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PubMed1998

Factors associated with waiting time for surgery.

OBJECTIVE: To explore the factors associated with waiting times for surgery in public hospitals. SETTING: Three major acute care public hospitals in one Area Health Service. PARTICIPANTS: 691 adult patients entered onto the computerised booking list between 16 and 22 November 1994, and then between 16 January and 12 February 1995, were interviewed prospectively and followed up over a minimum of 18 months. Data were obtained from the Area Health Service's computerised booking system and patient self-report. RESULTS: Relevant surgical specialty, urgency rating, employment status and health insurance status were significantly associated with waiting time. Age, hospital, sex, country of birth, education, marital status and holding a Health Care Card were not significantly associated with waiting time. Self-reported health status (as measured by the SF-36) was not associated with waiting time for surgery. CONCLUSIONS: Waiting time for surgery was not simply determined by how urgently patients need surgery, but also by the type of surgery needed and patient's employment and health insurance status. The extent of disability experienced by patients, as measured by the SF-36, was not reflected in waiting times for surgery.

Adult↗
PubMed2004

Knowledge-based changes to health systems: the Thai experience in policy development.

Over the past two decades the government in Thailand has adopted an incremental approach to extending health-care coverage to the population. It first offered coverage to government employees and their dependents, and then introduced a scheme under which low-income people were exempt from charges for health care. This scheme was later extended to include elderly people, children younger than 12 years of age and disabled people. A voluntary public insurance scheme was implemented to cover those who could afford to pay for their own care. Private sector employees were covered by the Social Health Insurance scheme, which was implemented in 1991. Despite these efforts, 30% of the population remained uninsured in 2001. In October of that year, the new government decided to embark on a programme to provide universal health-care coverage. This paper describes how research into health systems and health policy contributed to the move towards universal coverage. Data on health systems financing and functioning had been gathered before and after the founding of the Health Systems Research Institute in early 1990. In 1991, a contract capitation model had been used to launch the Social Health Insurance scheme. The advantages of using a capitation model are that it contains costs and provides an acceptable quality of service as opposed to the cost escalation and inefficiency that occur under fee-for-service reimbursement models, such as the one used to provide medical benefits to civil servants. An analysis of the implementation of universal coverage found that politics moved universal coverage onto the policy agenda during the general election campaign in January 2001. The capacity for research on health systems and policy to generate evidence guided the development of the policy and the design of the system at a later stage. Because the reformists who sought to bring about universal coverage (who were mostly civil servants in the Ministry of Public Health and members of nongovernmental organizations) were able to bridge the gap between researchers and politicians, an evidence-based political decision was made. Additionally, the media played a part in shaping the societal consensus on universal coverage.

Cost Control↗
PubMed2002

[Validity of care assessment in disabled and mentally retarded children].

16 children with spastic cerebral palsy and 25 mentally retarded children were assessed via the scales "Self-Care" and "Mobility" of the Pediatric Evaluation of Disability Inventory (PEDI). Age-adjusted PEDI scores were compared with the classification according to the three levels of the German statutory nursing insurance. Good correlations and highly significant dependence were found in children with spastic cerebral palsy but no dependence was seen in mentally retarded children. Apparently, assessment guidelines of the German statutory nursing insurance do not guarantee a valid assessment in all disabled children. In conclusion, future assessments of nursing needs in children should employ standardised assessment methods.

Cerebral Palsy↗
PubMed1976

Men with disability pension.

In 1964, temporary or permanent disability pension was granted to 2.9 per thousand of all men in Malmö aged 16 to 66 years. The figure for 1974 was 10.6 per thousand, i.e. 3.7 times as high. The 235 men who in 1964 for the first time had been granted temporary or permanent disability pension by the Regional Social Insurance Office were compared with 235 men chosen at random from the 893 who in 1974 had been granted these benefits for the first time. The relation between temporary and permanent disability pension in the 1964 material was 1:2, and in the 1974 material, 1:4. In the 1964 material, the average age was 54.9 years; in the latter 57.4. The main diagnoses mental disorders, diseases of circulatory system, and diseases of the musculoskeletal system represent about 70% of the cases in each of the materials.

Age Factors↗
PubMed2002

Reasonable accommodations for medical faculty with disabilities.

An unknown number of medical school faculty have disabilities, and their experiences have generally escaped notice and scrutiny. Although most medical schools offer long-term insurance and extended leaves of absence for disability, relatively few have policies explicitly addressing accommodations for faculty with disabilities as they perform teaching, research, and clinical duties. We discuss accommodating active medical school faculty with disabilities, drawing on University of Pennsylvania School of Medicine initiatives exploring the concerns of faculty with sensory and physical disabilities. Anecdotal reports suggest that many faculty, fearing reprisals, resist seeking job accommodations such as those mandated in the 1990 Americans with Disabilities Act (ADA). Although some faculty with disabilities have found supportive academic mentors, others report that lax institutional enforcement of ADA requirements, including physical access problems, demonstrates a tepid commitment to disabled staff. Potentially useful job accommodations include adjusting timelines for promotion decisions; reassessing promotions requirements that inherently require extensive travel; improving physical access to teaching, research, and clinical sites; and modifying clinical and teaching schedules. Faculty with disabilities bring identical intellectual and collegial benefits to medical schools as their nondisabled counterparts. In addition, they may offer special insights into how chronic illness and impairments affect daily life.

Architectural Accessibility↗
PubMed2003

Comparing the medical expenses of adults with Medicaid and commercial insurance in a health maintenance organization.

The objective of this study was to compare the health care costs of adults with Medicaid aged 19 to 65 years (n = 29,680) and adults in the same age range with commercial insurance (n = 29,680) who were members of the same health maintenance organization between 1996 and 1998. After adjusting for age and sex, income-eligible Medicaid-insured adults were $35 (29 percent) per month more expensive than commercially insured adults. The medically needy/indigent (excluding "spend-down") were $61 (51 percent) per month more expensive than commercially insured adults, and the blind or disabled were $289 (240 percent) per month more expensive. When the analysis adjusted for health status as well as age and sex, however, income-eligible Medicaid adults were $12 (p = 0.01) per month less costly than commercially insured adults. The costs of Medicaid-insured adults were substantially higher than those of commercially insured adults; these differences were likely due to higher rates of pregnancy and to worse health status among the Medicaid cohort.

Adult↗
PubMed2000

[What protection for handicapped child and his family today and tomorrow? The Precariousness Commission of the French Society of Pediatrics].

The recent decision of a large insurance company to put an end to the contracts of insurance subscribed by thousands of French parents for their disabled children, has brought to light the precariousness of the disabled children in our society. The available assistance for the disabled children in the French social welfare is described. Although significant this national assistance remains insufficient in order to avoid the precariousness of the disabled children and their families. An additional effort of solidarity of both the community and the insurance companies is therefore necessary.

Adolescent↗
PubMed1975

The compensation experience of patients with chronic beryllium disease.

The experience of patients with chronic beryllium disease seeking workmen's compensation indicates that the system does not meet its intentions of providing for relief of workers for job-related illness. In the instance of beryllium disease there is undue delay in adjudication of the compensation. This delay has its origin in part from litigation over the diagnosis and disability on the part of private insurers and in part on failure of the IAB to press for findings. Moreover, the process of litigation and delay may produce significant psychological distress. For others the compensation for a chronic disability is inadequate. Whether compensation acts as a system of relief depends on whether the patient has a working husband or wife. Among the women here with beryllium disease, the system worked only to the extent that they could rely on their husbands. Compensation benefits should be provided in accord with rises in the cost of living index. Compensation boards should press for prompt settlement of claims.

Adolescent↗
PubMed1994

[Oligophrenia as a disability diagnosis. Disability pensions in the period 1967-1992 in a group from Bergen born in 1940].

The authors discuss the use of unspecified oligophrenia as a diagnosis for disability pension, and draw attention to unrecognized oligophrenia. The study is based on a cohort of 1,570 persons, comprising all live births from 1940 of the mothers then residing in Bergen. The cohort was followed up in the school system in Bergen at age 14 years, again at age 30 years (1971) and up to the end of 1992. Relevant information on disability pensions was extracted from the files of the National Insurance Administration. The results of medical and psychological examinations in 1971 of a random sample of the cohort are also included. In the cohort 180 persons became new pensioners during the years 1967-92. Of these 10.6% were diagnosed as disable due to oligophrenia. In the sample 69.6% of the IQ-group 55-69 were receiving a disability pension, two thirds with a diagnosis of oligophrenia. In the IQ-group 70-84, 46.4% had a disability pension, one third with the diagnosis oligophrenia. These findings suggest that the use of oligophrenia as a disability diagnosis is less frequent than the prevalence of oligophrenia would in fact seem to justify.

Adult↗
PubMed1997

The transplant trap: the impact of health policy on employment status following renal transplantation.

This study examined the relationship between concern for health insurance coverage and employment status following renal transplantation. The sample consisted of 293 individuals who underwent renal transplantation at The Ohio State University Medical Center. The study found fewer individuals reported employment during the past year (58%) than indicated they were able to work (72%). Although 72% of the sample indicated the physical ability to work 41% reported receiving a monthly disability check. Regression analysis revealed that receipt of a monthly disability check and employment status one day prior to transplant were the two most significant predictor variables for employment activity during the year prior to participation in this study. Intervention that is coordinated on a psychosocial level from the time of diagnosis of ESRD throughout the post-transplant period is critical to supporting individuals in pursuing their goals. Research findings should be utilized to advise policy-makers and advocate for system changes that support employment for individuals with ESRD.

Adolescent↗
PubMed2005

[Do psychiatric patients receive disability pension before adequate diagnostics and treatment? Evaluation of 101 psychiatric expertises done on behalf of Swiss Invalidity Insurance and the Psychiatric Outpatient Department Basel in 2002].

OBJECTIVE: a) Does the psychiatric expertise confirm the claimed psychiatric diagnoses in patients applying for a disability pension due to a psychiatric (co)morbidity? b) Had the patients received adequate psychiatric treatment before being sent for the psychiatric disability expertise? METHODS: Key data of 101 psychiatric expertises done in 2002 on behalf of the Swiss invalidity insurance/Basel were analysed. RESULTS: a) 17% did not have a psychiatric diagnosis affecting the ability to work. In 50%, the ability to work was reduced by max. 30%, i. e. the prerequisites of a pension were not met. b) Patients with a psychiatric diagnosis affecting the ability to work: 50% reported to take a specific psychotropic medication, but only in 40% of them (i. e. 20% of the patients with a psychiatric disorder) the blood level was within the therapeutic range; only 35 % reported to have "some form of psychotherapy"; only 15% had been previously hospitalized. CONCLUSIONS: Many of the 101 patients applying for a disability pension had not been sufficiently diagnosed and had not received adequate psychiatric/psychotherapeutic treatment before the expertise.

Adult↗
PubMed2000

Medicolegal issues for the dermatologist.

Medicolegal issues for the dermatologist cannot be ignored. Appropriate legal advice from an attorney with such expertise may represent an unwanted office expense. However, the value of this advice in an increasingly hostile health care environment cannot be underestimated. Legal consultation, an insurance policy against the vagaries of health care law, has become a necessity in our litigious society.

Dermatology↗
PubMed2002

Medicaid and indigent care issue brief: Medicaid: access to health services: year end report-2002.

Medicaid provides health insurance coverage to low-income children, parents meeting specific income thresholds, pregnant women, the elderly and people with disabilities. In 1999, Medicaid provided health care insurance to approximately 32 million low-income Americans. However, in that same year, 42 million Americans had no health insurance at all. In order to reduce the number of people without health insurance, states have expanded or clarified their eligibility standards to allow more people to enroll in Medicaid and other medical assistance programs.

Adult↗
PubMed2003

Medicaid and indigent care issue brief: Medicaid: eligibility: year end report-2003.

Medicaid provides health insurance coverage to low-income children, parents meeting specific income thresholds, pregnant women, the elderly and people with disabilities. In 1999, Medicaid provided health care insurance to approximately 32 million low-income Americans. However, in that same year, 42 million Americans had no health insurance at all. In order to reduce the number of people without health insurance, states have expanded or clarified their eligibility standards to allow more people to enroll in Medicaid and other medical assistance programs.

Aged↗
PubMed2002

Public housing accommodations for individuals with disabilities.

The federal Housing Act of 1962 as amended and the subsequent laws of accommodations insure that all groups within American society, including those with disabilities, have access to housing opportunities. In spite of the clear provisions of various laws of accommodations enacted after 1962, it is questionable whether disabled individuals are adequately served by resident programs operated by Public Housing Agencies (PHAs) because rates of poverty, unemployment, domestic violence, and suicide are much higher among people with disabilities than in the nondisabled population. There are approximately 5 million residents living in 2.5 public housing units nationwide. New York, Puerto Rico, Chicago, Philadelphia and Baltimore have the five largest PHAs in the country. In combination, they rent 320,000 of the 1,300,495 inventory of rental properties owned by the country's 3,400 PHAs. Elderly and disabled residents without children account for 43% of all public housing families in the country.

Architectural Accessibility↗