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PubMed1989

Long-term vocational adjustment of cancer patients diagnosed during adolescence.

Long-term vocational achievements of 40 survivors of cancer diagnosed during adolescence were examined and compared with 40 healthy sex-matched and age-matched controls. Patients' ages at diagnosis ranged from 13 to 19 years (mean, 16.15). Study subjects had survived cancer for over 5 years and were on no cancer therapy. Assessment measures included the Rand General Well-Being Scale, the Rand Functional Limitations and Physical Abilities Batteries, and a semistructured interview. The relation of physical disability and limitations caused by cancer to patients' achievements also was evaluated. Although cancer patients, on the average, were more concerned about their health and reported lower general spirits than controls, no differences were found between control and study groups with regard to overall general well-being. More cancer patients than controls reported that their health limited their ability to engage in vigorous activities. A greater functional deficit was found among unemployed than employed cancer patients. Employers and co-workers often were aware of the patient's diagnosis (85% and 67%, respectively). Cancer patients reported disease-related discrimination in hiring (7.4%), induction into the military (66.7%), and obtaining health, life, and disability insurance (31.5%). There was no significant relationship between health status and employment. Nevertheless, cancer patients had a higher average income than controls. Sixty-four percent of patients believed that changes in certain physical features of the workplace were necessary to facilitate readjustment to the job. Despite the disabilities experienced by cancer patients and generally negative public attitudes, long-term survivors have a good outlook on life and are competitive members of the workplace and society.

Adolescent↗
PubMedDate not supplied

Genetic testing for Alzheimer's disease and its impact on insurance purchasing behavior.

New genetic tests for adult-onset diseases raise concerns about possible adverse selection in insurance markets. To test for this behavior, we followed 148 cognitively normal people participating in a randomized clinical trial of genetic testing for Alzheimer's disease for one year after risk assessment and Apolipoprotein E (APOE) genotype disclosure. Although no significant differences were found in health, life, or disability insurance purchases, those who tested positive were 5.76 times more likely to have altered their long-term care insurance than those who did not receive APOE genotype disclosure. If genetic testing for Alzheimer's risk assessment becomes common, it could trigger adverse selection in long-term care insurance.

Alzheimer Disease↗
PubMedDate not supplied

A new Medicaid program.

This paper suggests a new federal-state partnership--a new Medicaid program--for coverage of the uninsured and long-term care. It discusses national eligibility standards, based on financial need (rather than categorical eligibility); buy-ins and reinsurance for high-risk populations; a national strategy of "Medicaid plus tax credits" to cover the uninsured; Medicaid long-term care with expanded eligibility, better financial protection, and home and community-based care benefits; quality initiatives; administration; and possible financing sources (such as estate taxes and an increased Social Security Disability Insurance wage base). Without a new mission and national standards, Medicaid will continue to grow in a patchwork fashion with huge gaps and inequities.

Cooperative Behavior↗
PubMed2001

Dually eligible individuals with AIDS: characteristics and health services use.

This paper explores the prevalence and health care utilization of dually eligible Medicare and Medicaid participants among New Jersey Medicaid recipients with AIDS using linked administrative data. Merged Medicaid claims and AIDS surveillance data were used to analyze participation in the Medicare program by Medicaid recipients in New Jersey diagnosed with AIDS who received services between January 1988 and March 1996. We found that nearly 30% of Medicaid participants had Medicare claims during the observation period, suggesting that Medicare is becoming an important payer of HIV care among individuals eligible for Medicaid. Traditionally disadvantaged groups such as women and racial minorities were less likely to be dually eligible for Medicare, reflecting differences in survival and in eligibility requirements for Social Security Disability Insurance (SSDI). Controlling for other characteristics, dually eligible individuals had shorter lengths of stay and had lower charges per inpatient stay than Medicaid only enrollees. Dual eligibles were also more likely to use antiretroviral (ARV) drugs and were more consistent users of ARV treatment measured by the proportion of time on ARV therapy. Our study suggests that persons with AIDS who may qualify for Medicare because of their disability are different than individuals who only received Medicaid reimbursed services in terms of their health care utilization. Further research is needed to determine the cause of such differences which may include socioeconomic differences between dual eligibles and Medicaid only eligibles, dissimilarities in health status between the two groups, and variation in aspects of insurance coverage particularly in the choice and reimbursement of office-based physicians.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Privacy Act of 1974; report of new system of records--SSA, HHS.

In accordance with the Privacy Act (5 U.S.C. 552a (e)(4], we are issuing public notice of our intent to establish a new system of records: the "Disability Insurance (DI) and Supplemental Security Income (SSI) Demonstration Projects and Experiments System, HHS/SSA/ ORSIP . 09-60-0218." The purpose of the proposed system is to maintain information which we will use to conduct demonstrations and experiments of approaches to encourage individuals receiving either DI benefits under title II of the Social Security Act (the Act) or SSI disability payments under title XVI of the Act to find gainful employment. We also are proposing to establish routine uses of information which will be maintained in the proposed system as discussed below. We invite public comments on this proposal.

Civil Rights↗
PubMed2003

What rehabilitation counselors should know to assist Social Security beneficiaries in becoming employed.

The 1999 Ticket to Work and Work Incentive Improvement Act (TTWWIIA) has opened new employment opportunities for vocational rehabilitation professionals. The legislation minimized longstanding disincentives in the return to work efforts of beneficiaries collecting Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). Although some of these key disincentives have been eliminated, rehabilitation counselors working with this population will find some interesting new challenges posed by this population. This article will outline the Social Security Administration's SSI/SSDI programs and process for applying; characteristics of beneficiaries; and information regarding the psychological and physiological aspects of beneficiaries with psychiatric disabilities and musculoskeletal disorders.

Counseling↗
PubMed1987

Medicare utilization by disabled-worker beneficiaries: a longitudinal analysis.

Medicare eligibility for Social Security disabled-worker beneficiaries begins after 2 years of cash benefit receipt. Extension of the current coverage is often proposed as a way to encourage beneficiaries to return to work. Little is known, however, about the long-run Medicare costs for the disabled and how costs vary by demographic and health characteristics. This article describes Medicare utilization and reimbursement amounts for 1974-81 for a cohort of disabled-worker beneficiaries under age 62 and first entitled to cash benefits in 1972. The data come from a first-time linkage of Disability Insurance program data with data on Medicare utilization. The tables provide a detailed look at several factors that are associated with variation in Medicare costs among beneficiaries and over time.

Persons with Disabilities↗
PubMed1992

Disability beneficiaries who work and their experience under program work incentives.

This research examines the return to work by Disability Insurance beneficiaries who were first entitled to benefits in 1980-81 and who were originally selected to be interviewed in the New Beneficiary Survey. To facilitate an examination of actual labor-force participation by beneficiaries, information on work and participation in program work incentives was collected from their claims folders. The analysis shows that approximately 10 percent of disability beneficiaries work during their initial period of benefit entitlement. About 80 percent are granted a trial work period, and over 70 percent of those granted trial work successfully complete it. More than half of them, however, were not successful in leaving the rolls through their work effort. In fact, benefit terminations due to work occurred for fewer than 3 percent of all beneficiaries in the cohort; approximately one-third of them had returned to the rolls by the end of the period under study. Beneficiaries most likely to make a work attempt were young and had a high level of education. Those with a high Social Security benefit amount were less likely to make a work attempt.

Adult↗
PubMed1987

Income of new disabled-worker beneficiaries and their families: findings from the New Beneficiary Survey.

In 1982, disabled workers who came on the social security disability insurance rolls from mid-1980 to mid-1981 had median monthly incomes of less than $500 if they were unmarried and less than $1,300 if they were married. These median monthly income levels, which include the income of a spouse and minor children if present, are roughly half those of the noninstitutionalized population aged 25-64. Social security benefits are the most important source of income for disabled workers and their families: They account for 40 percent of the total family income of married disabled workers and 65 percent of the total income of unmarried disabled workers. Social security benefits provide at least half of all income for more than 80 percent of unmarried disabled-worker beneficiaries and for 50 percent of the married beneficiaries. For married disabled-worker beneficiaries, earnings of the spouse are the second most important income source. Spousal earnings account for 28 percent of total income. Pensions and asset income each account for about 10 percent of total income for these married beneficiaries. Earnings are not an important source of income for unmarried disabled-worker beneficiaries for whom they amount to only about 3 percent of total income. Pensions, asset income, and public transfers each account for about 10 percent of total income of the unmarried beneficiaries.

Adult↗
PubMed2005

Factor structure of the pain disability index in workers compensation claimants with low back injuries.

OBJECTIVE: To examine the factor structure of a telephone-administered Pain Disability Index (PDI) and the effects of race and sex on the PDI. DESIGN: Computer-assisted telephone interviews of a cohort with occupational low back injuries. SETTING: General community. PARTICIPANTS: Missouri workers compensation claimants (N=1329) with low back injuries. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: PDI, levels of pain severity, Social Security Disability Insurance status, and the Fear-Avoidance Behavior Questionnaire. RESULTS: Results for the total sample and by race/sex group indicated support for a 2-factor model of the PDI corresponding to voluntary activities (eg, social, occupational, recreational) and obligatory activities (eg, activities of daily living, eating, sleeping). Additional psychometric analyses of the voluntary and obligatory subscales indicated adequate reliability and construct validity overall and in each of the race/sex groups. African Americans reported more pain-related disability on both subscales than whites. Women reported more disability on the voluntary subscale than men. CONCLUSIONS: The results support use of the PDI as a bidimensional measure of pain-related disability, with strong psychometric properties. They also support its administration by telephone.

Adolescent↗
PubMed1996

Trends in the characteristics of DI and SSI disability awardees and duration of program participation.

We analyze the effects of trends in the age and diagnostic mix of new disability awardee cohorts from 1975 through 1993 on expected duration on the Disability Insurance (DI) and Supplemental Security Income (SSI) rolls. The 1975-93 shift toward younger awardees is estimated to increase duration by 1.4 years for DI and about 5 years for SSI. Much of the increase in SSI duration is attributable to the recent influx of childhood awardees. For working age adults, the DI and SSI trends are comparable. We also estimate that about half of the 1975-93 increase in DI duration is explained by the increase in the proportion of younger DI-insured workers. During the 1993-2006 period, the effect of changes in the age mix of DI-insured workers will be reversed. This will moderate, but not eliminate, likely upward pressures on caseloads arising from the anticipated rise in incidence rates and the future effects of past increases in expected duration.

Adolescent↗
PubMed1981

Social Security Disability Amendments of 1980: legislative history and summary of provisions.

This article describes the legislative history of Public Law 96-265, the Social Security Disability Amendments of 1980, and contains a summary of the provisions of the new law. In passing these major disability insurance and supplemental security income provisions, the Congress hoped to improve the equity of the program, remove disincentives to rehabilitation and work, increase positive work incentives, and strengthen program administration. Other provisions were intended to strengthen and improve the administration of both the aid to families with dependent children and the child support enforcement programs.

Persons with Disabilities↗
PubMed1984

Economics and extended longevity: a case study.

Preventive and therapeutic advances have brought life expectancy in the United States to well over 70 years and have shifted mortality causes from acute to chronic diseases, the determinants of which are genetics, lifestyle, the environment, and aging itself. Plausible approaches to chronic disease prevention are likely to increase longevity further, with some foreseeable effects on demographic and economic projections. Primarily, longevity advances would swell forecasts of population size, and would thus have to be met by production advances in order to maintain or improve living standards. This study, a restricted example, considers the probable demographic and economic consequences of a limited prevention program in the context of the Ford Motor Company, based on actual experience and certain expectations up to the year 2000. According to the results, prevention would reduce outlays for life insurance, disability, and health care, but would also generate the higher costs of extending pension plans. Undoubtedly, prevention will continue to be highly ranked in society's pursuit of happiness, and society must prepare to meet its effects with appropriate social and economic policies.

Aged↗
PubMed1999

Health services research in workers' compensation medical care: policy issues and research opportunities.

OBJECTIVE: To describe some of the unique aspects of medical care offered under workers' compensation insurance systems and discuss the major policy considerations relevant to health services researchers undertaking investigations in this area. BACKGROUND AND FINDINGS: State-based workers' compensation (WC) insurance systems requiring employers to pay for medical care and wage replacement for workplace injuries and illnesses were first developed between 1910 and 1920 in the United States. Employers are generally required to purchase state-regulated workers' compensation insurance that includes first-dollar payment for all medical and rehabilitative services and payment of lost wages to workers with work-related illness or injury. Injured workers have variable but usually limited latitude in choosing their health care provider. Employers and workers' compensation insurers have incentives for controlling both the cost of medical care and lost wages. CONCLUSION: The major policy issues in WC medical care--the effect of patient choice of provider and delivery system structure, the ensuring of high-quality care, the effect of integrating benefits, and investigation of the interrelationships between work, health, and productivity--can be informed by current studies in health services research and by targeted future studies of workers' compensation populations. These studies must consider the extent of patient choice of physician, the regulatory environment, the unique role of the workplace as a risk and modifying factor, and the complex interaction between health and disability insurance benefits.

Health Benefit Plans, Employee↗
PubMed1994

Design of the Project NetWork return-to-work experiment for persons with disabilities.

As the Nation's first rigorous large-scale evaluation of vocational rehabilitation (VR) assistance to persons with severe disabilities, the Project NetWork demonstration will provide a wide range of information to policy-makers, researchers, and other interest groups. The evaluation of Project NetWork addresses two key policy questions: Is it feasible to increase participation in VR services among Disability Insurance (DI) beneficiaries and Supplemental Security Income (SSI) applicants/recipients through a combination of intensive outreach, case management, and enhanced work incentives? Do the interventions tested produce net benefits from the perspective of participants, society, the DI Trust Fund, and the Federal Government, as a whole? The study utilizes a randomized field experiment design to evaluate the net impact of the demonstration on participant employment, earnings, receipt of transfer benefits, social and psychological well-being, and other variables of interest to policymakers. A combination of SSA administrative data, information from the demonstration's onsite management information system (MIS), and in-person interviews (containing a rich array of information on disability, health, and attitudes) supports the evaluation. This article summarizes three aspects of the evaluation: Its experimental and sample design; the methods and data to be used to analyze project benefits, costs, and participation; and the challenges faced during demonstration implementation. It also presents preliminary data on the characteristics of Project NetWork participants and eligibles.

Adult↗
PubMed1998

[Evaluation of disability pensions by a medical polyclinic: 1990-1995].

The question if and in what manner changes of the labour market, in first line increasing unemployment, may influence the composition of the collective demanding a disability pension on one hand and the diagnoses relevant for assessment of requests on the other hand have been investigated as well as possible influences on the criteria for assessments. To this end all expert reports elaborated by the Medical Outpatient Clinic of the University Hospital of Zürich and submitted to the disability insurance between 1990 and 1995 have been evaluated retrospectively. The results show that the fraction of men remained stable around 70% over the whole observation period. The number of persons employed in auxiliary functions remained also constantly high. Over the whole period of observation there was a high, growing percentage of foreign applicants. The most marked change during the observation period was a significant increase of unemployment in the collective. This increase particularly affected applicants with higher ranking jobs or persons over 50. Foreigners became an important part of the unemployed applicants. Rheumatoid disorders and "back pain" in particular were of increasing importance among the relevant diagnoses for assessment of disability. There was a significant decline in the extent of invalidity acknowledged in marked contrast to our initial expectation that the strictness of the applied criteria would weaken when confronted with an increasing number of applications.

Adult↗
PubMed2006

Predicting employment outcomes of rehabilitation clients with orthopedic disabilities: a CHAID analysis.

PURPOSE: To examine demographic and service factors affecting employment outcomes of people with orthopedic disabilities in public vocational rehabilitation programs in the United States. METHOD: The sample included 74,861 persons (55% men and 45% women) with disabilities involving the limbs or spinal column who were closed either as rehabilitated or not rehabilitated by their state-run vocational rehabilitation agencies in the fiscal year 2001. Mean age of participants was 41.4 years (SD = 11.2). The dependent variable is employment outcomes. The predictor variables include a set of personal history variables and rehabilitation service variables. RESULTS: The chi-squared automatic interaction detector (CHAID) analysis indicated that job placement services significantly enhanced competitive employment outcomes but were significantly underutilized (only 25% of the clients received this service). Physical restoration and assistive technology services along with support services such as counseling also contributed to positive employment outcomes. Importantly, clients who received general assistance, supplementary security income, and/or social security disability insurance benefits had a significant lower competitive employment rates (45%) than clients without such work disincentives (60%). CONCLUSION: The data mining approach (i.e., CHAID analysis) provided detailed information and insight about interactions among demographic variables, service patterns, and competitive employment rates through the segmentation of the sample into mutually exclusive homogeneous subgroups.

Adult↗
PubMed1986

Criteria for screening workers for the establishment of disability.

Disability determination in the US is traditionally based on the classical medical disease-illness paradigm: if one defines the quantity of disease (pathoanatomical abnormality), one can predict the magnitude of illness (symptoms), including how the illness will operate in the workplace. This inference underlies the Handbook of Social Security Disability Insurance (SSDI) and the early attempts at "schedules" in workers' compensation. The reliability and validity of this inference, however, leave much to be desired. The alternatives currently used include the "expert opinion," even when based on direct examination, which is heavily used in both programs. The opinion of the worker's personal physician is relied upon only before the administrative law judge in the SSDI program. These administrative alternatives color the doctor-patient relationship and the worker's perceptions of his illness.

Disability Evaluation↗