Researchers on the study did employee interviews in 2002 and 2003 in four states--California, Massachusetts, Pennsylvania and Texas.

The study found that when workers chose their provider, costs were generally higher, perceived recovery of health outcomes were not better, and return-to-work outcomes were often poorer than when employers chose the provider. However, workers reported much higher satisfaction with care.

According to the report, this finding suggests that employers, on average, may be well-positioned to select good quality, lower-cost providers--or at least better positioned than many workers.

The report also suggests that employers, in practice, were not generally selecting inferior-quality providers==although there may be exceptions, they were not frequent enough to affect overall results.

A pre-existing relationship with a provider, the study said, may be very important. When workers selected providers who had treated them previously, costs and worker outcomes were not dramatically different from when employers selected the providers. However, when workers selected new providers, costs were higher and return-to-work outcomes poorer.

According to the study, this evidence suggests that state laws that grant employers greater influence over the choice of provider may lead to lower costs and better return-to-work outcomes than laws that allow workers to select providers where they do not have a pre-existing relationship with a primary care provider.

When workers selected the providers--either prior or new--they expressed higher levels of satisfaction with overall medical care, researchers found.

According to the report, the higher level of satisfaction for workers who selected new providers was surprising, given that costs and return-to-work outcomes appeared to be worse.

After examining the data on satisfaction further, the report's authors speculate that the greater satisfaction may be related to empowerment, trust in the employee-selected provider, or the process of care that leaves workers more satisfied with the new-provider choices--but not likely to be related to better physical or economic outcomes.

The study observed that workers and their advocates believe that the choice of treating doctor or provider should be left to the worker to ensure they are treated by someone they trust and whose interests align with the workers' interests.

By contrast, the report found that employer advocates say the choice of provider should be made by the employer to ensure that incentives exist for keeping costs of care reasonable and appropriate.

While the study found evidence to support both sides of the argument, it concluded that it appears possible to improve the design of provider choice laws to lower costs and improve return-to-work outcomes without adversely affecting physical recovery from workplace injuries.

The report noted that from the late 1980s to the early 1990s--a period of rising workers' comp costs--a number of states modified "employee choice" laws to require that workers select providers from within approved networks of providers created by employers.

Recently enacted measures in California (Senate Bill 899) and Texas (House Bill 7) changed the rules regarding provider choice that, in part, allows employers to establish networks of physicians and gives them the sole right to decide which providers are in the network. Both states' statutes permit an exception when the worker has pre-designated his or her primary care provider.

The conclusions of this study regarding employee choice of new providers and prior providers are particularly salient for California, WCRI said.

According to the group, the results for California provide some evidence that the costs are higher and return-to-work outcomes were worse when workers selected providers with whom they have no prior relationship.

The study said this suggests that the recent legislative changes in California may have struck an appropriate balance by significantly expanding the limits on worker choice of provider, but retaining an exception where there is a pre-existing provider relationship.

WCRI is a nonpartisan, not-for-profit membership organization conducting public policy research on workers' comp, health care and disability issues.

The Public Policy Institute of California is a private, nonprofit organization "dedicated to improving public policy in California through independent, objective, nonpartisan research on major economic, social, and political issues."