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PubMed1998

Trends in disability duration and cost of workers' compensation low back pain claims (1988-1996).

Previously published epidemiologic studies of low back pain (LBP) have reported that the prevalence of low back disability has increased dramatically. These studies based their findings on either the number of disability claims filed, the disability duration, or both. This information was from countries other than the United States or from the US Social Security Disability Insurance data, with findings reported only to the early 1980s. More recent studies of US workers' compensation LBP claims reported a decrease in the incidence rate from the late 1980s to the mid-1990s. No studies have been found that report on the trends of disability duration for workers' compensation LBP claims. This study examined recent trends in the length of disability (LOD) for LBP claims and associated costs, using a large sample of claims from the privately insured US workers' compensation market. LOD and cost information were derived for injuries from 1988, 1990, 1992, 1994, and 1996. For each year, the distributions of LOD and cost were skewed, with the small percentage of claims that lasted more than one year (4.6%-8.8%, depending on the year) accounting for a large percentage of the total disability days (77.6%-90.1%) and cost (64.9%-84.7%). From 1988 to 1996, the average LOD decreased 60.9%, from 156 days to 61 days. The probability of being on disability for a long period of time has decreased over the years. Over the study period, the average cost of a claim decreased 41.4%, while the median cost increased 19.7%. The most influential change in the LOD and cost distributions was a reduction in expensive claims with a long disability duration. The evolution of LOD and cost is also detailed for different disability durations for the study period.

Cost of Illness↗
PubMed1988

Workers' compensation: 1980-84 benchmark revisions.

The first workers' compensation program was introduced 80 years ago. Its purpose was to compensate occupationally injured workers and their families for lost wages and medical expenses from job-related injury, regardless of fault. Today, each of the State and Federal programs that provides coverage to more than 86 percent of the work force uses a combination of private insurance, State or Federal funds, and self-insurance to meet its benefit obligations. The workers' compensation program is of continuing interest to the Social Security Administration (SSA) for several reasons. Since 1965, Social Security Disability Insurance benefits have been subject to reduction if such benefits, when combined with those provided under workers' compensation laws, exceed 80 percent of the worker's earnings. Because the two programs have gaps in protection as well as duplication in coverage, a periodic review of the workers' compensation program is necessary. In addition, SSA administers Part B of the Black Lung program--established to provide income-maintenance protection to coal miners disabled by pneumoconiosis--to about 1 million beneficiaries whose claims were filed before July 1973. This article provides revised benchmark data on the workers' compensation programs and presents a review of program operations during the early 1980's.

Costs and Cost Analysis↗
PubMed1989

Displaced concern: the social context of the work-disability problem.

The Social Security disability insurance program benefits were reduced in the early 1980s, in the belief that income supports induced people to stop working. The action failed to stem the number of program participants from rising, as older men with activity limitations due to chronic disease continued to withdraw from the labor force. Attention paid in this and other instances to work disability derives from the problem's social context, displacing concerns about work loss itself and its effects on workers' lives. While slow growth in the economy as a whole may be a root cause of the problem, policies to address the nature and scope of work disability directly remain adrift.

Adolescent↗
PubMed1991

[Compensation claim forms in cases of occupational disability].

Confronted with the contents and questions of the Application Forms, presently in use for disability claims, it appears necessary to revise these forms in several details. Rulings by the Supreme Court to be considered and the existing great variety of definitions in the field of private and legal disability insurance--under the aspects of Social Law in general--call for a critical review, especially with regard to the details to be filled in by the police holder in support of his claim. The author is presenting 2 drafts of revised forms (Application Form for Disability Claims/Medical Report in the Case of Disability), which, in his opinion, should meet the requirements more effectively. On the other hand the author does not claim, that the presented drafts be the ultimate version.

Disability Evaluation↗
PubMed1995

Length of stay on the Supplemental Security Income Disability Program.

This article analyzes duration on the Supplemental Security Income (SSI) disability rolls prior to age 65 among children and working-age adults, based on a 10-year followup of 1974-82 cohorts of new awardees by utilizing monthly data from administrative records for 1974-92, and on statistical projections beyond the followup period. Although SSI means testing is responsible for a high proportion of early suspensions, when multiple spells are accounted for, long stays dominate. The estimated mean length of all first SSI spells is 5.5 years. It is 11.3 years for disabled children, 1.3 years for disabled adults eligible for both the Social Security Administration's Disability Insurance (DI) and SSI, and 6.4 years for adults eligible for SSI only. When multiple spells are accounted for, the projected mean total preretirement-age SSI disability stay almost doubles to 10.5 years for all awardees and increases to 26.7 years for children.

Adolescent↗
PubMed1993

A comparison of the recovery termination rates of disabled-worker beneficiaries entitled in 1972 and 1985.

This article reports on the final phase of a longitudinal analysis of two cohorts of Disability Insurance (DI) beneficiaries. The analysis shows that changes in DI program provisions and demographic shifts in the beneficiary population have considerably affected standard recovery termination rates. Several covariates were also found to affect the rates, particularly age and education. Overall, the 1985 cohort has a lower standard recovery termination tendency during the first few years of entitlement. After an attempt was made to define a recovery event for the 1985 cohort to make it comparable to the 1972 cohort, it was found that the termination rate for the 1985 cohort was still lower than the termination rate for the 1972 cohort. These findings suggest that there will be fewer recoveries for beneficiaries who entered the DI program in the late 1980's than for those who came on the rolls earlier.

Adolescent↗
PubMed1994

Disability trends in the United States: a national and regional perspective.

Between 1978 and 1993, the number of persons receiving disability benefits under either the Supplemental Security Income program or the Old-Age, Survivors, and Disability Insurance program increased more than 43 percent--from 4.7 million to 6.7 million. In 1993, 4.08 percent of the U.S. resident population aged 18-64 were receiving a disability benefit under one or both of the programs, compared with 3.37 percent in 1978. This ratio had declined to 2.93 percent in 1983. The article examines the change in growth since 1975 in each of the two disability programs and provides an overview of key legislative changes occurring during the period. The emphasis is on regional and State changes during the 1987-92 period, identifying those areas where growth has been the most dramatic.

Adolescent↗
PubMed1984

Workers' compensation: coverage, benefits, and costs, 1982.

Workers' compensation provides medical care and income maintenance protection to workers disabled from work-related injury or illness. This program is of considerable interest to the Social Security Administration (SSA) from several perspectives. For example, since 1965 Social Security Disability Insurance (DI) benefits and workers' compensation payments have been integrated. Information on the experience under workers' compensation provides a framework for examining questions concerning gaps and overlaps in the Nation's social insurance system. In addition, since December 1969 SSA has administered claims filed through 1973 under part B of the Black Lung program--the program providing income maintenance protection to coal miners disabled by pneumoconiosis. The workers' compensation experience reported here consists of information on benefits for work-related injury and disease, including data on the combined benefits paid under the entire Federal Black Lung program administered by the Labor Department and SSA.

Coal Mining↗
PubMed1999

Improving return-to-work strategies in the United States disability programs, with analysis of program practices in Germany and Sweden.

The General Accounting Office (GAO) has made recommendations for improving the disability programs by citing practices that have been successful in Germany, Sweden, and the private sector. This issue is important in the United States because the number of disability beneficiaries is growing rapidly, program costs are increasing proportionately, and few disability recipients are leaving the disability rolls to resume work activity. GAO points out that the estimated lifetime savings for removing an additional 1 percent of the disabled beneficiaries from the rolls of the Disability Insurance (DI) and the Supplemental Security Income (SSI) programs each year will ultimately reach $3.0 billion. GAO cites three specific practices as showing the most promise for returning the disabled to work. They are (1) intervening as soon as possible after a disabling event to promote and facilitate return to work, (2) identifying and providing necessary return-to-work assistance and managing cases to achieve return-to-work goals, and (3) structuring cash and health benefits to encourage people with disabilities to return to work. This article examines these suggestions to improve the rate of rehabilitation of disabled workers using research by experts on return-to-work practices in Germany, Sweden, and the United States. Experts caution that any consideration of borrowing practices from other countries needs to take into account the unique economic, social, and political elements in each country. Although other countries appear to be very successful in their rehabilitation programs, practices that are successful in one country may not necessarily work well in another. Countries have different definitions of disability and payment structures. The existence of temporary and partial awards in Germany and Sweden may ensure a number of easily rehabilitated individuals, while the U.S. vocational rehabilitation (VR) agencies have been mandated to focus on only the most severely disabled individuals. Public expenditures for vocational rehabilitation, work for the disabled, and disability benefits are much higher as a percentage of gross domestic product in Germany and Sweden than they are in the United States. Compared with the United States, Germany spent twice as much for VR, and Sweden spent 2.6 times more. Impediments to GAO's suggestions include divergent goals of the Social Security program and VR agencies, lack of availability of VR services, the timing of VR referral (which is significantly later than the onset of the disability), and little incentive for return to work built into the payment structure. The Work Incentives Improvement Act of 1999 is currently being considered by a Congressional conference committee. The bill would establish a Ticket to Work and Self-Sufficiency program and would require or authorize the Social Security Administration to demonstrate and evaluate different ways of encouraging return to work. In designing these demonstrations, early intervention after a potentially disabling illness or injury is an approach that merits serious attention.

Persons with Disabilities↗
PubMed1996

Job patterns of disabled beneficiaries.

This article presents basic findings about the job patterns of disabled-worker beneficiaries covered under the Social Security Administration Disability Insurance (DI) program as reported in the New Beneficiary Follow-up survey. Beneficiaries are asked retrospective questions about labor-force participation from the time of their first entitlement to disability benefits to the time of the interview. Twelve percent of those persons who enter the DI program as nonworking beneficiaries start a job during their entitlement to benefits. The mean time to the start of the job was 3.4 years. Of those who start a job, 50 percent end the job before the end of their entitlement. Most of these persons leave the job for health-related reasons and, for most of them, the employer does not play a major role in their decision to stop working. For those who end the first job and are employed in subsequent jobs, the percentage who recover while still in the job decreases as the number of jobs increases.

Persons with Disabilities↗
PubMed1981

[Work disability as a form of early retirement].

This article explores to what extent a disability-insurance-law for employees in the Netherlands (the WAO) functions as an early-retirement-program. It is shown that there are strong positive correlations between age and the chance to quality for disability-benefits on the one hand and age and the duration of the disability on the other hand. This results in reduced participation-rates among older age-groups in the laborforce. This is one of the reasons why the pensionable age fixed by law at sixty-five does not lead to a clear-cut rift in these participation-rates at this pensionable age.

Aged↗
PubMed1982

Actual costs of the Social Security system over the years compared with 1935 estimates.

It is believed by many that the cost of the Social Security program currently is considerably higher than it had been estimated that it would be when the program was enacted in 1935. The analysis in this article indicates that the cost of the Old-Age and Survivors Insurance program in 1980, when expressed as a percentage of taxable payroll, was almost exactly the same as it was estimated initially to be then. Such cost, however, does not include the Disability Insurance and Hospital Insurance programs and, moreover, is estimated to increase by about 50 percent over the next 50 years, whereas the initial estimates showed no cost increases after 1980.

Costs and Cost Analysis↗
PubMed2001

Health and federal budgetary effects of increasing access to antiretroviral medications for HIV by expanding Medicaid.

UNLABELLED: OBJECTIVES. This study modeled the health and federal fiscal effects of expanding Medicaid for HIV-infected people to improve access to highly active antiretroviral therapy. METHODS: A disease state model of the US HIV epidemic, with and without Medicaid expansion, was used. Eligibility required a CD4 cell count less than 500/mm3 or viral load greater than 10,000, absent or inadequate medication insurance, and annual income less than $10,000. Two benefits were modeled, "full" and "limited" (medications, outpatient care). Federal spending for Medicaid, Medicare, AIDS Drug Assistance Program, Supplemental Security Income, and Social Security Disability Insurance were assessed. RESULTS: An estimated 38,000 individuals would enroll in a Medicaid HIV expansion. Over 5 years, expansion would prevent an estimated 13,000 AIDS diagnoses and 2600 deaths and add 5,816 years of life. Net federal costs for all programs are $739 million (full benefits) and $480 million (limited benefits); for Medicaid alone, the costs are $1.43 and $1.17 billion, respectively. Results were sensitive to awareness of serostatus, highly active antiretroviral therapy cost, and participation rate. Strategies for federal cost neutrality include Medicaid HIV drug price reductions as low as 9% and private insurance buy-ins. CONCLUSIONS: Expansion of the Medicaid eligibility to increase access to antiretroviral therapy would have substantial health benefits at affordable costs.

Acquired Immunodeficiency Syndrome↗
PubMed1993

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 1992 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 is projected to be able to pay benefits for about 50 years. Congress will eventually need to take action to assure the long-range financial soundness of the program. The Federal Disability Insurance (DI) Trust Fund is projected to be exhausted in about 2 years. As a result, the Board urges that prompt legislative action be taken to improve the financial integrity of this trust fund by reallocating to the DI fund a larger share of the overall OASDI tax rate. The Federal Hospital Insurance (HI) Trust Fund is projected to be able to pay benefits for only about 6 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 through specific program legislation and 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 is adequately financed. The Trustees urge the Congress to take additional actions designed to control SMI costs through specific program legislation and as a part of enacting comprehensive health care reform.

Actuarial Analysis↗
PubMed1988

Compensation status and symptoms reported by patients with chronic pain.

This study examined the initial symptoms of patients with chronic pain who were (n = 70) or were not (n = 52) involved in some aspect of the compensation system--worker's compensation, litigation, or Social Security Disability Insurance. Analyses indicated that compensation patients were discriminable from noncompensation patients (p less than 0.0001). Compensation patients were younger and less likely to be female; they also tended to report fewer surgeries, shorter pain durations, and more vocational and sexual disability. Finally, they perceived their medical conditions to be more severe than had been diagnosed by physicians. The groups did not seem to differ in severity of pain or psychologic distress. These data are consistent with studies indicating that compensation patients are not "symptom magnifiers," although the data do indicate that the life disruptions reported by these patients may be greater than those reported by patients not involved in compensation systems.

Adult↗
PubMed2006

[Permanent disability and the insurance estimation process].

INTRODUCTION: The casualties are indemnified according to two processes. First by transaction on rate proposition of insurance physicians, and the second process on rate proposition by a medical expert assigned by law-court. Indemnification scale failure justifies the Interafrican Conference of insurance Markets code adoption. MATERIAL AND METHOD: Six insurance societies and the Automotive Guarantee Fund were debtors. Only 627 victims had been indemnified between 1986 and 2003. Expert valuations done at forensic medicine service were the support of the investigation. Inquired parameters were insurance societies, regulation type, aftermaths and the retained prejudices. The data collected on computer card have been analyzed by software Epi Info. RESULTS: The partial permanent inabilities fixed since its adoption differ to inabilities fixed before this adoption. Transaction process concerned 567 victims (90.4%). Sixty victims were indemnified by judicial way. According to process type, the rates fixed in judicial process were 61.6% middle permanent partial inabilities. After 1997, there have observed a decrease in the high and middle permanent partial inabilities in the two processes. The appreciation of the pretium doloris is more subjective but must repair the aftermaths. The middle pretium was majority in the two processes, before and after 1997 with a high decrease of the middle pretium in the transaction process (-15.07) and a small pretium increase of 10.98 points. CONCLUSION: A common scale code has decreased the judicial litigation concerning casualties in spite of scales' limits. Only the patients with important aftermaths arrive in the judicial process since 1997.

Disability Evaluation↗
PubMed1989

Lack of correlation between the Steinbrocker staging of hand radiographs and the functional health status of individuals with rheumatoid arthritis.

We evaluated the correlation between destructive changes seen on hand radiographs and disability in 54 patients with definite or classic rheumatoid arthritis. No statistically significant correlation was found between radiographic findings and patient disability as determined by patient and physician assessment or by the patient's score on the Arthritis Impact Measurement Scales questionnaire. These findings call into question the appropriateness of using hand radiographs as a determinant of disability or as a criterion for disability insurance benefits.

Adolescent↗