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PubMed1984

Disability indices, the economic costs of illness, and social insurance: the case of multiple sclerosis.

Debilitating, long-term illness can impose a significant economic hardship on families affected with the illness and on the wider society as well. In addition to medical research to find a cure or a prevention for such illnesses, society may wish, in the interim, to allocate resources to compensate the families burdened by the illness for the economic losses they have suffered. Such compensation will take the form of a social insurance program. The socially optimal insurance program requires two crucial pieces of information: (i) an index of physical disability and (ii) an accurate assessment of the economic losses associated with each stage of disability as measured by that index. This paper reports on an initial attempt using U.S. data to provide these two important facts for one long-term, disabling illness: multiple sclerosis.

Adult↗
PubMedDate not supplied

[Change in the income status of the disabled after introduction of long-term care insurance].

Up to the present time, long-term-care needs in the Federal Republic of Germany have only been covered to a limited extent through health insurance. The needs of the majority of those requiring long-term care must be covered from their pension funds or acquired wealth. This often does not suffice, which results in those needing long-term care becoming recipients of social assistance. The introduction of a long-term-care insurance should bring an end to this situation, which is considered unacceptable. At present, two competing schemes for covering the social risk of long-term care are being discussed: a social security insurance and a private insurance. When comparing the planned benefits under consideration, the social security insurance is more favorable in regards to nursing-home treatment, as well as with at-home care and benefits in kind. The private insurance is more favorable when considering nursing-home treatment and monetary benefits. If the private insurance is adopted, over 31% of those formerly relying on nursing-home care would no longer need social assistance. In the case of social security insurance, almost 46% would no longer require social assistance. Most of the remaining individuals requiring social assistance would be women.

Aged↗
PubMed1995

Problems in the assessment of psychosomatic conditions in Social Security benefits and related commercial schemes.

The medical community must recognize that support of claims for Incapacity Benefit and related commercial schemes places the patient in a small and special sub-population of clinical practice which may require specialist investigation, treatment, and documentation. Determination of functional capacity and of disability requires knowledge either not available or unfamiliar to most physicians with caring and therapeutic roles, especially of legal or contractual provisions and occupational data. However, it is not necessary for them to determine disability and they should not be asked to do so. The new, medical assessment procedures for Incapacity Benefit in the UK do not require this, and the largest provider of related commercial schemes (Long Term Disability; Permanent Health Insurance) has already eliminated this requirement from its application process. When such application is anticipated or requested, the medical record should be prepared and appropriate consultation obtained. Subjective issues should be identified and addressed. Comprehensive psychiatric evaluation, especially in subjective impairment, is critical in chronic incapacity. The estimation of functional capacities in the absence of objective data is particularly troublesome, but, clinicians can provide the Disability Medical Analyst with appropriate medical documentation.

Diagnosis, Differential↗
PubMed2003

Duration of employment is not a predictor of disability of cleaners: a longitudinal study.

AIMS: Cleaning is a high-risk occupation for developing musculoskeletal disorders. Sickness absence is twice as high as in other occupations. Disability pensions for musculoskeletal disorders are twice as high in cleaners as in other employed women. However, a result from Norwegian and Danish studies shows that female cleaners do not report higher morbidity of musculoskeletal disorders than other women. The objective was to analyse whether female cleaners have a higher risk of obtaining a disability pension than women in other unskilled occupations and whether the length of employment influences the risk. METHODS: The material is from the National Census in 1980 and 1990 and supplemented with disability pensioning data from the National Insurance Administration and the Population registry. Women aged 20-49, working as cleaners, seamstresses, nursing, kitchen, or shop assistants in 1980 were followed until 1990 or until receiving disability pension. Female cleaners aged 30-59 years in 1990 were categorized into two cohorts by occupation in 1980. They were followed from 1991 to 1994, to the date they died, or received disability pension. Incidence rates and incidence rate ratio for disability pension and mortality was calculated by Poisson regression. Cox regression calculated the relative risk of obtaining disability pension. RESULTS: Disability pension rates were higher among cleaners than among other women in unskilled occupations (1.4 per 1,000 person years (CI 95% 1.35-1.46)), but the risk of obtaining disability pension did not increase with increasing exposure to cleaning (HR 0.8 (CI 95% 0.6-1.2)). CONCLUSIONS: The cleaning occupation has high disability rates compared with other unskilled occupations. A contribution factor to these high rates is a selection of women with poor health into the occupation.

Adult↗
PubMed1996

[Results of expert assessment of disability with reference to selected diagnostic groups by the Medical Service of Hospital Insurance].

A topical survey is given by the documentation of the examination for the statutory nursing care insurance. The first part of the report contains the complete tabulated results of the Federal Republic of Germany. Furthermore a graphical comparison of selected groups of diagnoses like psychiatric disorders has been statistically evaluated and is commented upon.

Adult↗
PubMed2002

Changes in the prevalence of disability pension in Iceland 1976-1996.

AIMS: The objectives were to determine changes in the prevalence of disability pension in Iceland and its distribution according to gender, age, and main diagnoses. METHODS: The study includes all persons receiving either full or partial disability pension in 1976 and 1996. The age-standardized risk ratio between the years 1976 and 1996 was calculated for all disability pensions and for full disability pension only. RESULTS: The prevalence of all disability pensions decreased significantly among both men and women in 1996 as compared with 1976. When the figures were disaggregated, however, theyrevealed an increased risk of full disability pension and a decreased risk of partial disability pension. Th e prevalence of full disability pension had increased in most disease categories. CONCLUSION: The decreased prevalence of disability pension in 1996 as compared with 1976 is noteworthy, as unemployment was increasing during the years immediately preceding 1996. It seems likely, however, that the decrease of partial disability pension and increase of full disability pension is a reflection of increased competition for work in the labour market as well as increased attractiveness of full disability pension due to new supplementary sickness insurance benefits linked to full disability pension.

Adolescent↗