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PubMed1958

Medico-legal aspects of traumatic epilepsy.

The medico-legal problems of cranial injuries require a broad assessment of many factors, not always related to the nervous system, and a nicety of judgment in correctly evaluating the role of each factor in relation to all of them. Seizures in the period immediately after trauma are not necessarily precursors of later development of epileptic attacks. If such seizures do occur, it can be said in general, from statistical data, that the sooner they occur after injury the less the likelihood of disabling attacks later. It would seem a reasonable medical probability that if a patient has no neurological symptoms or deficit, has a normal electroencephalogram and has gone two years after injury without evidence of seizures, he will not have epilepsy. Putting a label of "post-traumatic epilepsy" on a patient, unless he is known to have had authentic seizures, may stigmatize him without warrant and lead to unjust settlement of litigation or to unreasonable compensation awards. In doubtful cases, perhaps an equitable solution of compensation for damage would be to award an insurance policy providing suitable payments if disabling seizures should develop later as a sequel of cranial injury.

Bone and Bones↗
PubMed1991

Genetic discrimination: the use of genetically based diagnostic and prognostic tests by employers and insurers.

Genetic discrimination is detrimental to public health programs, as well as to society generally. Advances in genetic testing and screening, accelerated and prompted by the Human Genome Initiative, increase society's ability to detect and monitor chromosomal differences. These technologies and their resulting genomic data will enhance medical science, but may also encourage discrimination. Although few employers or insurers currently utilize genetic screening, testing or data, rising employee benefit costs and market forces create powerful incentives for usage. Current municipal, state and federal laws, including the Americans with Disabilities Act (ADA), may not sufficiently protect employees and insureds from genetic discrimination. While municipal and state protections should not be overlooked, the ADA's sweeping scope may currently provide the most comprehensive safeguard. Federal laws banning discrimination on the basis of race or sex might also successfully redress some forms of genetic discrimination. Genetic technologies' advent necessitates efforts to rectify state and federal statutory coverage gaps, strictly regulate employers and produce comprehensive guidelines regarding its use.

Persons with Disabilities↗
PubMed2003

Mental health services use among school-aged children with disabilities: the role of sociodemographics, functional limitations, family burdens, and care coordination.

OBJECTIVE: To examine the use of mental health services and correlates of receiving services among community-dwelling children with disabilities, ages 6 to 17 years. STUDY DESIGN: Data are from the 1994 and 1995 National Health Interview Survey Disability Supplements (NHIS-D), conducted by the National Center for Health Statistics. The study sample is 4,939 children with disabilities, representing an estimated eight million children with disabilities nationwide. Parents of children under 16 years of age reported (17-year-olds self-reported) on health, emotional and behavioral problems, mental health services use, and who, if anyone, coordinated the child's health care. PRINCIPAL FINDINGS: Among disabled children with poor psychosocial adjustment (11.5 percent), only 11.8 percent received mental health services in the past year. Multivariate logistic regression analysis showed service use was associated with poor psychosocial adjustment; communication, social, and learning-related functional impairments; public health insurance; and financial family burdens. Younger and black disabled children were less likely to receive mental health services. The odds of service use were greater with the involvement of a health professional in coordinating care, in contrast to no one or family only. Moreover, children with disabilities were more likely to use outpatient mental health services if their care was jointly coordinated by a family member and a health professional, compared to a health professional working alone. In contrast to inpatient and outpatient care, race and family burden were not associated with the likelihood of mental health counseling in special education school settings. CONCLUSIONS: Findings indicate that only two in five disabled children with poor psychosocial adjustment receive mental health services. Differences by age, race, and insurance coverage suggest that inequalities to access exist. However, the school setting may be one in which some barriers to mental health services for disabled children are reduced. The study also shows that the involvement of health professionals in care coordination is associated with greater access to mental health care for disabled children. These findings underscore the importance of engaging both health care professionals and the family in the care process.

Adaptation, Psychological↗
PubMed2005

[An epidemiological study of the relationship between the number of remaining teeth and the disabled elderly receiving long-term care].

This study attempts to clarify the relationship between the long-term care of the elderly and the number of remaining teeth by comparing the remaining teeth of the healthy with that of the disabled elderly. A survey was conducted in a town, Fukuoka Prefecture. The disabled group consisted of 62 persons with level of disability of 4-5 according to the Long-term Care Insurance categorization. Controls were selected randomly from healthy elderly residents, one for each in the disabled group, matching gender and age (less than +/- 1 year old). Public health nurses conducted interviews using a questionnaire to determine the cause of disease, medical history, lifestyle and period of long-term care, and counted the remaining teeth. The mean number of remaining teeth presented a significant difference with 3.7 for the disabled group and 9.1 for the control group (p < 0.01). A logistic regression analysis revealed that the odds ratio for long-term care to that of the reference with 20 or more teeth was 7.03 (95% CI: 1.15-42.85) for 10 to 19 teeth, 15.61 (2.89-84.26) for 1 to 9 teeth, and 15.11 (2.84-80.48) for no teeth. The age group of 65-69 years and 70-79 years in the disabled group had significantly smaller mean numbers of remaining teeth than their control group counterparts by approximately 14 and 12 respectively, but in the age group of 80 years or more, no significant difference was observed between the two groups. In conclusion, our results suggested that elderly people with fewer remaining teeth have a high risk for long-term care. Especially, the risk was thought to be strongly associated with the loss of some teeth in middle age.

Aged↗
PubMedDate not supplied

How your "free" tail liability policy is funded.

The Extended Reporting Endorsements for Claims-made Professional Liability policies are provided to insured doctors in the event of death, disability, and retirement (DDR) with no additional premium charge if certain criteria are met. However, this "free tail" policy is actually pre-funded via a percentage loading applied to all insureds' ongoing premium. The amount of this loading is determined by continual monitoring of the demographics of the insured population. This article sheds light on the process used by professional liability companies to price "free tail" policies and reviews the key concepts involved.

Humans↗
PubMed1983

[Striving for a nursing home insurance].

The present study emphasizes the necessity to alleviate the frail and handicapped elderly from paying the full amount of nursinghome costs by themselves. Because of today's exorbitant high nursinghome fees the resident becomes destitute within a very short period of time. To change this two solutions are discussed. One deals with a monthly downpayment by all younger members of society. Under the assumption that all adults between 25 and 65 years would participate and nursinghome referrals would not change considerably, each adult had to pay DM 6,-per month. Another way would be the introduction of an optional or mandatory nursinghome insurance plan. This would cost a single individual DM 9,-per month. In setting-up these kinds of measures disabled elderly could live a dignified life without the embarassment of loosing all their lifetime savings and of becoming destitute.

Aged↗
PubMed2003

Reduction in sick leave and costs to society of patients with Meniere's disease after treatment of temporomandibular and cervical spine disorders: a controlled six-year cost-benefit study.

This study compares the frequency of sick leave between the three-year period after and the three-year period before coordinated treatment of temporomandibular and cervical spine disorders in 24 patients (ten males and 14 females) diagnosed with Meniere's disease. The frequency of sick leave for the patients was also compared with the frequency of sick leave in a control group from the population. A cost-benefit analysis was made regarding the costs to society of sick leave related to the treatment costs of the patients. In a previous study the same patients were treated for their severe signs and symptoms of temporomandibular and cervical spine disorders, and they reported a substantial reduction in their vertigo, non-whirling dizziness, tinnitus, feeling of fullness in the ear, pain in the face and jaws, pain in the neck and shoulders, and headache. The number of days of sick leave and the year the patient began to receive disability pension due to the symptoms of Meniere's disease were obtained from the National Health Insurance Service in Sweden. Two of the patients received disability pension benefits due to Meniere's disease 17 years prior to their normal retirement pension. A third patient received disability pension for another reason and two were receiving a retirement pension. Data on the remaining 19 patients showed a considerable reduction in number of days of sick leave during the three-year period after coordinated treatment (270 days) compared with the three-year period before the treatment (1,536 days). The control subjects used a total of 14 days sick leave for the same symptoms during the same six-year period. Vertigo (nine days) was the dominant cause followed by pain in the neck and shoulders, and headache. The reduction in sick leave for the 19 nonretired patients and the treatment costs for the 24 patients can be used for a simple cost-benefit calculation for the subgroup of nonretired patients. During the first three years after treatment the reduction in sick leave was on average 66.6 days for each of the 19 nonretired patients. Within the limits of this study, it can be concluded that the costs to society for sick leave and disability pension due to Meniere's disease are substantial. A coordinated treatment of temporomandibular and cervical spine disorders appears to substantially reduce these costs.

Adult↗
PubMed2006

Health insurance and health at age 65: implications for medical care spending on new Medicare beneficiaries.

OBJECTIVES: To investigate the consequences of endogeneity bias on the estimated effect of having health insurance on health at age 63 or 64, just before most people qualify for Medicare, and to simulate the implications for total and public insurance (Medicare and Medicaid) spending on newly enrolled beneficiaries in their first years of Medicare coverage. DATA: The longitudinal Health and Retirement Survey of people who were 55-61 years old in 1992, followed through biannual surveys to age 63-64 or until 2000 (whichever came first), and those who were 66-70 years olds from the Medicare Current Beneficiary Surveys, 1992-1998. STUDY DESIGN: Instrumental variable (IV) estimation of a simultaneous equation model of insurance choice and health at age 63-64 as a function of baseline health and sociodemographic characteristics in 1992 and endogenous insurance coverage over the observation period. FINDINGS: Continuous insurance coverage is associated with significantly fewer deaths prior to age 65 and, among those who survive, a significant upward shift in the distribution of health states from fair and poor health with disabilities to good to excellent health. Treating insurance coverage as endogenous increases the magnitude of the estimated effect of having insurance on improved health prior to age 65. The medical spending simulations suggest that if the near-elderly had continuous insurance coverage, average annual medical spending per capita for new Medicare beneficiaries in their first few years of coverage would be slightly lower because of the improvement in health status. In addition, total Medicare and Medicaid spending for new beneficiaries over their first few years of coverage would be about the same or slightly lower, even though more people survive to age 65. CONCLUSIONS: Extending insurance coverage to all Americans between the ages of 55 and 64 would improve health (increase survival and shift people from good-fair-poor health to excellent-very good health) at age 65, and possibly reduce total short-term spending by Medicare and Medicaid for newly eligible Medicare beneficiaries, even though more people would enter the program because of increased survival.

Aged↗
PubMed2005

Exercise and physical activity in persons aging with a physical disability.

The relationship between physical functioning and physical activity isa reciprocal one; physical functioning provides the individual with the capability to engage in physical activities, and physical activity helps to maintain and in some cases improve physical functioning. This reciprocal relationship, coupled with the high prevalence of physical inactivity among persons aging with a disability, has profound implications for rehabilitation practice, especially in evaluating intermediate and long-term outcomes of clinical practice. For rehabilitation to play a role in the long-term maintenance and enhancement of physical functioning among persons with disabilities, increasing participation in various types of physical activity in the community must be part of the recovery and maintenance continuum. There is also a critical need to identify specific doses of physical activity for specific disabilities and secondary conditions. HMOs and other health insurers will require evidence-based outcomes before establishing reimbursement procedures for physical activity programs for persons aging with a physical disability.

Activities of Daily Living↗