering around the edges with stuff such as healthy school schemes.

  7. Psycho Milt 7
    11 March 2009 at 2:12 pm

    This article at Spiked Online is quite good on why the moral panic about obesity is crap, but they also have a whole series on obesity that goes into it in greater depth.

  8. Psycho Milt 8
    11 March 2009 at 2:21 pm

    They also have a good one on why using schools to peddle “healthy” eating obsessions to schoolkids is crap:

    As the researchers themselves admitted: ‘After two years, there were no differences between intervention and control schools in the prevalence of obesity.’ Even more shocking, they reported that ‘the intervention had no effect at the upper end of the BMI distribution on the incidence, prevalence, or remission of obesity’.

  9. Rachael Le Mer 9
    11 March 2009 at 2:23 pm

    You wank on about fat kids, what about sexually abused kids covered by ACC?
    That’s far more of a problem than schoolyard obesity.

    • George Darroch 9.1
      11 March 2009 at 3:11 pm

      Reducing sexual and physical violence against children is a very serious matter. If people actually listened to children’s advocates… We’d have a much better society.

  10. Strathen 10
    11 March 2009 at 4:36 pm

    What else could be a cause of the increase in rehabilitation time/costs?

    Does anyone know if there is any research on Physio’s fraudulently billing for client visits even though they have been rehabilitated?

    Has there been an anonymous questionnaire to people asking if they were taking the time off work prescribed to them, even though they could return earlier? (This one occurs to me as last year I had an operation and was given 3 weeks off work. I was back after 4 working days as I was recovered and bored. Had to complete an extra form to say I would be back earlier. I’m wondering if there is an increase of people who are taking the doctors recommended time off to the letter?)

  11. ghostwhowalks 11
    11 March 2009 at 6:53 pm

    When I had physio about 6 or 7 years ago after an accident, I was only on the recommendation of the orthopedic surgeon and then was limited to a view visits, however there was an option for extra visits at my own cost.
    Is it now open slather, bowl up to the physio say you have had an accident and get a months worth of free treatment ?

  12. Jum 12
    11 March 2009 at 7:20 pm

    Ianmac
    Au contraire.
    National will inform all weighty persons that any illness (heart attack is already one) as a consequence of being overweight will be privately billed. The finer issues of weight gain from medical issues will be ignored. Everything else they’ve done has been very simple…minded.

    Everything they have done has ignored one important factor – the personal touch, the personal plan, the personal psychology of buying into healthy change. All that so called touchy feely stuff that actually works.

    Shame we couldn’t harness that star quality of winner Valerie Vili. Watching her with her coach I could see she had everything going for her – the determination, the talent, the total focus of winning but with that star quality – sharing her success.

    National/Act simple-minded peas in a pod that they are, don’t get that. Vili knew that her Coach was just as important to that win as what she herself gave to it.

    Shame we are reversing back to the 90s and the negative, nasty, vindictive, divisive selfish punishing psychology of NAct.

  13. Jum 13
    11 March 2009 at 7:31 pm

    Rachael Le Mer
    March 11, 2009 at 2:23 pm

    ‘what about sexually abused kids covered by ACC?’ There won’t be any under National. Pushed back home behind closed doors like it used to be. Didn’t happen. Like rape.

    If it didn’t happen National won’t have to pay anything towards healing. It’s all right, anyway. The bible says so…

  14. QoT 14
    11 March 2009 at 9:14 pm

    Unless detail is given as to how obesity was determined in *any* study, it’s basically worthless. If said detail amounts to “calculated using BMI”, it’s worse than worthless.

    What’s hilarious is that while decrying the “sensationalist” coverage of ACC’s finances, the anonymous guest poster has bought in hook, line and sinker to equally, if not more, sensationalist OBESITY EPIDEMIC OH NOES!!!!!!! media coverage.

    Don’t want to sound harsh, but please, Guest Poster, it’s all so much bullshit, and I invite you to read
    http://kateharding.net/but-dont-you-realize-fat-is-unhealthy/
    before starting on the fat-hate.

    • L Jae 14.1
      12 March 2009 at 9:14 am

      Hmm read that website. I will acknowledge that it is true, society places a huge stigma on those that are overweight or obese, I am overweight. Whether its in the media or the playground its not cool to be fat. I will also acknowledge you can be fat or overweight and be healthy, but it is often the best indicator of illness.

      It is obvious that in our medical system that is in the western world, obese people cost more to treat. In turn they cost the rest of society more money. Obese patients require more special treatment, for example the increased costs of treating infertility among obese women.

      Those 5 – 6 per cent of NZ’rs who are obese cost more to the system its as simple as that. Those 5-6 per cent group are going to get larger as time progresses. In a market driven health system which is what we have that is a concern. You cannot just ignore that. You may want to believe obesity is not a big problem, fine. But don’t lie to yourself about the costs.

  15. Maia 15
    12 March 2009 at 1:16 am

    If anyone wants to read what the study actually said you can find it here. I’ve responded on my blog

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