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[Orthopedics and life insurance medicine].
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[Insurance medicine--prognosis medicine].
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[Differences in application and granting benefits for severely disabled patients before and after introduction of new benefits within the scope of the public health reform law].
Constituting part of the health reform in Germany ("Bundesgesundheits-Reformgesetz"), an extension of health insurance benefits for severely disabled persons was introduced in 1991. The assessment of eligibility for benefits is based on standardised medical examinations. Examinations performed in the state of Baden-Württemberg in 1990 (n = 6401) were compared with a 20% random sample of those performed in 1991 (n = 7563) in order to analyse eventual changes in acceptance rates of applications. Acceptance rates decreased from 87.9% in 1990 to 70.8% in 1991. The difference could not be explained by differences in age, sex, medical diagnosis or dependence on help in daily activities. This suggests that acceptance criteria were less restrictive before introduction of the extension of benefits.
A guide to understanding the insurance world's most confusing and most important type of policy.
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[5 concepts of disability].
Disablement is a measure indicating how the individual manages or does not manage to cope with the tasks life presents. Different concepts of disablement are applied: Tabular disablement is used to measure the physical resources needed by the individual to undertake an unspecified register of tasks. Medical disablement is a measure of the aggregate resources (physical, mental and social) needed by the individual to undertake an unspecified register of tasks. Occupational disablement is a measure of the aggregate resources needed by the individual to carry out his previous occupation. Economic disablement is a measure of the aggregate resources needed by the individual to carry out some kind of work for which he is fit. Social disablement is a measure of the aggregate resources needed by the individual to maintain contact with other people. The tabular and medical concepts of disablement are used in connection with compensation for non-pecuniary loss. Insurance companies and administrative bodies, when determining the amount of compensation for such losses, lay most of the emphasis on tabular disablement (accident insurance and industrial injury compensation). The courts, when assessing the compensation, attach the main weight to the concept of medical disablement (compensation for non-pecuniary loss). The insurance companies and the administrative bodies have a system that is quite easy to operate, whereas the courts have a system leaving considerable room for discretion. The concepts of occupational and the economic disablement are used when granting compensation for loss of income.(ABSTRACT TRUNCATED AT 250 WORDS)
Rehabilitation and insurance relationships.
The ultimate goal of the health care process is to restore an individual to a maximal level of function within the constraints of the existing pathology. It is unfortunate, however, that this potential is often underestimated so that the individual is deprived of reintegration in society. Rehabilitation is the unfinished business of medicine. Reasonable goals need to be identified and clear cost benefit projections need to be established regarding any intervention. To decrease an individual's dependency means that the lifetime cost of care of the individual decreases dramatically. Physical independence and cognitive competency reestablish for the patient optimal levels of health care that need to be facilitated, and involve integrated, innovative insurance liaisons to assure achieving this goal.
[Dental insurance, system and its function in the dental care for the handicapped].
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Costs to business for an HIV-infected worker.
We use a Markov model to calculate the expected medical, disability, employee replacement, life insurance, and pension costs to a business firm for an HIV-infected employee. This analysis differs from previous HIV/AIDS cost analyses because we take the perspective of a business firm rather than of society, and we focus on the expected costs over a time frame relevant for business decision making. The maximum expected five-year cost to a business firm for an HIV-infected employee is estimated at $32,000, with an average expected cost of $17,000. These expected employment-based costs are less than the lifetime medical AIDS costs to society for an individual, which are estimated at more than $85,000. Employment-based costs are most influenced by the type of benefits provided under employer-based health insurance plans.
[MEDICOLEGAL AND INSURANCE CRITERIA IN VIBRATION DISEASE].
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When back pain becomes disabling: a regional analysis.
Back pain is a common condition and in most cases is not disabling. We have investigated disabling back pain that leads to health care utilization, time lost from work, and high costs. Disabling back pain remains of obscure origin because the focus in studying it has been too narrow. Our indicator of disability is the industrial insurance claim rate for back sprain by county (N = 39) in the State of Washington. After controlling for the size of the labor force and the proportion of workers in occupations that are particularly at risk of back sprain, we determined the effect of 3 socioeconomic factors on the claim rate: the unemployment rate, percentage receiving food stamps, and per capita income. For 2 of the 3 years studied, socioeconomic factors accounted for about one-third of the variance in the claim rate. Even though claimants of industrial insurance are employed, the unemployment rate was significantly related to the claim rate in the 3 years studied. Our interpretation is that disability is a symptom of distress. Where there is a rise in job insecurity and an attendant rise in economic insecurity, there is a greater likelihood that back pain will become disabling.
[Assessing the quality of medical certificates II--useful criteria or unnecessary schedule?].
BACKGROUND: In Norway, doctors must provide the National Health Insurance (NIS) with a special medical certificate if a sick-leave exceeds eight weeks. The aim of this study was to evaluate this medical information in relation to the NIS criteria for further sickness benefits and the usefulness of the certificate in assessing the need for early rehabilitative and vocational initiatives. MATERIAL AND METHODS: 2,237 consecutive eight-week medical certificates submitted to 21 NIS offices in the county of Hordaland in 1994 were independently evaluated by the NIS officer and the NIS medical consultant in a questionnaire survey. RESULTS: Both evaluators found sufficient medical information in the vast majority of medical certificates, though in about 12% of the cases the medical criteria for further benefits were not sufficiently documented. In less than 10% of the cases, active rehabilitative or vocational measures were called for at this point in time. However, there was a rather low degree of consensus between the NIS officer and the medical consultant about in which cases supplementary information or active measures were warranted. INTERPRETATION: We conclude that the eight-week medical certificate usually contains enough medical information but is of limited use in assessing the need for active intervention by the NIS. Supplementary information from the absentee and the employer should be collected at an early stage of the sick leave.
Insurance: content of insurance policies not governed by the ADA.
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An explorative, population-based study of female disability pensioners: the role of childhood conditions and alcohol abuse/dependence.
AIMS: This study investigates the association in women between conditions during childhood and adolescence and alcohol dependence or abuse in adulthood on the one hand, and disability pensions and long-term sickness absence on the other. METHODS: A stratified population-based sample of women in Göteborg was interviewed. For analyses in this study the following variables were selected from the interview protocol: childhood and adolescence, education, employment, social class, self-rated physical health and alcohol dependence or abuse (ADA), with diagnoses assessed according to DSM-III-R. Information on disability pension and sickness absence was obtained from the local Social Insurance Office. RESULTS: Unfavourable conditions during childhood and adolescence and school difficulties as well as early deviant behaviours predicted disability pension and long-term sickness absence in adulthood. For most risk factors ADA could explain only a minor part of the odds ratios found in crude and age-adjusted analyses. CONCLUSION: It is concluded that conditions early in life are predictors in women of disability pension and long-term incapacity to work. There are similarities in the pattern of early risk factors for later alcohol dependence or abuse and for disability pension/long-term sickness absence.
[Conversion of results of expert evaluation in disputed work disability(section 275 paragraph 1a SGB V regulation)].
A statutory insurance for persons who are unable to care for themselves and require nursing attention, has been introduced in Germany. Employers must contribute to the insurance funds, and employees are likewise compelled to pay their share. To compensate employers to some extent for these expenses they can now take recourse to expertising by the Medical Services of the statutory insurance bodies if they have any doubts about an employee's inability to work. The results of such expertising have been assessed statistically and their translation into reality has been examined. Recommendations on how to improve the expertising procedure are given in this article. Laymen's wrong ideas regarding signs for possibly unjustified claims for inability to work are corrected.
Orthoptic training for the treatment of learning disabilities.
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The canary in the mine.
Many Americans are concerned about their access to health care in the future, especially their ability to pay for needed services. However, a person with a disabling condition requiring ongoing clinical vigilance, supportive care, and other assistive services or technologies faces special difficulties: that person is the "canary in the mine," warning others about fundamental problems within our health care system. Persons with disabilities who have health insurance are often unable to get items and services not covered by their plans. They experience more problems than others with follow-up care, availability of specialists, getting to doctors, and obtaining help during off hours. These problems suggest that people with disabilities fall into the "quality chasm," the metaphor used by the Institute of Medicine to describe the gap between ideal care and current reality. The Crossing the Quality Chasm report suggests 6 aims for fundamental reform, exhorting the health care system to become safe, effective, patient-centered, timely, efficient, and equitable. Each of these aims holds special resonance for persons with disabilities. Despite the compelling need to overhaul the health care system, the American public as yet seems little inclined to fundamental change. Perhaps the impetus must come from subgroups within the population who are particularly at risk from the current system, such as persons with disabilities. As solutions are crafted, people with disabilities, their families, and communities should help design and direct fundamental changes to the health care system.
[Sick listing--correct and more insurance-based assessment is necessary].
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