Purpose This study investigates the impact of an intensive case management program on sick leave days, permanent work incapacity levels and treatment costs for severe vocational injuries set up by the French National Insurance Fund in five health insurance districts. Methods The method employed relies on a four-step matching procedure combining Coarsened Exact Matching and Propensity Score Matching, based on an original administrative dataset. Average Treatment effects on the Treated were estimated using a parametric model with a large set of covariates. Results After one-year follow-up, workers in the treatment group had higher sickness absence rates, with 22 extra days, and the program led to 2.7 (95% CI 2.3–3.1) times more diagnoses of permanent work incapacity in the treatment group. With an estimated yearly operational cost of 2,722 € per treated worker, the average total extra treatment cost was 4,569 € for treated workers, which corresponds to a cost increase of 29.2% for the insurance fund. Conclusions The higher costs found for the treatment group are mainly due to longer sick leave duration for the moderate severity group, implying higher cash transfers in the form of one-off indemnities. Even though workers in the treated group have more diagnoses of permanent work incapacity, the difference of severity between groups is small. Our results on longer sick leave duration are partly to be explained by interactions between the case managers and the occupational physicians that encouraged patients to stay longer off-work for better recovery, despite the higher costs that this represented for the insurance fund and the well-documented adverse side effects of longer periods off-work.

目的本研究调查了法国国家保险基金在五个健康保险区设立的强化病例管理计划对病假天数、永久丧失工作能力水平和严重职业伤害治疗费用的影响。方法所采用的方法依赖于基于原始管理数据集的四步匹配程序，结合粗略精确匹配和倾向得分匹配。使用具有大量协变量的参数模型来估计对治疗者的平均治疗效果。结果一年随访后，治疗组工人因病缺勤率更高，多出 22 天，并且该计划导致治疗组永久性丧失工作能力的诊断数增加了 2.7 倍（95% CI 2.3–3.1） 。预计每位接受治疗的工人每年的运营成本为 2,722 欧元，接受治疗的工人平均额外治疗总成本为 4,569 欧元，相当于保险基金的成本增加了 29.2%。结论治疗组的费用较高主要是由于中等严重程度组的病假时间较长，这意味着一次性赔偿形式的现金转移较多。尽管治疗组中的工人被诊断出更多的永久性丧失工作能力，但各组之间的严重程度差异很小。我们关于更长病假时间的结果在一定程度上可以通过案例管理者和职业医生之间的互动来解释，这种互动鼓励患者延长休假时间以实现更好的康复，尽管这会给保险基金和福利带来更高的成本。记录了较长时间下班的不利副作用。