Coverage Gaps and Cost-Shifting for Work-Related Injury and Illness: Who Bears the Financial Burden?

Med Care Res Rev. 2020 Jun;77(3):223-235. doi: 10.1177/1077558719845726. Epub 2019 Apr 25.


The heavy economic burden of work-related injury/illness falls not only on employers and workers' compensation systems, but increasingly on health care systems, health and disability insurance, social safety net programs, and workers and their families. We present a flow diagram illustrating mechanisms responsible for the financial burden of occupational injury/illness borne by social safety net programs and by workers and their families, due to cost-shifting and gaps in workers' compensation coverage. This flow diagram depicts various pathways leading to coverage gaps that may shift the burden of occupational injury/illness-related health care and disability costs ultimately to workers, particularly the most socioeconomically vulnerable. We describe existing research and important research gaps linked to specific pathways in the flow diagram. This flow diagram was developed to facilitate more detailed and comprehensive research into the financial burden imposed by work-related injury/illness, in order to focus policy efforts where improvement is most needed.

Keywords: cost-shifting; financial burden; occupational injury/illness; social safety net; work disability; workers’ compensation.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Delivery of Health Care
  • Disabled Persons / statistics & numerical data*
  • Humans
  • Insurance Coverage / organization & administration
  • Occupational Injuries / economics*
  • Workers' Compensation / economics*