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Decision support system for social occupational injury insurance institutions: cost analysis and targeted resource allocation

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Abstract

Occupational injuries are a great burden on health care costs worldwide as they do not only cause costs directly related to the accident but also enormous long-term follow-up costs for individuals, insurance companies, employers, and the economy. We develop a detailed decision support system called “Cost Calculation Tool” for the main Austrian social occupational insurance institution (AUVA) that investigates total direct and main indirect costs of individual injury claims from the time of the incident for all injured individuals up to their death. We discuss policy implications for the occupational injury data of the year 2010. In the first two years after the accident registration, treatment costs account for about 66 %, pension costs for about 12 %, and co-payments for sick leave for about 10 % of the total AUVA costs (117.85 million Euro). An example of an underlying costly case is a middle-aged male who had a traffic-related accident at work and injured his back with lifelong costs of about 4.8 million Euro (pensions, treatment, rehabilitation, prostheses, transportation). However, pension costs are the main cost driver with nearly 50 % of total AUVA costs under a lifelong cost-perspective, while treatment costs only account for less than 15 %. In addition to these total AUVA costs, we also approximate main costs for the employers and the economy. All present and future costs predicted by the “Cost Calculation Tool” are included in the data warehouse of the AUVA and help clustering patients into risk groups according to criteria that most influence related total costs. AUVA decision makers can now optimally target prevention strategies and better plan for prevention budgets. Based on these insights and earlier research projects, the AUVA highly focuses its prevention strategies on injuries on the road to/from/at workplace, accidents at construction sites, as well as accidents in forestry and agriculture.

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Acknowledgments

This work was financed by the AUVA. We are especially grateful to the most valuable support provided by the department of prevention and occupational illness (head: DI Klaus Wittig), department of statistics (head: MBA Beate Mayer), department of informatics (head: MBA Alessandro Silvestri), and department of finance (head: MBA Guenter Poetz). Furthermore, the departments of coordination and law, of rehabilitation, and of human resources greatly supported us during the project. Thanks are also due to DI Philipp Neuner who helped adopting the “Excel Tool” and programming the interfaces, databases, and several pre-calculation procedures of the “Cost Calculation Tool” which he also partly parallelized to enhance performance. We are indebted to MBA Rainer Steinbauer for his valuable contribution to the external data gathering process. Finally, we are thankful to Associate Professor Dr. Bernhard Schwarz from the Medical University of Vienna for his guidance regarding the replacement rules of prostheses and medical devices which were then further improved by Dr. Michael Janotka and his colleagues at the AUVA.

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Authors and Affiliations

  1. Department of Innovation and Technology Management, University of Vienna, Oskar-Morgenstern-Platz 1, 1090 , Vienna, Austria

    Marion S. Rauner

  2. Department of External Accounting, University of Vienna, Oskar-Morgenstern-Platz 1, 1090 , Vienna, Austria

    Michaela M. Schaffhauser-Linzatti

  3. Vienna, Austria

    Johannes Bauerstaetter

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  1. Marion S. Rauner
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  2. Michaela M. Schaffhauser-Linzatti
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  3. Johannes Bauerstaetter
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Correspondence to Marion S. Rauner.

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Rauner, M.S., Schaffhauser-Linzatti, M.M. & Bauerstaetter, J. Decision support system for social occupational injury insurance institutions: cost analysis and targeted resource allocation. Cent Eur J Oper Res 23, 1–29 (2015). https://doi.org/10.1007/s10100-013-0323-6

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