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PubMed2004

Swedish Council on Technology Assessment in Health Care (SBU). Chapter 11. Physicians' sick-listing practices.

Physicians' sick-listing practices have been studied to a very limited extent. There is limited scientific evidence that physicians perceive sick-listing duties to be difficult and problematic, regarding both the medical and the insurance-related aspects. There is limited scientific evidence also that quality is often deficient in the sickness certificates issued by physicians. This may affect case management at the local insurance office. There is insufficient scientific evidence to explain the differences in physicians' sick-listing patterns. The effects on patients are also insufficiently studied.

Demography↗
PubMed2002

Depression predicts disability in long-term chronic pain patients.

PURPOSE: Investigators have examined factors that predict treatment outcome and disability status in chronic pain patients, including psychopathology and personality characteristics with equivocal results. The purpose of this study was to evaluate the usefulness of personality characteristics, depression, and personality disorders in predicting disability status in pain patients with long-term follow-up. The setting was a rehabilitation hospital in Southern Sweden. METHOD: Subjects were 184 pain patients (mean age = 43.4 (10.8) years; 72.8% female) who had no more than 365 sick leave days (Mean sick leave days = 132.7 (128.2)) prior to the baseline personality and psychiatric evaluation. The baseline evaluation consisted of a psychiatric interview that included the administration of the Structured Clinical Interview for DSM-IV Screen Questionnaire (SCID-II), the Montgomery-Asberg Depression Rating Scale (MADRS), and the Karolinska Scales of Personality (KSP). Disability status was assessed by insurance record review a minimum of two-and-a-half years after baseline evaluation. RESULTS: Multivariate logistic regression suggests that age (OR = 1.09, 95% CI = 1.02-1.18; p = 0.013), number of sick leave days prior to evaluation (OR= 1.01, 95% CI= 1.01-1.02; p = 0.018), and baseline diagnosis of depression significantly predicted subsequent disability status (OR = 7.04, 95% CI = 1.15-42.93; p = 0.034). Baseline personality traits and the diagnosis of a personality disorder were not useful predictors of disability status in our sample. CONCLUSIONS: These data suggest that depression, but not personality disorders characteristics, was an important disability predictor in chronic pain patients with extended follow-up.

Adult↗
PubMed1993

When injury strikes.

EMTs and paramedics who are injured on the job may wind up thousands of dollars in debt. In the first of an ongoing series of articles focusing on insurance, EMS examines the need for disability coverage.

Emergency Medical Technicians↗
PubMedDate not supplied

[Forensic neuropsychology: principal issues and applications].

INTRODUCTION: The term Forensic Neuropsychology refers to the application of the knowledge of the field of Neuropsychology to the legal matters. The field of Clinical Neuropsychology has experienced a great development, thanks to the investigations and publications that have been made both in the basic and applied fields. Nevertheless, only in the last years, clinical neuropsychologists have participated actively in the courts. DEVELOPMENT: The testimony as experts of neuropsychologists is more and more common. They inform to the judge on the behavioral, emotional and cognitive sequels following lesions to the human brain, as well as the importance of psychosocial variables in modulating brain function and dysfunction. The relationship between Neuropsychology and Law has been influenced by the confluence of a series of related factors that have contributed to the professionalization of this discipline. Among these, we can emphasize the study of brain-behavior relationships by means of quantitative methods, the interpretative strategies to infer the presence, location and type of neuropathology; the decision making on legal subjects like the determination of disability; the description of the characteristic cognitive-behavioral profiles of neurological disorders; the implication of the psychosocial variables and the decision on the most appropriate interventions. Some of the most important objectives of this new discipline are: the identification of the sequels of mild traumatic brain injury as the posconmocional syndrome , the determination of premorbid intellectual functioning and the valoration of cognitive loss. There is no doubt that in the next years this field of application of Clinical Neuropsychology is going to experience an important growth in our country, thanks partly, to the norms that are followed to establish the degree of disability and the compensations of the insurance agencies, that consider these neuropsychological sequelae.

Brain Damage, Chronic↗
PubMed1994

Obesity and insurance risk: the insurance industry's viewpoint.

Obesity is regarded by insurance companies as a substantial risk for both life and disability policies. This risk increases proportionally with the degree of obesity. Mortality statistics for life insurance were the earliest indicator that the cost of obesity to the individual was a decreased life span and increased illness, particularly that affecting the cardiovascular and musculoskeletal systems. The prevalence of coronary heart disease rises with increases in the body mass index in both men and women. Cigarette smoking greatly augments these risks in both sexes. Hypertension and diabetes are very common in obese persons and add further to the risks of vascular disease. Abdominal obesity (when the abdominal girth measured round the umbilicus exceeds the maximum measurement round the hips) is correlated with the risk of cardiac disease and stroke, independently of bodyweight. Insurance companies consider abdominal obesity as unfavourable and rate it accordingly. Obesity (even that of moderate degree) greatly increases the chances of disability due to cardiovascular disease or musculoskeletal illness. In one study of 51 522 adult Finns, 25% of disability pensions in women were found to result directly from obesity. Obesity causes increased health expenditure, decreased life span and productivity, and premature retirement. Insurance companies are compelled to build these risks into their policies. However, because the excess mortality occurs late in mild to moderate obesity, some companies may minimise this risk for life policies that mature early.

Cardiovascular Diseases↗
PubMed2003

Are there inequities in the assessment of dementia under Japan's LTC insurance system?

BACKGROUND: Just two years after its inception, Japan's Long-term Care (LTC) insurance system is facing considerable criticism about whether or not it has developed a fair and appropriate way of allocating resources to the nation's disabled elderly population, especially those people with dementia. OBJECTIVE: The present study has investigated: (i) the relation of the Government-Certified Disability Index (GCDI) of the LTC insurance system to characteristics of people with dementia and their family caregivers; and (ii) whether the GCDI scores adequately reflect needs of people with DAT (dementia of Alzheimer's type) and VD (vascular-type dementia). METHODS: Subjects were assessed on their visits to outpatient clinics for their Activities of Daily Living (ADL), behavioural disturbances, MMSE, GCDI, service utilization and caregiver burden. Correlation analyses were conducted to examine the relationships among these variables, which were subsequently compared between the DAT and VD patients. RESULTS AND CONCLUSIONS: The GCDI was found to be associated with patients' ADLs and MMSE scores, and not with behavioural disturbances or caregiver burden. Compared to VD patients, people with DAT tended to have more behavioural disturbances but better ADL functioning. As a result, DAT patients were classified as 'less disabled' on their GCDI than VD patients, even though their caregivers felt as much burden as the caregivers of VD patients. These results show that the GCDI probably underestimates the impact of behaviour problems. Suggestions are made for a more balanced assessment of demented patients that is more consistent with their needs.

Activities of Daily Living↗
PubMedDate not supplied

[Equitable indemnity].

Explore the source record for details and available documents.

Disability Evaluation↗
PubMed1991

Results of statutory rehabilitation measures in Germany.

The success of medical rehabilitation measures taken by the LVA Oberfranken and Mittelfranken in 1984 was scrutinized for 12,291 insured people. The criteria for evaluating success were the state of health of the insured persons before rehabilitation and at one month and one year afterwards. Two thirds of the insured persons were at work again one month after discharge from rehabilitation. One year after rehabilitation 14 per cent received a disablement pension. Only every second person insured who was ill before rehabilitation took up work again afterwards. Most of the insured people who were already receiving a pension before rehabilitation continued to receive their pension afterwards (86 per cent). The highest rate of inability to work and also the highest pension rate is found with insured persons suffering from an ischaemic cardiac disease. Only 33 per cent of these persons resume work after rehabilitation.

Adult↗
PubMed2002

Redistributive effects of the Swedish social insurance system.

BACKGROUND: Four principles are used to distribute payments via the Swedish social-insurance system in cases of temporary or permanent illness and death. This paper studies the redistributive effects on income of these four principles. METHODS: The analysis is based on aggregate social-insurance data from the 25 municipalities that comprise Stockholm County in Sweden. For nine different types of social-insurance payments based on the four principles, the degree of income redistribution is measured according to concentration indexes and differences between Gini coefficients with social-insurance payments excluded and included. RESULTS: The concentration indexes for payments from the nine social-insurance schemes in total is -0.0469. The Gini coefficient falls from 0.0437 excluding insurance payments (i.e. for income only from gainful work, IGW) to 0.0379 when including insurance payments with income from gainful work (IGW + TP). That is, the Gini coefficient is 15% lower when insurance payments are included. Decomposition by payment shows that the largest redistribution effect on income inequality is made by disability pension. CONCLUSION: Municipalities with low average income are favoured by the Swedish social-insurance system. Payment principles can be ranked according to their redistributive capacity: mix of compensating-lost-income and flat-rate, compensating-lost-income, means-testing, flat-rate, and need-based respectively. The nine social-insurance schemes contribute very differently to income redistribution. Disability pension and sickness allowance contribute most to income redistribution and reducing income inequality.

Cost of Illness↗
PubMed1998

Physicians as gatekeepers: will they contribute to restrict disability benefits?

OBJECTIVE: To study how general practitioners (GPs), specialists, and National Insurance Administration (NIA) medical consultants reacted to the narrowed eligibility criteria for disability benefits in Norway from 1991. DESIGN: Records of first-time applicants for disability benefits from the first quarters of 1990 and 1993 were analysed for proposals from the physicians in relation to the decision. SETTING: Two Norwegian counties, Ostfold and Møre and Romsdal. SUBJECTS: 668 applicants--half the granted cases, and all the refused ones. RESULTS: The number of applicants fell by 39% from 1990 to 1993 and the refusal frequency increased from 8 to 21%. Nevertheless, GPs recommended refusal to about the same extent as before, 8-9% of all cases, with probably a minor fall from 52 to 42% of the refused ones (p = 0.19). Specialists did not recommend more refusals than the GPs. Cases evaluated by the NIA medical consultants increased from 29 to 41%, and their concordance with the patients' GPs seemed to be approximately 50%. GPs did not give more detailed medical descriptions in 1993 than in 1990, and discussed eligibility criteria but slightly more comprehensively. CONCLUSION: GPs are willing to act as gatekeepers for social insurance benefits for their patients, also when eligibility criteria become restricted.

Adolescent↗
PubMed2000

Sickness benefits. Railroad Retirement Board. Final rule.

The Railroad Retirement Board (Board) hereby amends its regulations under the Railroad Unemployment Insurance Act (RUIA) to permit a "nurse practitioner" to execute a statement of sickness in support of payments of sickness benefits under the RUIA. The Board does not currently accept statements executed by a nurse practitioner, which in some cases may delay payment of benefits.

Disability Evaluation↗
PubMed1992

Return to work of road accident victims claiming compensation for personal injury.

Road accidents resulting in personal injury are an increasing cost to society. This study is based on 609 accident victims (of whom 521 survived injury) who were in employment when injured and whose claims for personal injury were settled for 5000 pounds or more by one insurance company over 2 years. It examines survivors' residual disablement, return to work and involvement with rehabilitation services. Data on a representative sample of 101 cases are analysed in more detail to identify possible 'predictors' of return to work. Both univariate and stepwise logistic regression analysis suggest that return to work is less associated with clinical variables, on which much medical advice on return to work is based, than with such other variables as time off work, absence of psychological problems and younger age. Very low rates of referral to rehabilitation may indicate that a rehabilitative approach to cost containment is underutilized in comparison with the traditional emphasis on preventive measures and enhanced medical treatment. More effective rehabilitation, however, may require new approaches to clinical case management, especially in orthopaedic departments where most personal injury claimants are treated.

Accidents, Traffic↗