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PubMed1984

Funding health services for children.

This paper reviews major federal laws that have helped raise a consciousness in this country for increasing availability of health care services for handicapped and chronically ill children, and have authorized financial assistance for these services. This review is intended to provide a basic understanding of these key statutes so that they can be used to expand available occupational therapy services. Private health insurance is also reviewed since approximately one-third of all health care costs for children is reimbursed by this source.

Child↗
PubMed1980

Health Services Administration--Maternal and child health/crippled children's service program; policy statement on third-party reimbursement for services to mothers and children. General notice.

It is the position of the Health Administration that grantees receiving funds under the Maternal and Child Health/Crippled Children's (MCH/CC) program are required to make all reasonable efforts to obtain reimbursement for the costs of providing preventive, diagnostic and treatment services from third-parties, including private insurance carriers and government agencies. This requirement applies regardless of whether or not a charge is made to the individual for such services.

Adult↗
PubMed2001

[Medical and coordination aspects of workers' health care improvement and occupational therapy advances in present economic situation].

Medical and social aspects of workers' health care in present economic situation should be based on a Federal Law? 125 "On mandatory social insurance covering occupational accidents and occupational diseases" accepted in 2000. Medical care for workers could promote further improvement of occupational therapy service, foundation of industrial medicine centers similar to "AutoVAZ" Health Center, specification of new periodic documents on practice of periodic medical examinations, criteria determining disability degree. These measures could improve medical management of workers.

Accidents, Occupational↗
PubMed2002

[Development of a tree model that allows simple estimation of the required care level using the items of the basic investigation of long-term care insurance].

In long-term care insurance, the required care level of the disabled elderly is calculated from the results of the basic investigation. However, this calculation involves complex mathematical processes, and the estimation of the required care level at small facilities is difficult. We, therefore, developed a tree model that allows simple estimation of the required care level from the state of noticeable disabilities in daily activities. The model was prepared separately for dementia and physical disabilities. From the patients being cared for at Higashiyama Geriatric Hospital for the Elderly who had undergone primary rating, a total of 240 individuals consisting of 20 each in each of the 6 required care levels for both dementia and physical disabilities were selected, and the results of their primary rating were reviewed. "Putting on and taking off a jacket" and "care after urination", in which the required care levels increase relatively consistently as the investigation items progressed from those for "independent" to those for "totally assisted", were selected as the first selection items in dementia and physical disability models respectively. In a dementia model, the state of "putting on and taking off a jacket" and "care after urination" were matched for various required care levels as follows: "Independent"-->assistance needed, "observation needed" and "independent" in "standing up"-->required care level 1, "observation needed" and "not independent" in "standing up"-->required care level 2, "partly assisted"-->required care level 3, "totally assisted" and "not totally assisted" in "eating"-->required care level 4, and "totally assisted" and "totally assisted" in "eating"-->required care level 5. In a physical disability model, the state of "care after urination" was matched for various required care levels as follows: "Independent" and "independent" in "walking"-->assistance needed, "independent" and "not independent" in "walking"-->required care level 1, "direct or indirect assistance"-->required care level 2, "totally assisted" and "independent" or "observation needed" in "eating"-->required care level 3, "totally assisted" and "partly assisted" in "eating"-->required care level 4, "totally assisted" and "totally assisted" in "eating"-->required care level 5. The accuracy rate, i.e. the frequency of complete matching between the estimation of the required care level using this tree and that of the primary rating, was 71.1% in those with dementia and 66.7% in those with physical disabilities. The near accuracy rate, i.e. the frequency of matching between the two estimations within one rank higher or lower was 98.3% in those with dementia and 99.2% in those with physical disabilities. From these results, this tree model is considered to be useful for clinical rating.

Activities of Daily Living↗
PubMed1995

Medical and health care needs of families providing in-home care for relatives with developmental disabilities.

The purpose of this investigation was to attempt to describe the health care needs of families providing in-home care to members with developmental disabilities as well as the characteristics and demographics of families providing in-home care. The survey included 761 families who participated in a federal demonstration project in rural southern Georgia. The results indicated that impoverished families need increased assistance to provide adequate medical and health care when providing in-home care to relatives experiencing developmental disabilities. Implications for administration of programs and development of policies are discussed.

Caregivers↗
PubMed1996

Overweight, gender and knee osteoarthritis.

A 10-year follow-up study was carried out among 6647 farmers aged 40-64 y to investigate associations between age, gender, body mass index (weight/height2) and the incidence of disabling knee osteoarthritis. After the follow-up (1980-1990) a record linkage with the Social Insurance Institution's register was made to identify disability pensions. All the medical certificates for the disability pensions (N = 965) were reviewed to find out the incident cases (N = 126). Age, female gender and body mass index were all independent predictors of disabling knee osteoarthritis. The relationship between body mass index and the incidence of disabling knee osteoarthritis was linear, the adjusted relative risk was 1.4 (95% CI, 1.2-1.5) per standard deviation of the index (3.8 kg/m2). In women, as compared with men, the adjusted relative risks (95% confidence intervals) of right unilateral, left unilateral and bilateral knee osteoarthritis were 7.0 (2.5-19.7), 3.3 (1.1-9.8) and 4.8 (2.4-9.3), respectively. Overweight is a strong risk factor for disabling knee osteoarthritis.

Adult↗
PubMed2005

[Catastrophic health expenditures in Mexico: magnitude, distribution and determinants].

OBJECTIVE: To describe the magnitude, distribution, and determinants of catastrophic health expenditures in Mexico. MATERIAL AND METHODS: The information source was the National Performance Assessment Survey and the methodology, the one developed by the World Health Organization for assessing fair financing. Households with catastrophic expenditures were defined as those with health expenditures over 30% of their ability to pay. Multivariate analysis by logistic and linear regression were used to identify the determinants of catastrophic expenditures. RESULTS: A total of 3.8% of the households incurred in catastrophic health expenditures. There were huge differences by state. The uninsured, poor, and rural households showed a higher impoverishment risk. Sixty percent of the catastrophic expenditures were attributable to outpatient care and medication. A 10% increase of insured households could result in a 9.6% decrease in catastrophic expenditures. Disability, adults 60 years of age and older, and pregnancy increased the probability of catastrophic expenditures. CONCLUSIONS: The insurance of older adults, pregnant women, and persons with disabilities could reduce catastrophic health expenditures in Mexico.

Adult↗
PubMed2001

Sarcoidosis severity and socioeconomic status.

Several chronic diseases are more severe in persons who are Black, of low socioeconomic status (SES), and underinsured. The authors ask if this is true for sarcoidosis. Associations among sarcoidosis disease severity, SES, insurance coverage, and functional limitations were analysed. Back and White sarcoidosis patients (n=110) of a municipal and university hospital sarcoidosis registry were interviewed by telephone. Data on disease severity were abstracted from patient charts. Most patients reported good or excellent health by demographic characteristics. Low SES and no or public insurance were associated with worse health status and more severe dyspnoea. More advanced radiographic stage was associated with lower income, and forced vital capacity impairment with less education. Physical and social activity limitations due to physical and emotional disability were related to no or public insurance and lower income, but not education. Sarcoidosis severity is associated with socioeconomic status and insurance indicators; no or public insurance and low income are associated with functional limitations. Sarcoidosis-associated limitations are substantial, emphasizing the social significance of sarcoidosis. Lack of private insurance may inhibit the use of medical care, contributing to disease severity and impairment.

Black or African American↗
PubMed1986

Medical aspects of motor insurance.

Changes in the law related to, and the administration of, compensation under the Motor Vehicle Insurance Act of 1972 are likely in the near future. This Act makes the treating medical practitioner an obligatory assessor of damage incurred by individuals entitled to compensation under this legislation by completion of an MVA 13 form. The value judgment of a treating practitioner and an independent medical assessor in defining injuries and disabilities subject to legal claims are discussed and 5 cases are used to illustrate the disadvantages of the treating medical practitioner as the definitive source of assessment opinion--these are lack of objectivity, perpetuation of errors of omission and lack of specialized knowledge. The very limited value (if any) of the MVA 13 form is emphasized.

Accidents, Traffic↗
PubMedDate not supplied

Racial and ethnic differences in ADHD and LD in young school-age children: parental reports in the National Health Interview Survey.

OBJECTIVES: Racial and ethnic disparities have been documented for many physical health outcomes in children. Less is known, however, about disparities in behavioral and learning disorders in children. This study uses data from a national health survey to examine racial and ethnic differences in identified attention deficit hyperactivity disorder (ADHD) and learning disability (LD). METHODS: The 1997-2001 National Health Interview Surveys obtained information from parents about the health and sociodemographic characteristics of children. Using these data, prevalence rates of identified ADHD and/or LD were estimated for Hispanic, African American, and white children 6-11 years of age. Racial and ethnic differences in health conditions, income, and insurance coverage were examined as possible explanations for disparities in parental reports of ADHD and LD, as well as the use of any prescription medication among children with ADHD. RESULTS: Hispanic and African American children, compared to white children, had parental reports of identified ADHD without LD less often, and adjustments for the confounding variables-birthweight, income, and insurance coverage-did not eliminate these differences. Hispanic and African American children, compared to white children, also had parental reports of ADHD with LD less often after adjustments for the effects of confounding variables. By contrast, after adjustments for confounding variables, Hispanic and African American children were as likely as white children to have LD without ADHD. Among children with ADHD, use of any prescription medication was reported less often for Hispanic and African American children than white children. These disparities in medication use persisted after adjustments for confounding variables. CONCLUSIONS: The prevalence of ADHD and the use of any prescription medication among children with ADHD differed among Hispanic, African American, and white children. These disparities could not be explained by racial and ethnic differences in other health conditions and sociodemographic variables.

Attention Deficit Disorder with Hyperactivity↗
PubMed1983

Retirement disability among workers in a natural gas distribution company.

Epidemiological investigations of occupational disability are severely limited because of the inherent difficulties in standardizing definitions of disability and because of the lack of appropriate comparison data. Nevertheless, occupational disability is of great concern to workers. An investigation of disability, defined as permanent retirement due to medical disability, among hourly employees of a natural gas distribution company was undertaken in response to a request by the employees' union. Because of the above limitations, a hypothesis-generating rather than hypothesis-testing approach was taken, utilizing both disability retirement incidence rates and a prevalence survey of the living disabled retirees. It was hypothesized from the analysis that this group of workers did experience an excess of retirement disability for the period 1971-1980 when compared to estimated disability incidence rates of the general Social Security insured population, and that this excess may have been due in part to an excess of musculoskeletal disabilities associated with occupational physical stresses and strains.

Accidents, Occupational↗
PubMed1989

Domestic politics and international expertise in the history of American disability policy.

Architects of American disability policy partly emulated British and German social insurance programs through the New Deal's early years. Thereafter, social planners failed to tailor European manpower and income-maintenance programs to gain American lawmakers' approval. Distrust between the planners and legislators, intrafederal bureaucratic competition, congressional responsiveness to particular interests, and revitalized federalism all politically hindered Social Security from becoming a full-fledged social insurance program. Public/private-sector linkages, court actions, and voluntaryism constitute other salient American means of aiding persons with disabilities.

Persons with Disabilities↗
PubMed1997

Does psychological distress predict disability?

STUDY OBJECTIVE: To evaluate psychological distress as a predictor of disability due to common chronic disorders. STUDY POPULATION AND METHODS: A 10-year follow-up study was carried out among a representative cohort (N = 8655) of 18-64 year old Finnish farmers, who had participated in a health survey in 1979 and were able to work at baseline. A record linkage with the nationwide register of the Social Insurance Institution was made to identify disability pensions granted between 1980 and 1990 in the cohort. The medical certificates of 1004 (11.6%) prematurely retired farmers were reviewed to confirm and classify disabling conditions. A sum score based on self-reports of 11 symptoms at the baseline was used as a measure of psychological distress. RESULTS: After adjustment for age, sex, smoking and body mass index, the cause-specific relative risks (RR) (95% confidence intervals [CI]) of disability in the highest quartile of the psychological distress score as compared with the lowest quartile were for myocardial infarction 2.34 (95% CI: 1.17-4.69), for depression 2.50 (95% CI: 1.09-5.72), for neck-shoulder disorders 1.98 (95% CI: 1.26-3.11), for unspecified low-back disorders 1.76 (95% CI: 1.24-2.49), for knee osteoarthritis 1.55 (95% CI: 0.91-2.63) and for trip osteoarthritis 0.89 (95% CI: 0.42-1.85). The corresponding RR for overall disability was 1.76 (95% CI: 1.44-2.14) in the highest quartile of psychological distress score as compared with the lowest quartile. CONCLUSIONS: Psychological distress is an independent risk factor for disability. Its predictive significance varies between disorders leading to functional deterioration. The association mechanisms are likely to vary from one disorder to another.

Adolescent↗
PubMed1995

A cohort study of disability pensioning among Norwegian painters, construction workers, and workers in food processing.

The debate on the potentially adverse effects of long-term occupational exposure to organic solvents has mainly been based on observations in cross-sectional studies. We present results from a retrospective cohort study of three cohorts: 11,542 industrial and house painters, 36,899 construction workers, and 9,314 workers in food processing, all identified by the 1970 Norwegian census. The cohorts were followed to the end of 1987 for registration of disability pensioning by linkage of the census files to the files of the National Insurance Administration. The analysis revealed an increased risk for disability pensioning due to neurosis among the painters, compared with construction workers (rate ratio = 1.62; 95% confidence interval = 1.36-1.93) and compared with the workers in food processing (rate ratio = 1.84; 95% confidence interval = 1.42-2.38). The painters were also at increased risk of disability pensioning due to alcoholism. We found no major differences in ischemic heart diseases, disability pensioning due to all causes, or overall mortality. These results support the hypothesis that occupational exposure to organic solvents is a risk factor for disabling effects on the central nervous system.

Adult↗
PubMed1992

[Eligibility for intensive nursing care. Part 1: Guidelines and current experience].

Against the background of the planned statutory Pflegeversicherung (insurance for nursing care) in Germany, a report is presented on experience gained to date with the new Leistungsbestand "Schwerpflegebedürftigkeit" (situation requiring social benefit "urgent need of nursing care") (Para. 53 ff. SGB V). The experience gained so far is of particular interest since, for the first time on a large scale, monetäre Erstattungsleistung (the provision of a monetary entitlement) replaces the Sachleistungsprinzip (benefit in the form of services) that is otherwise applied in the area of health insurance. It is intended that this form of entitlement will form the core of the planned nursing care insurance scheme.

Persons with Disabilities↗