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PubMed1991

[Statutory accident insurance--obligatory social accident insurance in Switzerland].

According to the new Accident Insurance Law, in Switzerland it is mandatory for all employees to be insured against accidents and occupational diseases. The legal bases, organization and implementation of this mandatory social accident insurance are described. Discussed in particular are the specific Swiss features, such as the inclusion of non-occupational accidents (leisure-time accidents), and special medical aspects in the assessment of incapacity, injury and occupational diseases.

Accidents, Occupational↗
PubMed2000

[Need for and availability of services by nursing insurance for patients with rheumatoid arthritis].

UNLABELLED: Although rheumatoid arthritis is amongst those functional disabling diseases requiring massive help and care, there is as yet no study on how RA patients master their everyday lives, nor are there reports on how many of those patients are in need of and/or do in fact receive benefits from the German Nursing Care Insurance. METHODS: In a representative sample of considerably disabled RA patients (functional capacity < 67%) in rheumatological care it was investigated how many patients received nursing care insurance benefits and how many more would have been entitled to receive them. Standardized interviews exploring functional capacity, amount of help and care needed and help-seeking behaviour were conducted to determine which patient-related and resource-related characteristics were associated with unmet need regarding the patients entitlement to benefits of nursing care insurance. Using the relation between justified need for nursing care insurance benefits and the functional status score, a coefficient was computed by logistic regression to project the expected proportion of RA patients entitled to care insurance benefits. RESULTS: A projected 5.4% of all RA patients needed benefits from the nursing care insurance, but only 63% of those did in fact receive benefits. It was found that unmet need was almost exclusively due to the fact that patients actually eligible for insurance benefits did not apply for it, whereas unjustified rejection of applications by insurance experts made up for only a marginal proportion. CONCLUSION: Applying for nursing care insurance benefits is still not a matter of course. It must be considered that about one third of all obviously care-dependent RA patients either claim care insurance benefits too late or never do. To avoid unmet need, experts should encourage particularly those patients who are unaware of their right to ask for help.

Adult↗
PubMed2004

Swedish Council on Technology Assessment in Health Care (SBU). Chapter 5. Risk factors for sick leave - general studies.

Extensive information is available from official statistics and descriptive studies on the association between different socio-demographic background factors and sickness absence. This information addresses age, gender, place of residence, and socio-economic status. However, few studies have thoroughly analysed these background factors, and rigorous scientific evidence on the causal relationship between these factors and sick leave is lacking. Regarding the family, we found no scientific evidence that marital status or children living at home were associated with sickness absence. However, we found limited scientific evidence for an effect of divorce. Regarding work-related factors, we found limited scientific evidence for an effect of physically stressful work, and moderate scientific evidence for low psychological control over the work situation. We found limited scientific evidence for a correlation in time between unemployment and sickness absence, but insufficient scientific evidence for the causes of the association. There was moderate scientific evidence that the amount of sickness absence is influenced by the design of the social insurance system, but insufficient evidence on the magnitude of change required to influence the level of sickness absence. Essentially the same results apply to disability pension, although the number of studies is small. However, we found moderate scientific evidence for the effects of socio-economic status, which could be explained partly by childhood experiences.

Absenteeism↗
PubMed2001

Assessing impairment and disability for syndromes presenting with chronic fatigue.

Many disability claims are based on the subjective symptom of fatigue, which can be caused by a wide spectrum of diagnoses including fibromyalgia, chronic fatigue syndrome and cardiopulmonary diseases. Chronic pain is very often a compounding problem. It is vital for every insurer to have fair and objective criteria to distinguish between invalid claims and those with merit. This review article proposes objective tools and parameters to achieve this goal.

Activities of Daily Living↗
PubMed1994

Determining differences in post discharge outcomes among catastrophically and noncatastrophically sponsored outpatients with spinal cord injury.

This study tested differences in functional independence status, level of psychologic distress and extent of handicap experienced after discharge from inpatient rehabilitation among a group of 125 outpatients with spinal cord injury (SCI) sponsored by one of three types of rehabilitation insurance payors: catastrophic (Michigan Automobile No-Fault and Workers' Disability Compensation), Medicaid and third-party privates. Outcome measures included the functional independence measure, the brief symptom inventory and the Craig handicap assessment reporting technique. Insurance data was obtained via medical chart reviews and interviews that were conducted either face-to-face or by telephone, using the benefits coverage inventory. No differences in terms of post discharge functional independence across subjects sponsored by the three payors was found when controlling for neurologic status. However, SCI subjects sponsored by different payors reported receiving different amounts of benefits. Subjects also differed on the extent of psychologic distress experienced after discharge and the extent of their handicaps. SCI subjects sponsored by Medicaid reported receiving fewer benefits, being more distressed and experiencing greater handicap in comparison to others. Third-party privately sponsored subjects, conversely, experienced less handicap and distress than did the study's other subjects.

Activities of Daily Living↗
PubMed2001

[Somatoform pain disorder and work disability].

Over the past few years, the number of i.v. pensioners has risen drastically. According to BSV statistics the diagnosis for the new pensions was mainly based on psychological disorders and problems with the musculoskeletal system. A large portion of these people with new disabilities are probably suffering from somatoform disorder, whereby the insured person complains about pain for which there are no demonstrable organic findings. The author contests the fact that this condition automatically leads to disability and makes an appeal for stricter, more exacting diagnostic screening: psychiatric co-morbidity must be considered in order to be able to determine the degree of work disability. Due to its multiplicity and inconsistencies, current practice is no longer able to ensure equal handling of all insured persons.

Cross-Sectional Studies↗
PubMed1989

[Doctors' assessment of occupational injuries. Regulations and working methods].

Many medical practitioners deal with occupational injuries and diseases. Norwegian employees, military servicemen, fishermen, students and schoolchildren are entitled to specific social insurance benefits in the event of occupational injury (injury at school) or occupational disease. In most cases the social insurance office requires a medical assessment from the doctor. Adequate knowledge of the social insurance regulations and good working methods for medical assessment contribute to fair administrative decisions and help the doctor to deal with such cases. The authors present the part of the regulations most relevant for medical practitioners, and describe suitable working methods.

Accidents, Occupational↗
PubMedDate not supplied

Use of an artificial neural network (ANN) for classifying nursing care needed, using incomplete input data.

BACKGROUND: In German nursing insurance, the act of classifying the client into four categories of disability is based on legally defined distinct criteria. When classifying deceased persons it is often impossible to collect all the required information. PRIMARY OBJECTIVE: We aimed to determine the ability of an artificial neural network (ANN) to calculate the category of disability, to investigate the response of the ANN to input items of different nature, quantity and data quality, and to estimate the minimum number of training data required. RESEARCH DESIGN: The investigation was conducted as a retrospective observational study. METHODS AND PROCEDURES: The analysis was based on routine records of 14000 adult clients of the nursing insurance. Several ANNs were trained, varying nature, number and quality of the input items as well as the size of the training data set. Each ANN's classification competence was tested on independent validation data, judging the ANN's conformance to the result of the individual expert assessment, using kappa statistics. MAIN RESULTS: Fed with all 30 input items available, the net classified 80% of cases correctly (weighted kappa = 0.78). Using three input items, weighted kappa was 0.63. Severe misclassification (deviation by more than one category in either direction) ranged between 0.2% (all 30 input items) and 3.7% (3/30 items). The less complete the individual input items were, the less accurate was the net's estimate. A 20% rate of missing values was well tolerated. A training set comprising 500 cases was adequate. CONCLUSIONS: The input item set inherits redundancy. The ANN's ability to correctly respond to subsets of input items makes it a powerful tool in quality control. In the categorization of deceased persons when only an incomplete input item set is available, the ANN can achieve satisfactory results.

Activities of Daily Living↗
PubMed1991

Preoperative insurance status influences postoperative complication rates for gastric bypass.

One hundred morbidly obese patients who had gastric bypass surgery were studied to determine how various demographic and medical variables affected complication rates, weight loss, and reduction in comorbidities associated with obesity. During the follow-up period (range: 12 to 59 months), 42 patients developed at least 1 complication. Twenty-three patients developed postoperative medical complications, 9 developed psychiatric complications, and 24 developed complications related to food ingestion. No significant relationships were observed between outcome and age, sex, age of obesity onset, or associated medical disorders. Striking differences in outcome were noted, however, when patients were contrasted according to their preoperative insurance status. Patients dependent on medical assistance, social security disability, or workman's compensation (publicly funded group) (n = 40) developed significantly more medical and psychiatric complications than did those (n = 60) who had private medical insurance (p less than 0.02). Despite the higher complication rate, both groups had the same average weight loss (44.9 +/- 15.3 kg for the publicly funded group versus 43.1 +/- 12.9 kg for those with private insurance) and similar reductions in percent excess weight (66.0 +/- 18.4% versus 75.7 +/- 23.0%) during the first postoperative year. All patients also had similar reductions in medication requirements for hypertension, diabetes, and degenerative joint disease. Additionally, 45% of the publicly funded insurance group who either received public welfare (n = 26) or disability benefits (n = 14) preoperatively were able to attain either full-time or part-time employment postoperatively which allowed them to decrease their level of support (58% and 21%, respectively). Forty-six percent of women in the private insurance group who were not working outside the home also began part-time or full-time employment postoperatively. All patients who were working preoperatively continued to work. These data suggest that although the risks associated with gastric bypass surgery are greater in patients dependent on public funding, these patients benefit significantly from the surgery.

Adolescent↗
PubMed2000

Personal viewpoint: eclecticism in health services for developmental disorders.

The term 'eclectic', as applied to health care for children with developmental disorders, portrays an individualized, adaptive service response to local constraints and pressures. While this may appear appropriate for the local setting, the end result is a broad diversity of health care approaches. This paper discusses three separate processes that interact at a local level, increasing the likelihood of an eclectic local model of health care for this population of children. The first process draws from the direct clinical work. Variable training, knowledge and skills among health care providers, in combination with differing beliefs around the nature of the problems and their management leads to health care which directly reflects the attributes of the local clinicians. A separate, second process fuelling variability is the differing models of departmental responsibility across Australia - which Government departments fund which aspect of care for children with disabilities. The final process relates to funding streams for health care. State public health, federal Medicare and private insurance all support health services for children with disabilities, with the financial incentives (budgets compared to fee-for-service) driving a divergence of practice. This paper concludes that the external political, administrative and financial frameworks within which health care is constructed will continue to promote clinical eclecticism to a degree that would probably be considered unacceptable in other areas of child health care. The solution can only arise from within the clinical work itself, with greater clarity of understanding around the nature of the disorders, the outcomes for which health care takes responsibility, and an increasing focus on an evidence based set of approaches towards achieving these.

Australia↗
PubMed1993

[Role of the basic group in health insurance. Experiences with 70 cases in the municipality of Verdal].

The role and conclusions of the discussions in the basic group in the municipality of Verdal have been evaluated. 70 patients were referred to the group during a three year period. The large majority of the patients suffered from minor mental disease or musculoskeletal disease. 63% of the patients and 69% of their own doctors attended the discussion. Follow-up, first after one year and later after two to four years showed a fair degree of reliability as regards the accuracy of the group's conclusions. The basic group is an important collaborator for the Norwegian National Insurance Scheme and should be consulted at an early stage in many cases evaluated for rehabilitation benefits or disability pension.

Adult↗
PubMed2002

The role of gender in long-term sickness absence and transition to permanent disability benefits. Results from a multiregister based, prospective study in Norway 1990-1995.

BACKGROUND: The aim of the study was to identify predictors for the transition from long-term sickness absence into disability pension with a special focus on gender. METHODS: The study used data from a national database containing a 10% random sample of the Norwegian adult population (The KIRUT database). The study population were all individuals in the database who on 1 January 1990 were eligible for sick pay from the Norwegian National Insurance System: 83,398 men and 75,586 women. Individuals below 60 years with long-term sickness absence starting in 1990 and 1991 were identified, 6,434 men and 8,233 women, and followed up for three years. Background data were used as independent variables in a logistic regression of the probability for receiving disability pension during follow-up. RESULTS: Annual cumulative incidence of long-term sickness absence was 6.5% for women and 4.9% for men. During follow-up, 12.4% of the women and 12.6% of the men received disability pension. Among full-time employed women only 10.3% had become disability pensioners, while the corresponding proportion for women working part-time was 15.5%. For men the figures were 12.1% (full-time) and 18.1% (part-time). In the logistic regression of the whole sample the female odds ratio was insignificant. The dominant predictive factors for disability pension were age and duration of the sickness spells. Working part-time also increased the risk. Higher levels of education and having children below 7 years reduced the probability for disability pension. Separate regressions for men and women showed that the 'protective' effect of having small children only remained for women.

Adolescent↗
PubMed2000

Comparing the medical expenses of children with Medicaid and commercial insurance in an HMO.

BACKGROUND: In recent years, growing numbers of children with Medicaid have been enrolled in managed care plans nationwide. Yet, large, commercial managed care plans are increasingly discontinuing their participation in Medicaid because of low Medicaid payment rates. OBJECTIVE: To compare the healthcare utilization and costs of children with Medicaid and children with commercial insurance within the same health maintenance organization (HMO). STUDY DESIGN: Retrospective study using electronically captured cost and utilization data. PATIENTS AND METHODS: We compared the healthcare utilization and costs of children with Medicaid (n = 42,636) and children with commercial insurance (n = 159,651) who were members of the same large, nonprofit HMO at any time between January 1, 1995, and December 31, 1997. Medicaid children were grouped as income eligible, medically needy, and blind or disabled. RESULTS: The unadjusted costs of income-eligible, Medicaid-insured children were not significantly different from those of commercially insured children. The medically needy were $25 per month more expensive than commercially insured children (P = 0.02), and the blind or disabled were $213 per month more expensive (P < .01). After adjusting for age and sex, income-eligible children were $5 per month more expensive than children with commercial insurance (P = .07), the medically needy were $20 per month more expensive (P = .02), and the blind or disabled were $216 per month more expensive (P < .01). CONCLUSIONS: The costs of income-eligible, Medicaid-insured children in this HMO were similar to those of commercially insured children, but the costs for the medically needy and the blind and disabled were substantially higher.

Adolescent↗
PubMed1980

[The life expectancy after cardial infarct regarding the social-insurance company (author's transl)].

German insurance statistics indicate that the age for admission to disablement benefit after myocardial infarct has not increased during the past ten years, which means that there has been no improvement. From among the pensioners in the workers' annuity insurance (Rheinprovinz) as many as 63.0% survived the 7 years' observation period in the case of anterior and 80.1% in the case of posterior wall infarction. While in respect of posterior wall infarction the age dependence has been less distinct, the survival rate reduced by 86.7% in case of male patients younger than 40 years to 49.4% in case of patients of 60 years and over. Minor differences only have been found to exist in respect of females. Regarding the deceased, it has been discovered that also the mean survival rate in years strongly depended on infarct locality, i.e. anterior or posterior wall. Disability benefit used to be granted already on the average 2 years after infarction which means that applications were already filed in the year when the infarct occurred or in the year thereafter. This gives rise to the conclusion that there are too many doctors to whom a myocardial infarction diagnosis creates the impression that the majority of patients will never be able to undertake any kind of professional activity again.

Adult↗
PubMed2000

Assessing the needs of patients in pain: a matter of opinion?

STUDY DESIGN: A prospective cohort study including patients with nonspecific spinal pain was performed. OBJECTIVES: To investigate whether the use of expert judgment in routine practice can provide a basis for reliable decision making concerning the need for intervention in patients with spinal pain and their ability to benefit from treatment. SUMMARY OF BACKGROUND DATA: A wide range of instruments and techniques are used to assess and treat patients with spinal pain. Many instruments are used without being clinimetrically tested. METHODS: A questionnaire concerning the patients' need of treatment and their potential to assimilate it was sent to experts in the health care arena: physicians, physical therapists, social insurance officers. The experts included were those connected with patients participating in a larger outcome study. Two cohorts of patients (sample 1, n = 217; sample 2, n = 257) were followed for 6 and 12 months, during which time the patients' health and work status were mapped. RESULTS: No acceptable agreement was found between any of the experts' ratings of patients' needs and potential for rehabilitation. Logistic regression showed that the experts' judgments were based almost solely on the age of the patient. The prediction analyses showed that the most consistent predictor of the patients' status at the 6-month follow-up assessment was the patients' own belief in the existence of effective treatments and their perceived ability for learning to cope with the condition. CONCLUSIONS: Expert judgment as exercised in routine practice cannot be used as basis for reliable decision making concerning the need of the patient with spinal pain for intervention and the patient's ability to benefit from treatment.

Adult↗
PubMedDate not supplied

Disability pensions for epilepsy with or without mental retardation: a 15-year Swedish survey.

The disability pensions of the Swedish National Social Insurance Board to persons with epilepsy from January 1, 1971 to December 31, 1985 were studied. On the latter date 6,658 individuals in the register were receiving disability pensions. This corresponds to an age-specific prevalence (16-64 years) of 1.2 per 1,000. Female and male patients were about equally represented. Four diagnostic categories were specified: I: 34% with epilepsy as the main diagnosis; II: 43% with epilepsy as a complementary diagnosis; III: 4% with epilepsy as a main and mental retardation (MR) as a complementary diagnosis; and IV: 19% with MR as a main and epilepsy as a complementary diagnosis. Overall 43% had both epilepsy and MR. The crude prevalence per county ranged from 0.25 to 1.23 per 1,000. Age on entry was 1.8-63.8 (mean, 36.7) years, and pension duration was 0.1-15 (mean, 7.4) years. Mean age on prevalence day was 43.9 years. During the 15-year period annual pension costs were 20-380 million Swedish kronor (SEK) ($3-60 million), and the total costs were 2,370 million SEK ($365 million). Adjusted to 1989, the costs would be 84-463 million SEK ($13-71 million) and 4,258 million SEK ($655 million), respectively.

Adolescent↗