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PubMed2006

The economic impact of bipolar disorder in an employed population from an employer perspective.

OBJECTIVE: To determine the economic impact of bipolar disorder on health benefit costs and health-related work absences from an employer perspective. METHOD: Data on health benefit costs and health-related absences during 2001 and 2002 were retrieved from a database and retrospectively examined. Regression modeling measured the cost differences while controlling for potentially confounding factors. The study population consisted of employees at multiple large employers who were widely dispersed throughout the United States. These employees were grouped into 2 cohorts: (1) employees with a bipolar disorder diagnosis (primary, secondary, or tertiary ICD-9 code of 296.0x, 296.1x, 296.4x, 296.5x, 296.6x, 296.7x, or 296.8x) in 2001 and (2) employees with no bipolar disorder diagnosis during 2001 or 2002 (comparison cohort). Specific outcome measures included annual health benefit claim costs and salary-replacement payments for the following employee health benefits: health care insurance, prescription drug, sick leave, short- and long-term disability, and workers' compensation. Additional outcome measures included annual absence days due to workers' compensation, short- and long-term disability, and sick leave (separately). RESULTS: The analysis identified 761 employees (0.3%) with bipolar disorder and 229,145 eligible employees without bipolar disorder. Employees with bipolar disorder annually cost $6836 more than employees without bipolar disorder (p < .05) and were more costly in every health benefit cost category. Employees with bipolar disorder missed an average of 18.9 workdays annually, while employees without bipolar disorder missed 7.4 days annually (p < .05). CONCLUSION: The impact of bipolar disorder can be costly in the workplace, leading to increased health benefit costs and increased absenteeism.

Absenteeism↗
PubMedDate not supplied

Disability and receipt of clinical preventive services among women.

BACKGROUND: More individuals are surviving catastrophic injuries and living longer with persistent disability; however, their receipt of clinical preventive services is not well understood as compared with those without disabilities given the dual focus of care on both primary prevention and the prevention of secondary complications related to their disabilities. METHODS: Longitudinal analyses of 1999-2002 Medical Expenditure Survey (MEPS). Study sample consisted of 3,183 community-dwelling women aged 51-64 years and followed for 2 full years. Women with disabilities were defined as having reported any limitation in any area of activity of daily living in 2 years. Recommended clinical preventive services were defined as receiving the following at the recommended intervals: colorectal, cervical, and breast cancer; cholesterol screening; and influenza immunization. chi(2) tests and multiple logistic regressions were used to examine variations in use of clinical preventive services. RESULTS: Overall, 23% of the women in the study (n = 835) were disabled. Disabled women, however, were less likely to receive mammography and Pap smears within the recommended intervals. However, disabled women were more likely to receive influenza immunization, cholesterol screening, and colorectal screening within the recommended intervals. Among the disabled, usual source of care and health insurance remained significant predictors of receipt of clinical preventive services across all types, CONCLUSIONS: Disabled women were less likely to receive some of the cancer screening services, suggesting a need for targeted interventions to promote breast cancer and cervical cancer screening. Increased access to health care insurance and health care providers may also help.

Breast Neoplasms↗
PubMed2003

Pattern of antidepressant use and duration of depression-related absence from work.

BACKGROUND: Few studies have examined the relationship between antidepressant prescription and receipt of depression-related disability benefits. AIMS: To address two questions: first, is prescription of antidepressants in accordance with published clinical guides associated with better disability outcomes, and second, what is the relationship between guideline-concordant antidepressant prescription and length of disability? METHOD: An observational study was conducted using administrative data from three major Canadian financial and insurance sector companies. Short-term disability and prescription drug claims records for 1996-1998 were linked for workers receiving depression-related short-term disability benefits during that time. RESULTS: Recommended first-line agents and recommended doses were significantly associated with return to work (chi(2)=6.64, P<0.036). In addition, among those who returned to work, early intervention was significantly associated with a shortened disability episode (beta=-24.1; 95% CI -34.4 to -13.8). CONCLUSIONS: Depression-related workplace disability is a problem for which there is no simple solution. These results provide an additional piece to the puzzle of helping workers disabled by depression to return to work.

Absenteeism↗
PubMedDate not supplied

Using simulation to evaluate clinical competence after impairment.

It is important for individual dentists and the profession to have access to a process for evaluating the clinical competence of practitioners who are professionally impaired as a result of an accident or a medical disability. No common standards for such evaluations currently exist, however, as demand for this type of assessment is still rare. This article reviews the evaluative approach taken by a team of experienced dental educators in examining three dentists who suffered from medical disabilities. An attempt was made to standardize the evaluation process by using clinical simulation to create an environment that would be comfortable for the dentists and acceptable to the lawyers and the insurance companies. Following evaluation, recommendations on individual competence were made, contributing to a faster resolution of legal and insurance issues.

Adult↗
PubMed1964

[SOCIAL NEUROSES].

Explore the source record for details and available documents.

Diagnosis, Differential↗
PubMed1990

Health care financing for severe developmental disabilities.

The 1985-86 data from 308 children and young adults under age 25 with autism and from 326 with severe or profound mental retardation can be compared to national data from the 1980 MNCUES and the 1987 NMES because the methods are similar. These data provide detailed answers to the questions, what health care services are used? what are the expenses? Who pays them? Until now, the absence of comprehensive national data had hindered the development of new approaches to financing the care of children with serious, lifelong conditions. These data permit policymakers to take into account the needs and expenditures for severely developmentally disabled children when reforming the health care financing system. None of the children or young adults had expenditures in excess of $50,000, and very few reached the upper $20,000s. For children with autism the average annual health care expenditure was about $1,000 and about $1,700 for young adults, compared to the $414 average for all American children. They received an average of four physician visits annually, slightly above the U.S. average for children. Their hospitalization rate was twice the average for children. Hospitalization accounted for one-third the health care expenditures among children with autism, but for two-thirds among young adults. For children and young adults with severe retardation the average expenditure on health care was about $4,000, due to the physical impairments in two thirds of the children. They averaged about 12 physician visits annually, falling to 8 among young adults. Children were hospitalized about eight times the national rate, and young adults about twice. Among severely retarded children and young adults living at home, hospitalization accounted for over half the health care expenses, but for only one third for those in residential placement. Unfortunately, preventive and habilitative services were but a tiny fraction of health care expenditures and were demonstrably underutilized. Only 60% of these children had routine dental examinations within the last 12 months, a worse record than the average child. For the individuals whose primary physicians judged that they would benefit from physical or speech therapy, less than one quarter were receiving them. Care for seriously, chronically disabled children places great burdens on immediate family members. Only 20% of the severely retarded youngsters from age 10 to 24 could be left alone at home, even for a few minutes, and only 30% of the autistic ones. These developmental disabilities create needs for personal care and family support that traditionally have not been considered health services.(ABSTRACT TRUNCATED AT 400 WORDS)

Autistic Disorder↗
PubMed2001

Disability, chronic illness, and risk selection.

As high-cost users of health care, people with disabilities or chronic conditions are particularly vulnerable to risk selection. Preferred risk selection, in which insurers avoid enrolling high-risk people, threatens their access to coverage. Adverse selection, in which high-risk people enroll in the most generous plans, compromises the financial viability of plans that are most responsive to their specific needs. The Americans with Disabilities Act prohibits some forms of risk selection, but does not prevent all disability-based distinctions in insurance practices. From a disability perspective, risk selection must be addressed in a manner that: (1) adequately reflects the health care costs of such individuals; (2) eliminates their need to engage in adverse selection; (3) does not stigmatize them; (4) preserves confidentiality of information; (5) uses substantial outcome measures to ensure quality; and (6) creates market conditions that discourage disability-based discrimination. A risk adjuster based on prior use/expenditures or on a diagnostic indicator sensitive to disability issues may be effective. Failure of reform to address risk selection may threaten the viability of a market-based health care system.

Chronic Disease↗
PubMed2002

[Fitness for work after vocational rehabilitation organized by the State Social Security Institute of Iceland.].

OBJECTIVE: The evaluation of a vocational rehabilitation programme initiated by the State Social Security Institute in Iceland (SSSI) in 1999 with the aim of reducing disability. MATERIAL AND METHODS: New disability claimants who had been unable to work because of illness for a few months at least were referred by SSSI physicians to a multidisciplinary team for assessment of rehabilitation potentials and an advice on the appropriate type of rehabilitation. The study group included all the 109 individuals who were referred to the team in the year 2000. Data on marital status, number of children and level of education was compared with information about the Icelandic population obtained in a national survey. The outcome of the rehabilitation was assessed in a telephone survey, carried out by the Social Science Research Institute, University of Iceland, 1-2 years after the assessment and by information obtained from the disability register at SSSI. The effectiveness of the rehabilitation programme was evaluated by comparing the study group with a comparable group that had started to receive rehabilitation pension before the SSSI could offer vocational rehabilitation. Their progress was assessed a year and half after they had contacted the SSSI, the same length of time as the study group had been in the in the rehabilitation programme. RESULTS: In the study group there were about twice as many women as men. The mean age was 35 years (range 18-57 years). The main medical reasons for referral to the team were musculosceletal and psychiatric disorders. Those evaluated were more likely to be unmarried or divorced, had more children and a lower educational level than the general Icelandic population. After evaluation 40 individuals were referred to vocational rehabilitation for approximately 2 months in a rehabilitation clinic; 19 were referred to a 6 week personal computer training at a vocational rehabilitation centre and 15 to a longer (usually 18 months) rehabilitation program in the same centre. In all, 46 individuals received other treatment or education. Almost three quarters (72%) of the participants in the telephone survey said that their fitness for work had increased after rehabilitation, but only 47% had returned to work. At the time of the reserach, 23% were students and it is likely that a part of them will return to work when their studies are completed. Between one and two years after the evaluation by the multidisciplinary team 44 out of 109 (40.4%) in the study group received disability pension and a equal number received no social insurance benefits at all. In the comparison group 97 out of 119 (81.5%) received disability pension and 21 (17.7%) received no social insurance benefits at all. CONCLUSIONS: This study shows that vocational rehabilitation organized by the SSSI is effective and can prevent disability. The results of this study are similar to the results of two Swedish studies on the same topic.

English Abstract↗
PubMed2006

[Differences in medical care utilization rates of the disabled and the non-disabled with ambulatory care sensitive conditions].

OBJECTIVES: The purpose of this study was to determine whether the disabled have worse access to primary care than the non-disabled. METHODS: We used the National Disability Registry data and the National Health Insurance data for the calendar year 2003, and we analyzed 807,380 disabled persons who had been registered until December 2001 and we also analyzed 1,614,760 non-disabled persons for nine ambulatory care sensitive conditions (ACSCs). The rates of physician visits and hospitalizations for the patients with ACSCs were compared between the disabled and the non-disabled. Multiple logistic regression analysis was used to evaluate the association between medical care utilization and disability and to assess the association between hospitalization and the number of physician visits while controlling for potential confounders. RESULTS: The numbers of physician visits per 100 patients were 0.78-0.97 times lower for the disabled than that for the non-disabled with five of nine ACSCs. The numbers of hospitalizations per 100 patients were 1.16-1.77 times higher for the disabled than that for the non-disabled with all the ACSCs. While the ORs of a physician visit for the disabled were significantly lower than that for the non-disabled with all the ACSCs (OR: 0.44-0.70), and the ORs of hospitalization for the disabled were significantly higher (OR: 1.16-1.89). The lower physician visit group (number of physician visits < or =1) was more likely to be hospitalized than the higher physician visit group (number of physician visits > or =2) (OR: 1.69-19.77). The effect of the physician visit rate on hospitalization was larger than the effect of disability on hospitalization. CONCLUSIONS: The results suggest that the disabled were more likely to be hospitalized for ACSCs due to their lower access to primary care.

Adolescent↗
PubMed1999

Access to the environment and life satisfaction after spinal cord injury.

OBJECTIVE: To determine the potential relation between satisfaction with life after spinal cord injury and access to the environment as measured by selected items from the Craig Handicap Assessment and Reporting Technique (CHART). DESIGN: Prospective, correlational/predictive study using cross-sectional and longitudinal data from 18 Model Spinal Cord Injury Systems of Care. SUBJECTS: Adult persons with traumatic-onset spinal cord injury (n = 650) evaluated at 1 or 2 years postinjury. OUTCOME MEASURE: Satisfaction With Life Scale (SWLS). PREDICTOR VARIABLES: Demographic characteristics, impairment and disability classifications. medical complications, rehabilitation insurance status, occupational status as measured by the CHART Occupation Scale, self-perceived health (from SF-36), and access to the environment as measured by items from the CHART Mobility Scale. RESULTS: Access to the environment was positively and linearly associated with satisfaction with life, demonstrated both positive and negative change over time, and was positively associated with subject's neurologic status. Access to the environment added to the explanatory model to predict life satisfaction even after all other independent measures were accounted for. CONCLUSION: Access to the environment (an "outside the person" factor) is important in predicting satisfaction with life for persons with spinal cord injury. The measure of access to the environment developed here is promising and worthy of further exploration and expansion.

Activities of Daily Living↗
PubMed1999

Changing patterns of conditions among children receiving Supplemental Security Income disability benefits.

OBJECTIVE: To determine the relative growth of types of chronic health conditions among children and adolescents receiving Supplemental Security Income (SSI) benefits before and after major SSI program changes, including changes in definitions of childhood disability and outreach to identify eligible children. DESIGN: Retrospective analysis of Medicaid claims from California, Georgia, Michigan, and Tennessee. PARTICIPANTS: All children (aged < or = 21 years) newly enrolled in SSI programs in these states from July 1989 (n=21 222) to June 1992 (n=38 789). METHODS: Medicaid data indicate eligibility status and diagnoses for services rendered. For children newly enrolled before (time 1, July 1989 to June 1990), during (time 2, July 1990 to June 1991), and after (time 3, July 1991 to June 1992) the program changes, we used claims for the first 6 months of enrollment to determine rates of chronic conditions in general and rates of asthma, attention-deficit/hyperactivity disorder (ADHD), and mental retardation specifically. We also followed up time 1 enrollees during the study period to determine the likelihood of a chronic condition claim at any time. MAIN OUTCOME MEASURE: Presence of claims for chronic conditions. RESULTS: New SSI enrollees almost doubled during the study period. Increasing numbers of new enrollees had chronic condition claims in their first 6 months (from 29% to 36%); 58% of time 1 enrollees had such claims during any study month. Rates of chronic physical conditions other than asthma increased 14% (time 1 to time 3); asthma rates increased 73%. Rates of mental health conditions other than mental retardation and ADHD increased 63%; rates of mental retardation decreased 29%, while rates of ADHD increased almost 3-fold. CONCLUSIONS: The number of children with chronic conditions receiving SSI benefits experienced rapid growth from 1989 to 1992. Growth was particularly marked for children with diagnoses of asthma and ADHD.

Adolescent↗
PubMed2001

[Severely disabled employees and their experiences with corporate policies concerning job retention. Selected results of an empirical study].

While the public has been paying attention to the topics illness and disability with respect to public health, long-term care insurance and public old age insurance systems for years, the risk of becoming disabled at work has been considered less. Research in this area has for a long time been focused on questions regarding first-time entry and return to work of disabled persons into the regular labour market. Also, much policy research has tended to deny an active role of the enterprise as an independent player and creator of policy in the management of disability. Hence only little documentation of employers' programmes and strategies as well as analysis concerning the question of job retention is available. In order to cover the research deficit a study with regard to employment careers of severely disabled was conducted in Rhineland-Palatinate from 1997 to 1999. The study pursues two different paths: On the one hand living and working conditions of this group are analysed, on the other the study's purpose is to give an overview of employers' disability management practices from the severely disabled employees' point of view. This article deals with the results of the policies within the enterprise study. It concerns the analysis of the following issues: Does disability have a negative impact on the employees' careers? Which measures are preferred by the persons interviewed and why? The final question, whether the need for supporting measures ascertained may be satisfied by the existing instruments available under the German Severely Disabled Persons Act must be answered with a clear "No"! Employers and disabled employees need alternative measures of support.

Adolescent↗