This review assessed the effectiveness of prevention incentives for occupational health and safety using insurance and regulatory mechanisms. It found some evidence that specific deterrence through citations and penalties impacted upon reducing injury incidence and severity. While the authors' conclusions reflect the results of the review, it is uncertain whether they are reliable.

To assess the effectiveness of prevention incentives for occupational health and safety using insurance and regulatory mechanisms.

EconLit, MEDLINE, Sociological Abstracts, Wilson Social Science Abstracts, Ideas, Dissertation Abstracts International and the University of Toronto Library Catalogue were searched. Search terms were reported, but search dates were not. It was not clear whether there were any language restrictions on the search.

Quantitative studies investigating a relevant insurance or regulatory feature that employed multiple regression techniques were eligible for inclusion. Eligible studies used multiple regression techniques with a temporal element to the analysis.

The included studies were diverse. The main workers’ compensation features among included studies were the introduction of experience rating and degree of experience rating; the main occupational health and safety features included the introduction of regulations and the enforcement of regulations through inspections, citations and penalties.

Titles and abstracts were screened by one reviewer with periodic quality checks by a second. Full papers were independently screened by two reviewers, with disagreements resolved by consensus.

Quality assessment was undertaken through a two-part instrument developed by the authors. Part I focused on the overall study quality and contained six questions; part II measured validity and generalisability through two questions. A 5-point Likert scale was used for each question. Studies were categorised as high quality (70% or more), medium (50 to 69%) and low quality (below 50%) based on their average score.

Two reviewers conducted the validity assessment with disagreements resolved by consensus.

Data were independently extracted by two reviewers. Study details were blinded before extraction. Any disagreements were resolved by consensus.

The best-evidence synthesis approach was used which ranked the strength of evidence on the basis of the number, quality and consistency of studies on the topic. For each hypothesised relationship, the overall quantity and quality of evidence was ranked on a 5-level scale consisting of strong evidence, moderate evidence, limited evidence, no evidence and mixed evidence. Medium and high-quality studies were retained for the synthesis.

Workers' compensation regulations: For features related to workers’ compensation regulations, five studies (two high quality studies) dealt with the introduction of experience rating and five studies with the degree of experience rating. There was moderate evidence that the introduction of experience rating was associated with a reduction in the frequency of injuries. There was moderate evidence that the degree of experience rating was associated with a reduction in the frequency or severity of injuries.

Occupational health and safety regulation: For features related to occupational health and safety regulation, two studies reported on the introduction of regulation, 18 studies on the enforcement of regulation through inspections (eight high quality studies), and 16 studies on the enforcement of regulation through citations and penalties (five high quality studies). There was limited evidence that enforcement of regulation through inspections was associated with a reduction in the frequency or severity of injuries; five of the high-quality studies found evidence that previous inspections reduced current year injuries. Studies considering the enforcement of regulation through citations and penalties found mixed evidence that increased likelihood of being cited or penalised was associated with a reduction in the frequency or severity of injuries (two high-quality studies found a relationship, whereas nine medium-quality studies did not). There was strong evidence that actually being cited or penalised was associated with a reduction in injuries (based on findings in five high-quality studies and one medium-quality study).

Specific deterrence through citations and penalties had an impact upon reducing injury incidence and severity, whereas general deterrence was less effective.

The review question and inclusion criteria were clear but broad. The authors searched a number of relevant databases, including searching for unpublished studies. It was unclear whether any language restrictions were placed on the search. The study selection, data extraction and quality assessment were undertaken in duplicate to minimise error and bias throughout the process. An assessment of the methodological quality of the studies was undertaken; it was based upon an instrument developed by the authors in conjunction with external groups. The quality assessment findings were incorporated into the discussion of the results. The decision to adopt a narrative synthesis was appropriate, but no exploration of study heterogeneity was included in the synthesis. Given the vague inclusion criteria and lack of study details, it was uncertain what interventions were being used. While the authors' conclusions reflect the results of the review, it is uncertain whether they are reliable.

Practice: The authors did not state any implications for practice.

Research: The authors stated that future studies should include meaningful specifications of the nature of inspections, citations and other occupational health and safety features. Additionally, they should consider a fuller range of factors that impact upon injury outcomes and there is a need for a standardised set of reporting conventions for published studies.

Not stated.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.