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PubMed2004

Use of primary prevention services among male adults with cerebral palsy, multiple sclerosis, or spinal cord injury in managed care and fee-for-service.

Future research needs to clarify the biases in clinical practice and potential barriers that may exist at both the provider and health plan levels that exclude men with physical disabilities from routine preventive services. As the population of people with disabilities ages and lives longer, it is necessary that routine preventive services are accessible and made available to them, regardless of gender, disability, or health insurance type.

Activities of Daily Living↗
PubMed2006

Disparities in colorectal cancer screening: a guideline-based analysis of adherence.

PURPOSE: This study's primary objective was to describe colorectal cancer (CRC) screening disparities using a guideline-derived definition of CRC screening adherence while controlling for confounding factors associated with CRC screening. METHODS: This secondary data analysis of the 2000 National Health Interview Survey (NHIS) included 12,677 individuals age > or = 50 years. The primary outcome assessed was adherence to CRC screening guidelines, defined as a sigmoidoscopy or proctoscopy within the last five years, colonoscopy within the last 10 years, or home fecal occult blood test within the last 12 months. Age, race/ethnicity, gender, physical disability, household income, insurance status, education level, marriage status, rural or urban geographic area, and family history of CRC were analyzed as covariates in a logistic regression model. We assessed the association between these sociodemographic variables and receipt of physician recommendation for CRC screening among those respondents not adherent to CRC screening recommendations. RESULTS: In the multivariate model, the odds for being adherent with current CRC screening recommendations were lower for Hispanics (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.59-0.86) and African Americans (OR 0.82, 95% CI 0.71-0.95) than for Whites. Residents of urban areas had higher odds (OR 1.19, 95% CI 1.06-1.34) of being up-to-date than rural residents. Among subjects who were not up-to-date with CRC screening, similar disparities were noted in receipt of physician recommendation for CRC screening. CONCLUSIONS: Certain groups are at increased risk of not receiving CRC screening or recommendations for screening from their physicians. Interventions to reduce these disparities should be an integral part of overall efforts to improve CRC prevention and control.

Black or African American↗
PubMed1988

Workers' compensation: coverage, benefits, and costs, 1985.

The 84.3 million workers protected by workers' compensation laws in 1985 represented 87 percent of all wage and salary workers in that year. Both the amount of benefits paid to workers and the cost of the program to employers rose substantially from 1984 to 1985. Benefit payments totaled $22.5 billion-14.1 percent higher than in 1984 and the largest annual increase since 1978-79. About two-thirds of the payments in 1985 were money payments ($15.1 billion) and the remainder ($7.4 billion) went for medical care for disabled workers. Private insurance companies made nearly three-fifths of these payments and State funds and self-insured employers each paid about one-fifth of the total benefit amount in 1985. For the first time since 1978, the annual growth in employer costs exceeded the growth in workers' benefits, resulting in a slight decrease in the loss ratio for 1984-85. Employer costs were up nearly 17 percent from the previous year, reaching an estimated $29.3 billion. Covered payrolls increased by 7 percent in that same period. Total benefit payments as a percent of payroll also increased noticeably in 1985.

Costs and Cost Analysis↗
PubMed1980

Current development in Social Security financing.

The current financial outlook for the old-age, survivors, disability, and health insurance (OASDHI) program indicates several problems. During 1980-84, income and outgo for the OASDI and hospital insurance (HI) trust funds combined are roughly in balance, according to the annual report of the Board of Trustees. The OSI program, however, is running out of funds as automatic benefit increases exceed the growth in payroll tax revenues. Clearly, additional financing will be needed throughout the 1980's. Funds now earmarked for the DI and HI trust funds could serve this purpose, although more short-range financing will be needed if real wages continue to show losses instead of the usual gains. The 1977 amendments that strengthened social security financing provided only a thin margin of safety against unfavorable experience during the early 1980's. The short-range economic picture has darkened considerably since 1977, with adverse consequences for social security financing. Only the DI experience has improved. Based on tax rates in the present law, a large buildup of OASDI trust funds is expected over the next 25 years. HI financing, however, is projected to become inadequate after 1990. Projections over the next 75 years indicate severe financing problems for the OASDI program early in the 21st centruy, as the aged population grows relative to the work force.

Actuarial Analysis↗
PubMedDate not supplied

Radiography of the carpal navicular.

As described, radiography of the carpal navicular is a complex task for the radiologic technologist and is of crucial importance in the diagnosis and treatment of the orthopedic patient. Failure to adequately demonstrate navicular fractures can result in a painful and severely disabled wrist. To insure proper diagnosis, special positions and methods must be used; an AP and lateral projection is not adequate. A series of views to specifically demonstrate the navicular will insure proper diagnosis and treatment and result in a better prognosis for the patient.

Carpal Bones↗
PubMed1977

Federal civil-service annuitants and social security, December 1975.

This article examines personal and work-related characteristics of a sample of the nearly 1 million Federal civil-service retirees who were receiving annuities based on their own wage records as of December 31, 1975. Employment patterns and subsequent annuities in civil-service careers have been related to corresponding experience in jobs covered under the old-age, survivors, disability, and health insurance (OASDIHI) program. With some exceptions, the review uncovered patterns generally similar to those found in a study of 1967 annuitants. About 2 out of 5 annuitants were entitled to OASDHI cash benefits in 1975. Most of these dual beneficiaries received benefits on the basis of their own OASDHI-covered earnings, but 11 percent were entitled as dependents or survivors of other workers. About two-thirds of the annuitants not currently receiving benefits had some OASDHI-covered employment during their work careers. In general, those with the shortest civil-service careers and lowest annuities were most likely to be entitled to OASDHI cash benefits.

Aged↗
PubMed1999

Impairment and work disability due to whiplash injury following traffic collisions. An analysis of insurance material from the Swedish Road Traffic Injury Commission.

A study was set up to determine the trends in medical impairment and work disability ratings for persons affected by whiplash associated disorders (WAD) and other injuries secondary to road traffic collisions, and into the influence of age, gender, professional status, and final medical impairment rating on final work disability. A cross-sectional study was carried out of insurance files of 2,523 subjects in 1989 and 3,223 subjects in 1994 judged to have a permanent medical impairment of 10% or more and work disability due to road traffic injury. Files were obtained from the Swedish Road Traffic Injury Commission. The main outcome measures were the crude frequency and age-specific, standardized percentage of traffic injuries with a medical impairment of 10% or more for the years 1989 and 1994. Final work disability status was analysed with respect to age, gender, type of injury, degree of medical impairment, and professional status. The proportion of medical impairment due to WAD was found to have increased from 16% in 1989 to 28% in 1994, but the proportion of work disability was found to have remained the same. Age over 40 years, low professional status, and having a medical impairment judgement of 15% or more were independently associated with reduced or full work disability.

Accidents, Traffic↗
PubMed2002

[Limited control of information for work disability evaluation].

OBJECTIVE: To investigate the information insurance physicians have at their disposal to assess employment disability and how they verify this information. DESIGN: Descriptive. METHOD: In the period January 1999-April 2000, data were collected by means of semi-structured interviews with 19 insurance physicians from the 5 social insurance companies and from observations of 73 consultations conducted by 6 experienced insurance physicians. RESULTS: The average duration of the consultations between the insurance physicians and the clients was 30 minutes. Within these consultations, several issues were briefly discussed. The information obtained by the insurance physicians was limited to the first day of illness, a general description of the complaints and a code for the diagnoses. In 23 cases (32%) the insurance physicians requested information from the attending physician, and in 2 cases (3%) an expert opinion was requested. CONCLUSION: For the insurance physicians, the client was often the most important or indeed sole source of information. Often there was no other information against which the patient's data could be verified and such information was mostly not requested.

Adult↗
PubMedDate not supplied

The TEFRA medicaid eligibility option for children with severe disabilities: a national study.

The Tax Equity and Fiscal Responsibility Act (TEFRA) Medicaid Eligibility Option, also known as the Katie Beckett Option, was developed to allow children with disabilities from near-poor and middle-income families to qualify for Medicaid. TEFRA has been available since 1982; however, little is known about the number of children served and their qualifying disability. This first national study found that 20 states enrolled nearly 25,000 children in 2001. Only 10 of these states allowed children to qualify because of a mental health disability. Additional research is needed to understand the role of TEFRA in providing insurance to children with disabilities.

Adolescent↗
PubMed2004

Nature and prevalence of mental illness in the workplace.

This discussion paper explores the state of knowledge about the prevalence of mental illness and its effect on the working population. Major trends in the literature are also commented on, and significant gaps in knowledge are identified. Annually, 12% of Canadians from 15 to 64 years suffer from a mental disorder or substance dependence. Few studies have examined the prevalence of mental disorders among Canadian workers. Results from Ontario estimate that monthly, about 8% of the working population has a diagnosable mental disorder. Preliminary findings also indicate differences in the prevalence of mental disorders among workers with regard to occupation, age, sex, physical disorders, work environment and work-related stress. Studies indicate that mental and emotional health problems are associated with staggering social and economic costs, which create a heavy burden on the workplace. About one-third of society's depression-related productivity losses can be attributed to work disruptions. The impact of mental illness on the workplace has been examined in terms of its effect on presenteeism, absenteeism and disability days. The presence of any of these has been used to indicate decreased productivity, the largest burden arising from presenteeism. In total, Canada annually loses about $4.5 billion from this decreased productivity. Mental illness is also associated with short-term and long-term disability, which in turn is often related to insurance coverage. Mental illness related disability claims have doubled and mental illness accounts for 30% of disability claims, at a cost of $15 to $33 billion annually. The needs of the working population and employers must be addressed. We must be aware of patterns of mental disorder among occupational groups and industry sectors. In addition, we must understand how the disability benefit structure impacts the prevalence as well as patterns of disability related to mental illness. Effective policies and programs must be based on solid evidence.

Absenteeism↗
PubMed1990

Morbidity, disability, and long-term care of the elderly: implications for insurance financing.

A scarcity of empirical information to specify appropriate provisions and base rates for coverage has hindered the development of long-term-care (LTC) insurance. Data from three nationally representative surveys on the prevalence of morbidity and functional limitations among the elderly population suggest that health status among older Americans is highly dynamic, especially at higher disability levels. The bioactuarial data may help insurers define potential markets of purchasers of policies, and identify the numbers of persons with disabilities severe enough to trigger use of benefits. If the accuracy of individual service predictions could be increased further, reserve requirements and overall costs to LTC insurance carriers might be reduced.

Aged↗
PubMed1989

[Possibilities and limits of using physician referred disability statistics compiled by the administration of social insurance of the federal trade union].

The doctors related figure data of unfitness for work of the social insurence provides important informations for management and comparisions of efficiency in health system. It should be used better than before. However it is not suited to reflect the quality of doctors expertise of unfitness for work, but it signals striking deviations about to be explained. At the interpretation of the doctors related figure data of unfitness for work the knowledge of some methodical particularities is necessary to avoid the risk of incorrect evaluations.

Absenteeism↗