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At least 1,315 records · Page 73Linked to original sources
PubMed1997

[A quarter of a century of rehabilitation of psychiatric patients in Germany].

The past quarter of a century marks the first and decisive phase of mental health care reform in Germany and of psychiatric rehabilitation throughout the world. During this great awakening, psychiatry passed beyond the custodial system of care, where potent therapy instruments were lacking and the connection to society, its living standard and progress in medicine had been lost. In Germany, the crucial step to modernity was taken with the creation of the Expert Commission on Mental Health Care in 1970 to 1975. The birth hour of rehabilitation followed the insight produced by Wing and Brown in 1970 and Wing and Bennett in 1972 that secondary impairments caused by social deprivation during long-term hospital stay can be favourably influenced by means of rehabilitation programmes. Inspired by the Expert Commission's report, and encouraged further by the recommendations of the Central Institute of Mental Health for the State of Baden-Württemberg (1987) and of an expert commission for the Federal Republic of Germany (1988), the Federal, State and Local governments as well as public welfare organizations supplied considerable funds for the development of services and programmes aimed at the reintegration of the chronically mentally ill and disabled. Job centres, health insurance schemes and retirement pension schemes as paying authorities had greater difficulties in contributing to the development of a functioning system of rehabilitation services for the severely socially disabled mentally ill. Not only the costs were involved but also the complexity of the needs for rehabilitation and confusion about the definition of the measures and about the distinction from basic needs. The needs, objectives and instruments of psychiatric rehabilitation are discussed within the context of the present financial situation. In view of the current perspectives of decreasing financial and human resources in our society, humanitarian and social responsibility for the particularly vulnerable and distressed group of the mentally ill and disabled is called for.

Cost-Benefit Analysis↗
PubMed1985

SIPP and health care issues.

There are three major areas in health care policy which can be addressed by the data elements in the Survey of Income and Program Participation (SIPP): (1) health insurance coverage and the stability of insurance over time; (2) health disability and its relationship to socioeconomic variables, including unemployment, over time; and (3) health care utilization. The survey does not, however, include information on health care expenditures or on details of visits to providers.

Persons with Disabilities↗
PubMed2001

[Intermediate-term results after arthroscopic subacromial decompression with special reference to ongoing disability claims].

The objective was to evaluate mid-term results after arthroscopic subacromial decompression (ASD) with special focus on the bias due to an application to social insurance for pension based on sickness disability. The study group consisted of 42 patients (28 male, 14 female). ASD was performed in 1993 or 1994 for impingement stage II. The mean age was 49.5 years. Thirty-nine patients (93%) were evaluated by an independent observer for an average follow-up of 3.5 years (range 1.5-5). Patients satisfaction with the outcome was assessed by a visual analog scale graded from 0 (extremely dissatisfied) to 10 (extremely satisfied). The functional result was assessed using the Constant score. At follow-up the mean VAS value was 6.4 +/- 3.4. The Constant score improved from 49.6 +/- 18.5 to 84.8 +/- 14.3. The subgroup of patients having applied to social insurance for pension had significantly worse results compared with the remaining patients: VAS: 4.9 +/- 3.1 vs. 7.5 +/- 3.1; Constant-Score: 76.1 +/- 12.7 vs. 88.3 +/- 13.5. The fact that patients try to get benefit from social insurance based on sickness disability significantly biased the outcome after ASD.

Acromioclavicular Joint↗
PubMed1978

Medical insurance feasibility study. A technical summary.

There are risks of adverse outcomes to patients in the course of health care management. A study was undertaken to measure these outcomes in California for 1974. Secondary benefits of the study include new insights into the types and sources of disabilities caused by health care management and the development of new methods for carrying out generic adverse-outcome monitoring.

California↗
PubMed1992

Employee lawsuit insurance covers possible liability under new laws.

Employers faced with increased liability under recently enacted federal legislation can now turn to insurance companies for protection against suits involving personnel practices. At least two insurance companies are now offering policies that protect companies against litigation for wrongful dismissal, sexual harassment, and/or discriminatory employment practices and procedures.

Costs and Cost Analysis↗
PubMed1977

The handicapped driver: an insurer's point of view.

This paper reviews the approach used by one automobile insurer to underwrite and to medically evaluate a handicapped driver. Significant factors which must be carefully developed for each application for automobile insurance are discussed. In the final analysis. The extent of any physical or mental impairment must be considered along with information verifying the capability of the handicapped person to safely operate an automobile. Cooperation in research programs among many disciplines, namely, state motor vehicle bureaus, insurers, product manufacturers, health professionals and driver educators as well as handicapped drivers, is clearly indicated.

Accidents, Traffic↗
PubMed2002

[Significance of medical data in work disability evaluation].

Research has shown that insurance doctors in assessing a claim mainly use information provided by the client, whose medical data are not checked with the attending physician, unless a refusal of or a reduction in the disability allowance is to be expected. Additionally, further medical investigations are hardly ever requested. After a year of absence company doctors hardly ever provide any information to the attending physicians, who in turn take just as little initiative with respect to employment disability. The significance of proper medical data for the claim assessment is limited; the majority of chronically ill individuals work and allowances are not given merely because of abnormalities or disorders. Medical data only become significant with reference to a problem analysis. This is often lacking; there is too little skepticism and too much compliance, which fits in with the conflict reducing function of being disabled for employment purposes. Providing more doctors so that more time and attention is available is not enough. Radical measures are needed to reduce the influx of claimants and to simplify the assessment process. Yet above all, greater responsibility should be given to the client and a different vision on employment and illness is also needed.

Chronic Disease↗
PubMed2003

Understanding the consequences of access barriers to health care: experiences of adults with disabilities.

PURPOSE: The study explores: (1) the scope and nature of the consequences that adults with disabilities perceive as the result of inappropriate access to health care services; (2) the variability of these consequences by demographic attributes such as disability type, gender, and health insurance type; and (3) the inter-relatedness and multidimensionality of these consequences. METHODS: Qualitative, semi-structured, in-depth interviews were administered over the telephone to 30 participants with spinal cord injury, cerebral palsy, or multiple sclerosis as part of a nation-wide study on access and utilisation in the USA. Interviews were transcribed and coded for analysis using the qualitative analysis program, NVivo. RESULTS: Consequences were grouped into one of five categories: social, psychological, physical, economic and independence issues. Responses differed slightly with regard to disability type, gender and health insurance type. There was substantial overlap among consequence categories. For most respondents, negative consequences were not limited to just one area--frequently, one consequence triggered others. CONCLUSIONS: Health insurers and providers need a better understanding of the multiple consequences of access barriers. Based on this knowledge, detrimental and costly effects of inappropriate service delivery could be more effectively prevented. Implications for health care services and policy are discussed.

Adult↗
PubMed1998

The misplace of litigation in medical practice.

Medical decision-making is based upon mathematical probability in determining the significance of variables involved. Truth is often not absolute and medical decisions often require reconsideration of information, reanalysis and possible change. Litigation based upon error negates the ordinary practice of medicine. Error is intrinsic to all human behaviour and contributed to by uncertainty concerning precision in diagnosis and treatment of some diseases, mood change affecting ability to process cognitive and analytic function, and adverse work environment. Error is an important process in learning and providing it is recognized and fully admitted is a creative process providing opportunity for improving medical practice. Litigation is based on proof of negligence. Negligence is defined as carelessness, which is a rare cause of human and medical errors. The law confuses error with negligence; error should not be the basis for litigation. Litigation based on error is counter-productive to the best practice and improvement of clinical medicine. The assessment of errors and negligence is limited by the method of choice of medical experts, the adversarial system often ignoring the intermediate position in favour of a yes-no answer, the selection of experts to favour the desired result rather than the real situation, the method of questioning of witnesses which discourages explanation and creative solution of disagreement, and the hierarchical system which does not allow exploration of the issues and creative solutions. The basis for financial compensation for ill health is relevant when this assists the sufferer to cope with the ill health. The ethical basis for compensation when ill health results from error by health care workers is not more valid than ill health resulting from biological or environmental factors. Human error is common normal behaviour, while biological and environmental causes of ill health are common errors of human biology and the environment. Unintentional human error should not be the basis of financial remuneration or punishment. This latter principle has been applied to all services between the customer and service supplier, which may lead to unnecessary mistrust, anxiety and alienation in modern society. Incapacity from injury or disablement is covered by damages payment in only a small percentage of permanent disability cases (1.5% in the U.K.). Universal insurance by government or private agencies e.g. as in motor accident insurance to include the 98% of the permanently disabled who are receiving no payment at present would be both preferable and fairer. The protection of barristers from litigation for negligence in court is based upon arguments that could apply to most other occupations, and are equally, if not more relevant to medicine. The legal system of settling claims for negligence by doctors needs to be replaced by an investigative system which seeks to explain the basis and cause of error, which would benefit the patient and the doctor, and improve medical practice. A creative process needs to replace a judgmental, rigid and punitive system. A committee involving specialist groups in selecting expert witnesses, a health counsellor and a patient representative may be most suitable. Criminal acts, where error is performed deliberately, assault or sexual misdemeanors, would still be subject to the common law.

Australia↗