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PubMed2004

The cost of eliminating the 24-month Medicare waiting period for Social Security disabled-worker beneficiaries.

OBJECTIVE: The objective of this study was to estimate the cost of eliminating the 24-month waiting period for Medicare entitlement for Social Security disabled-worker beneficiaries. There is concern that the waiting period could currently result in reduced access to health care. DATA: : The study linked Social Security and Medicare administrative records. METHODS: Social Security records were used to identify a 20% sample of disabled workers aged 61 or less and newly entitled to Social Security Disability Insurance (SSDI) in 1995 (n = 105,328). These records were linked to Medicare enrollment and claims data for 1997-2000. Cost prediction models were developed from the linked data to predict monthly Medicare costs. The prediction models were then used to estimate what Medicare costs would have been in the first 24 months of SSDI entitlement if the waiting period had been eliminated. RESULTS: Among the sample of new SSDI entitlees in 1995, 11.8% died during the waiting period, 2.1% recovered, and 86.1% became entitled to Medicare. For the first 24 months of SSDI entitlement, Medicare costs were predicted to be 10,055 US dollars per disabled worker in year 2000 dollars. Costs varied substantially by diagnostic group and whether the person died or recovered during the waiting period. CONCLUSIONS: Extrapolating from the study sample, predicted Medicare costs for the 24-month waiting period were 5.3 billion US dollars (inflation-adjusted to year 2000 dollars) for all disabled workers aged 61 or less and newly entitled to SSDI in 1995.

Adult↗
PubMed2000

[Work disability: malignant tumors as markers of noticeable risk in occupational groups].

A risk adequate premium development of private disability insurance requires a correct valuation of the disability probability. If the reasons for disability are known, especially the share of cancer, the development of damage within a job class can be anticipated. For this a relatively small collective is enough. The new findings should be substantiated as far as possible by further analysis and can be the basis for the evaluation of disability probabilities of job classes within the business in force.

Adult↗
PubMed2003

Tracking levels of psychiatric distress associated with the terrorist events of September 11, 2001: a review of the literature.

BACKGROUND: Early publicized predictions of an onslaught of psychiatric distress following the terrorist events of September 11, 2001, have not materialized, and it remains unlikely at present that the medical and insurance communities will experience a significant increase in psychiatric utilization rates secondary to September 11. A handful of research studies have begun to characterize the psychiatric impact of the events associated with the September 11 terrorist attacks. Information related to the manifestation of psychiatric distress following disasters is of particular interest to the scientific, clinical and disability insurance communities given the ongoing threat of further terrorist attacks. METHODS: A comprehensive literature search was completed to identify articles that address our current understanding of posttraumatic stress disorder (PTSD) and patterns of psychiatric distress that typically follow manmade disasters. To help in conveying such a conceptual framework, we integrated basic research relating to PTSD with epidemiological data relating to past disasters (e.g., the Oklahoma City bombing) and the events of September 11. RESULTS AND CONCLUSIONS: A critical analysis of the September 11 research literature is offered with suggestions for research that would strengthen our understanding of the manifestation of psychiatric distress associated with manmade disasters.

Humans↗
PubMed1995

Termination of employment.

The following questions and recommendations, taken from Jeffrey Hirsch & William Farrell's Labor and Employment in Rhode Island, provide a synopsis of the basic issues which employers should consider before making a decision to fire an employee: 1. Review all documentation and other company records considered when making the decision. Make sure all stated policies were followed by management. 2. Interview all managers who provided input on the decisions. 3. Be satisfied that the decision was made for the correct reason. 4. Was the employee aware that termination was likely? Can you document that awareness? 5. Was the individual given an opportunity to improve his or her performance? 6. Has the company discharged others for similar reasons in the past? 7. Has the company acted promptly and avoided relying on "stale" offense? 8. Is the employee protected by anti-discrimination statutes? (i.e. race, age, sex, national origin, handicapped or religion)? 9. Meet with the employee personally; do not discharge by phone or letter unless absolutely necessary. 10. Have a "passive" management witness at the meeting. 11. Conduct the meeting in a private area where other employees will not be able to see or hear the discussion. 12. Both the executive and management witness should prepare file memoranda concerning what is said at the discharge meeting. 13. Always tell the employee the reason for her or his discharge. 14. Discuss health insurance continuation (COBRA). 15. Discuss life and disability insurance, and pension/profit sharing status. 16. Discuss other issues, such as references and out placement policies. By taking the time to follow these suggestions and answer these questions, an employer can feel more secure that the termination has been conducted properly, and minimize the chances of becoming implicated in legal action related to the termination.

Employment↗
PubMed1994

Recent European trends in disability and related programs.

In most countries and especially in industrialized societies, social insurance disability programs and beneficiaries are often affected by external factors that can exert a profound impact over which there is little control. Among these factors are the effects that recessionary economies and aging populations can have on program financing as well as on application and award rates. Although these factors influence other social insurance programs too, this article particularly examines the impact on disability benefits and other related programs, such as health care and rehabilitation, in 5 European countries--France, Germany, the Netherlands, Sweden, and the United Kingdom--with information on the United States provided for comparative purposes.

Aged↗
PubMed2006

Employer-paid nonmedical costs for patients with diabetes and end-stage renal disease.

INTRODUCTION: Disease conditions such as end-stage renal disease (ESRD), which have severe consequences of disability and mortality, can generate substantial costs for large employers providing life insurance and disability insurance benefits. This study is the first to examine such disease-related nonmedical costs for employers and models the following employer-paid costs for ESRD in patients with diabetes: 1) life insurance benefits, 2) disability benefits, and 3) cost of replacing a worker. METHODS: We simulated a hypothetical cohort of 10,000 individuals with the age and sex distribution of a typical employee population in the United States. Data sources for the model parameters included the United States Renal Data System and proprietary life insurance and disability insurance claims databases. In addition, we used published information to identify the structures of typical employee benefits programs and annual salary information and to estimate the cost of replacing lost workers. RESULTS: The study estimated that employers may incur life insurance costs of 55,055 dollars per ESRD-related death, disability insurance costs of 31,671 dollars per ESRD-related disability, and worker replacement costs of 27,869 dollars per ESRD-related lost worker. Overall, the total monthly cost per employee with ESRD and diabetes was 5439 dollars. CONCLUSION: Our study finds that, other than the large direct medical costs documented in literature, ESRD onset also results in substantial nonmedical costs for employers. As employers continue to debate changes in the structure of future health plan benefits to reduce health care costs, they should consider potential indirect cost savings of providing affordable access to medical care that prevents or delays disability and mortality in their workers.

Diabetes Mellitus↗
PubMed1995

Affective responses to social comparison: a study among disabled individuals.

The present study examined the effects of social comparison among 112 individuals receiving payments under the Disablement Insurance Act. A part of a fictitious interview with another disabled person was presented to the subjects. This interview contained upward or downward social comparison information about either the problem severity or coping success of a target. In line with the predictions, the results indicated that upward comparison generated more positive affect than downward comparison only for subjects high in perceived control. Downward comparison generated more negative affect than upward comparison, regardless of perceived control. The nature of the comparison dimension (problem severity versus coping success) did not result in differences in positive or negative affect. Furthermore, subjects high in control identified more strongly with the upward target than with the downward target, especially when the comparison dimension was coping success. Some evidence was found that the effect of perceived control on the positive affective consequences of upward comparison was mediated by identification with the upward target.

Adaptation, Psychological↗
PubMed2006

Disparities in breast cancer treatment and survival for women with disabilities.

BACKGROUND: Breast-conserving surgery combined with axillary lymph node dissection and radiotherapy or mastectomy are definitive treatments for women with early-stage breast cancer. Little is known about breast cancer treatment for women with disabilities. OBJECTIVE: To compare initial treatment for early-stage breast cancer between women with and without disabilities and to examine the association of treatment differences and survival. DESIGN: Retrospective cohort study. SETTING: 11 Surveillance, Epidemiology, and End Results (SEER) Program tumor registries. PARTICIPANTS: 100,311 women who received a diagnosis of stage I to IIIA breast cancer at 21 to 64 years of age from 1988 to 1999. Women who qualified for Social Security Disability Insurance (SSDI) and Medicare at breast cancer diagnosis were considered disabled. MEASUREMENTS: Receipt of breast-conserving surgery versus mastectomy. For women who had breast-conserving surgery (n = 49 166), the authors examined receipt of radiotherapy and axillary lymph node dissection. Survival was measured from diagnosis until death or until 31 December 2001. RESULTS: Women with SSDI and Medicare coverage had lower rates of breast-conserving surgery than other women (43.2% vs. 49.2%; adjusted relative risk, 0.80 [95% CI, 0.76 to 0.84]). Among women who had breast-conserving surgery, women with SSDI and Medicare coverage were less likely than other women to receive radiotherapy (adjusted relative risk, 0.83 [CI, 0.77 to 0.90]) and axillary lymph node dissection (adjusted relative risk, 0.81 [CI, 0.74 to 0.90]). Women with SSDI and Medicare coverage had lower survival rates than those of other women in all-cause mortality (adjusted hazard ratio, 2.02 [CI, 1.88 to 2.16]) and breast cancer-specific mortality (adjusted hazard ratio, 1.31 [CI, 1.18 to 1.45]). Results were similar after adjustment for treatment differences. LIMITATIONS: Findings are limited to women who qualified for SSDI and Medicare. No data on adjuvant chemotherapy and hormonal therapy were available, and details about the underlying disability were lacking. CONCLUSIONS: Women with disabilities had higher breast cancer mortality rates and were less likely to undergo standard therapy after breast-conserving surgery than other women. Differences in treatment did not explain the differences in breast cancer mortality rates.

Adult↗
PubMed1997

Cost advantages of two-level anterior cervical fusion with rigid internal fixation for radiculopathy and degenerative disease.

BACKGROUND: Conventional anterior cervical discectomy with fusion is thought to require postoperative neck immobilization for the promotion of bony fusion. Rigid internal fixation with anterior cervical plates may decrease graft-related complications and provide immediate stability. This stability may obviate postoperative external immobilization. METHODS: This report reviews one surgeon's experience with the use of rigid internal fixation for two-level anterior cervical discectomy and fusion for radiculopathy to promote early mobilization without external bracing. It compares outcomes and costs with a similar population of patients treated with anterior cervical discectomy and fusion who did not undergo rigid internal fixation. We compared patients who underwent two-level allograft anterior cervical discectomy and fusion with or without rigid internal fixation between 1989 and 1994 performed by a single surgeon (FJP) to evaluate the cost advantages and outcome of each procedure. All patients had clinical evidence of cervical radiculopathy unresponsive to medical therapy with magnetic resonance imaging confirmation of the appropriate nerve root impingement. Thirty-nine patients underwent two-level Cloward allograft fusion using Synthes anterior cervical locking plates, 25 underwent identical fusion without plating. Follow-up was 6 months to 4 years (mean, 31 months). RESULTS: Twenty-three of 25 patients in the nonplated group and 36 of 39 patients in the plated group achieved excellent or good outcomes using the Odom criteria. There were six complications (two major and four minor) in each group. Patients who underwent plating returned to light activities (mean, 17 vs. 29 days), driving (28 vs. 57 days), and unrestricted work (66 vs. 136 days) sooner than non-plated patients (p < 0.05, paired t test). No patient with plates was given external immobilization. CONCLUSIONS: Two-level anterior cervical discectomy and fusion with anterior plating for radiculopathy is safe, effective, and seems to provide shorter convalescence compared with conventional anterior cervical discectomy and fusion. Patients returned to unrestricted work sooner, thus reducing short-term disability. Rigid internal fixation may provide cost advantages to patients and insurance disability providers. The authors conclude that the increased cost of treatment for rigid internal fixation is more than offset by the benefits of earlier mobilization.

Bone Plates↗
PubMed2002

Disability examinations: a look at the Social Security Disability Income System.

Disability income protection is an important part of a worker's safety net. U.S. workers who pay into Social Security are eligible for coverage under the federal government, and additional coverage is available in the free market. However, the costs to taxpayers and disability insurance policyholders are high, and a great deal of responsibility rests on the physician providing information on disability issues. A neutral attitude toward a patient requesting disability allows the physician to collect the facts regarding the patient's impairments. A history of the patient's work duties helps the examiner determine the basis for setting limitations or restrictions at work or home. The physician's knowledge base of treatment options assists in determining maximal medical improvement. Records released to the adjudicating body should contain a thorough history, pertinent physical findings, and a review of previous medical records, all of which are to be separated from the opinion of the examiner regarding specific limitations and restrictions. The physician should be aware of symptom magnification and depression as confounders to the patient's perception of disability.

Disability Evaluation↗
PubMed1987

Solution to the disability income problem.

The probability of a serious disability before age 65 is much greater than the probability of death, yet most dentists have done a better job of protecting themselves against the event less likely to occur. This article explores how much and what kind of disability insurance a dentist should own and discusses in depth the contractual provisions of quality disability income policies.

Adult↗
PubMed1991

Health insurance coverage among disabled Medicare enrollees.

In this article, we use the Survey of Income and Program Participation to identify patterns of non-Medicare insurance coverage among disabled Medicare enrollees. Compared with the aged, the disabled are less likely to have private insurance coverage and more likely to have Medicaid. Probit analysis of the determinants of private insurance for disabled Medicare enrollees shows that income, education, marital status, sex, and having an employed family member are positively related to the likelihood of having private health insurance, whereas age and the probability of Medicaid enrollment are negatively related to this likelihood.

Aged↗
PubMed1992

Actuarial status of the Social Security and Medicare programs.

The Boards of Trustees for the two Social Security and the two Medicare Trust Funds recently released their annual reports to Congress detailing the operations of the trust funds during 1991 and their projected financial status for future years. Based on the Trustees' best estimates, the reports show: The Federal Old-Age and Survivors Insurance (OASI) Trust Fund will be able to pay benefits for about 50 years. Congress will eventually need to take action to assure the long-range financing of the program. The Federal Disability Insurance (DI) Trust Fund will be able to pay benefits for only about 5 years and is not adequately financed. As a result, the Board is required to make a separate report to the Congress on the unfavorable financial condition of this trust fund. The Board urges that prompt legislative action be taken to improve the financial integrity of the trust fund, after a review of the disability program. The Federal Hospital Insurance (HI) Trust Fund will be able to pay benefits for only about 10 years and is severely out of financial balance in the long-range. The Trustees urge the Congress to take additional actions designed to control HI program costs either through specific program legislation or as a part of enacting comprehensive health care reform. The Federal Supplementary Medical Insurance (SMI) Trust Fund is financed on a year-by-year basis and, on this limited basis, is adequately financed. The Trustees urge the Congress to take additional actions designed to control SMI costs either through specific program legislation or as part of enacting more comprehensive health care reform.

Budgets↗
PubMed2006

Worklife after traumatic spinal cord injury.

OBJECTIVE: To develop predictive models to estimate worklife expectancy after spinal cord injury (SCI). DESIGN: Inception cohort study. SETTING: Model SCI Care Systems throughout the United States. PARTICIPANTS: 20,143 persons enrolled in the National Spinal Cord Injury Statistical Center database since 1973. INTERVENTION: Not applicable. MAIN OUTCOME MEASURE: Postinjury employment rates and worklife expectancy. RESULTS: Using logistic regression, we found a greater likelihood of being employed in any given year to be significantly associated with younger age, white race, higher education level, being married, having a nonviolent cause of injury, paraplegia, ASIA D injury, longer time postinjury, being employed at injury and during the previous postinjury year, higher general population employment rate, lower level of Social Security Disability Insurance benefits, and calendar years after the passage of the Americans with Disabilities Act. CONCLUSIONS: The likelihood of postinjury employment varies substantially among persons with SCI. Given favorable patient characteristics, worklife should be considerably higher than previous estimates.

Adult↗
PubMed2006

Managing depression-related occupational disability: a pragmatic approach.

OBJECTIVE: To identify the crucial issues that arise for psychiatrists and other physicians when dealing with occupational disability in their patients with depression and to suggest practical strategies for responding more effectively to the challenges of this aspect of patient functioning. METHOD: We identify fundamental concepts in the occupational disability domain and draw crucial distinctions. The wider context for occupational disability is articulated, involving the workplace environment and the disability insurance industry. Research with direct relevance to clinical decision making in this area is highlighted. We make pragmatic suggestions for effective management of occupational disability in patients with depression. RESULTS: To successfully manage issues of occupational disability, psychiatrists and other physicians must understand the distinction between impairment and disability. To make this decision fairly and accurately, the adjudicator requires particular types of information from the physician, with requirements varying across short-term or long-term disability claims; failing to provide relevant information may cause substantial stress or financial harm to the patient. Balanced and collaborative decision making regarding whether and for how long to take work absence will greatly help to maintain occupational function in the long-term. Realistic expectations and support of the patient's sense of personal competence foster recovery of occupational function. CONCLUSION: Management of depression-related disability is challenging. Thoughtful evaluation of the patient's functional status, careful response to the requirements of disability determination, and a focus on functional recovery yield substantial benefits.

Canada↗