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PubMed2005

Back to work: vocational issues and strategies for Canadians living with HIV/AIDS.

Much has been written since the first appearance of HIV/AIDS in 1981 about its effects on the Canadian health care and social services systems. However, researchers have given limited attention to issues of entry or re-entry to the competitive job market for HIV positive individuals. The emergence of highly active antiretroviral therapies (HAART) has allowed a significant number of persons who are HIV positive to experience a major recovery in health and energy. This increase in physical health has in turn led to a re-examination of the possibility of returning to former types and levels of activity, including the prospect of going back to work or entering the competitive workforce for the first time. The purpose of this paper is to outline some of the issues and concerns that impact HIV positive individuals' attempts to return to or enter the competitive workforce, particularly those relating to disability policies and public insurance. Data from in-depth interviews with a sample of people living with HIV/AIDS (PHAs) are used to help illustrate the disconnect between these policies and the lived experiences of PHAs. Also discussed are the opportunities for Canadian policies and practices to employ a functional definition of disability and a philosophy of early intervention in vocational rehabilitation.

Adult↗
PubMed2002

The impact of private long-term care insurance on claimants: formal and informal care in the community.

Policy makers show continuing interest in the potential for long-term care (LTC) insurance to save public money by reducing pressure on the Medicare and Medicaid programs. Although the purchase of LTC insurance is being encouraged by government - through tax incentives and the offering of private LTC insurance as an option for public employees - little is known about how benefits are used, whether those claiming benefits feel they are getting good value for their money, and whether the patterns of formal (paid) and informal (unpaid) service use differ for insurance claimants compared to similarly disabled persons without private LTC insurance. This brief provides information on older people claiming LTC insurance benefits and compares their experiences to those of non-privately insured older people who need LTC. We conclude that LTC insurance is an important source of support for those who lack informal support from family and friends. However, LTC insurance remains a complex product; claimants need help in using their benefits to obtain the appropriate level and quality of care and in understanding at the time of purchase how much protection they need.

Activities of Daily Living↗
PubMed2003

The changing world of ancillary benefits.

Amid salary and health care benefit cuts, ancillary benefits such as dental, life insurance, long-term disability and vision coverage can communicate employers' concern for their employees as well as serve as recruitment and retention tools. These benefits can be funded by the employer, the employee or both.

Dental Care↗
PubMed1976

Turnover and health selection among foundry workers.

The quantity, reasons, and health selection involved in labor turnover were studied with the use of questionnaires and employers' records. The basic material was the personnel of 20 representative foundries. The turnover in 1950--1972 was estimated from a sample of 588 workers. The causes and health selection were studied with questionnaires put to the 1,789 current employees (91% response), the 493 foundrymen who had left after at least 5 years of exposure (the 5-year-plus men, 71% response) and 424 of those who had left after less than 1 year of exposure (the 1-year-minus men, 55% response). The men were asked to describe their present and earlier work at the foundry, the nature and duration of their exposure, diagnosed lung and heart diseases, and chronic bronchitis and angina pectoris and to assess their present and former state of health and work capacity. The disability analysis was based on a sample of 2,834 men whose data were taken from the Social Insurance Register. The disability findings were compared to expected values based on the Finnish male population. Turnover proved to be rapid; short periods of employment predominated. The major reasons for leaving were poor work conditions, physically demanding work, low pay, and poor health. The turnover was fastest in dusty occupations. Relatively more exfoundrymen, both 5-year-plus and 1-year-minus, than current employees felt their health and/or work capacity to be poor. More of the older men in the 5-year-plus group than men of the same age in the current group had chronic bronchitis and diagnosed lung disorders. Both the 5-year-plus and the 1-year-minus exfoundrymen had relatively more diagnosed heart disorders than did the current employees. The disability prevalences of the foundrymen in any category of diseases did not exceed the expected values based on the male population. The overall findings indicate early health selection prior to pensionable disability and/or death.

Adolescent↗
PubMed1999

Returning to work through job accommodation: a case study.

1. As more people live longer and more active lives the likelihood of experiencing a disability during one's career increases. Although the unemployment rate among people with disabilities is high, workers with disabilities are becoming more common. 2. Effective job accommodation costs only a small fraction of the hundreds of thousands of dollars that would otherwise be paid out in disability benefits and insurance premiums, or wasted in litigation. 3. Job accommodation planning should begin as early as possible in the disability process and include the active involvement of the individual with the disability and appropriate clinicians, as well as the supervisor and coworkers. 4. Successful accommodation is the result of teamwork, The occupational health professional is often the coordinator of a number of internal and external resources in the job accommodation process. Tools are available for sharing information among all those involved in the accommodation process, without compromise of confidential medical or business information.

Accidents, Occupational↗
PubMed1997

Mutuality and solidarity: assessing risks and sharing losses.

Mutuality is the principle of private, commercial insurance; individuals enter the pool for sharing losses, and pay according to the best estimate of the risk they bring with them. Solidarity is the sharing of losses with payment according to some other scheme; this is the principle of state social insurance; essential features of solidarity are comprehensiveness and compulsion. Private insurance is subject to the uberrima fides principle, or utmost good faith; each side declares all it knows about the risk. The Disability Discrimination Act requires insurers to justify disability discrimination on the basis of relevant information, acturial, statistical or medical, on which it is reasonable to rely. It could be very damaging to private insurance to abandon uberrima fides. However, although some genetic information is clearly useful to underwriters, other information may be so general as to be of little use. The way in which mortality rates are assessed is also explained.

Cost Sharing↗
PubMed2002

[Does systematic evaluation of sickness certification II lead to less use of health insurance?].

BACKGROUND: The increasing prevalence of disability pensioning in Norway has led to several attempts at strengthening the proactive role of the National Insurance System (NIS) in cases of long-term sick-listing. Since 1988, a special medical certificate is required after eight weeks of sick-leave. The aim of this study was to examine whether systematic evaluation of this medical certificate by NIS officers and NIS medical consultants could reduce future health insurance expenditure. MATERIAL AND METHODS: In 1994 a randomised study using a paired design of the NIS local offices in the county of Hordaland was undertaken. All eight-week medical certificates in the intervention group (N = 2,237) were systematically reviewed, whereas standard routines were used for the control group (N = 1,764). RESULTS: After three years, no significant differences were observed between the two groups in health insurance utilisation. INTERPRETATION: We conclude that local NIS offices are unable to use the information in the eight-week sick notes to effectively influence future utilisation of health insurance. The reason may be that NIS offices lack the skills necessary for early intervention in long-term sick-listing.

Adult↗