Who pays for agricultural injury care?

Most states do not require worker compensation coverage for farms with small workforces, so the cost of injury-related care in agriculture, a high-risk industry, is likely to be borne by payers other than the employer. To characterize payment and cost for farm-related injuries in a state with a large rural population, we analyzed data from the state's hospital discharge database (HDD) and compared it with actual payment sources and amounts in a subset of patients hospitalized at an academic health center (AHC). We identified 295 hospitalizations with e-codes indicating the cause as agricultural injury, but the database did not include information to support patient occupational identification. Worker compensation covered only one in 20 of the hospitalized patients. “Self-pay” (usually uninsured) and Medicaid-funded patients were twice as common in the AHC group than in the HDD as a whole, while commercial health insurance covered nearly half (47.1%) of the HDD patients and 30.2% of the AHC patients. We estimated actual mean hospital and physician costs of $12,056 per hospitalization, yielding a total cost of $3.5 million, only 5% of which was borne by worker compensation coverage. Notably, 16.3% of hospitalizations statewide were unreimbursed or covered by Medicaid, suggesting a substantial cost-shift to public funding sources. The distinction between work-related injuries and those incurred outside the workplace is particularly problematic in agriculture and points to the need for comprehensive health coverage. However, health insurance coverage for work-related injuries should include employer and worker incentives for safe farming practices.