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PubMed1986

Worldwide trends and developments in social security, 1983-85.

This article highlights the major developments and trends in social insurance programs that are presented in detail in the 1985 edition of Social Security Programs Throughout the World. The data in that reference book reflect the fact that as countries have adapted to the slow economic growth in recent years, increased emphasis has been placed on the cost effective use of social security funds. Some industrialized countries have restructured benefit provisions and reallocated resources among programs and beneficiaries to target benefits for specific groups. In the developing nations, the introduction of additional programs and expanded benefits continued on a limited scale amidst widespread concern about maintaining the real value of benefits after years of high inflation.

Cross-Cultural Comparison↗
PubMed2002

Attention Deficit Disorder and Learning Disability: United States, 1997-98.

OBJECTIVES: This report presents national estimates of the prevalence of diagnosed Attention Deficit Disorder (ADD) and/or Learning Disability (LD) in U.S. children. Differences in the prevalence of these conditions are examined for children with selected sociodemographic characteristics. The occurrence of other health conditions and use of educational and health care services are contrasted for children with only ADD, those with only LD, those with both diagnoses, and those with neither diagnosis. METHODS: Estimates in this report are based on data from the National Health Interview Survey (NHIS), a national household survey of the civilian noninstitutionalized population of the United States. The analysis focuses on 8,647 children 6-11 years of age in the 1997 and 1998 NHIS. RESULTS: In 1997-98 over 2.6 million children 6-11 years of age were reported to have ever had a diagnosis of ADD or LD. A diagnosis of only ADD was reported for 3 percent of children, a diagnosis of only LD for 4 percent, and a diagnosis of both conditions for 4 percent. The prevalence of ADD with or without LD was greater for boys than for girls. Having health insurance was associated with a diagnosis of only ADD. Living in a low-income or mother-only family occurred more often among children with a diagnosis of LD. Children with LD were nearly five times more likely to be in special education than children with a diagnosis of only ADD. Children with ADD, in contrast to children without this diagnosis, more often had contact with a mental health professional, used prescription medication regularly, and had frequent health care visits.

Attention Deficit Disorder with Hyperactivity↗
PubMed2005

Treatment duration and cost of work-related low back pain in Korea.

The purpose of this study is to present the information on the duration of treatment and the cost of work-related low back pain. Using the compensation-database for 1997 work-related low back pain (n=9,277), this study estimated the duration of treatment, the cost of work-related low back pain, the relationship between them, and probability of being off treatment at different intervals. The mean and the median of the treatment duration are 252.6 days and 175 days. The mean and the median of the cost of total insurance benefit are 37,700,000 won and 14,400,000 won. The treatment duration of 51% of the study subjects was less than 6 months and their cost accounted for 10.2% of the total insurance benefit. The subjects who were treated more than 24 months were 5.8% but it accounted for 29.2% of the cost. It was found that approximately 50% of the subjects who will remain on treatment at the end of n months would be off treatment at the end of n+5 months. This study presents the point in time when the low back pain (LBP) workers need to prepare to return to work by forecasting their off-treatment period. From the treat duration and cost perspectives, this study may be utilized as evidence for active management of work-related LBP.

Absenteeism↗
PubMed2002

Prescription noncompliance due to cost among adults with disabilities in the United States.

OBJECTIVES: This study estimated national prevalence rates of medication noncompliance due to cost and resulting health problems among adults with disabilities. METHODS: Analyses involved 25,805 respondents to the Disability Follow-Back Survey, a supplement to the 1994 and 1995 National Health Interview Surveys. RESULTS: Findings showed that about 1.3 million adults with disabilities did not take their medications as prescribed because of cost, and more than half reported health problems as a result. Severe disability, poor health, low income, lack of insurance, and a high number of prescriptions increased the odds of being noncompliant as a result of cost. CONCLUSIONS: Prescription noncompliance due to cost is a serious problem for many adults with chronic disease or disability. Most would not be helped by any of the current proposals to expand Medicare drug coverage.

Adolescent↗
PubMed1991

[Street traffic accident--whiplash injury of the cervical spine from the viewpoint of insurance medicine].

The Swiss Accident Insurance Institute (SUVA), as the largest mandatory insurer against accidents in Switzerland, handles approximately 3000 cases of injury to the cervical spine every year, half of which are the result of traffic accidents. A considerable proportion of these involve whiplash injuries to the cervical spine. Epidemiological and statistical results according to this medical definition and based on material collected over a period of several years are presented. The assessment of these cases from the medical insurance point of view is discussed. Mild whiplash injuries are very common and as a rule they heal without sequelae. Severe whiplash injuries with massive soft-tissue damage and fractures are rare and present few problems for the causality assessment. Problemtical, on the other hand, are the not infrequent cases of whiplash injuries which initially seem to be ordinary sprains but which subsequently develop into lasting clinical syndromes that are very difficult to objectify. Further, the assessment and care of these problem cases in particular are discussed from the medical insurance point of view. In these patients, who suffer severe pain and discomfort, it is in most cases not possible to obtain any objective findings with the classical diagnostic measures of radiology, orthopaedics and neurology. They can very soon be suspected of malingering, exaggeration or pension neurosis. Only with the very sophisticated, modern diagnostic methods of neuropsychology, chiropraxis and functional computed tomography is it sometimes possible to objectify these syndromes in a reproducible manner and possibly to establish a post-traumatic instability as the cause. This then again opens up promising possibilities for the treatment of these patients. The SUVA supports research aimed at developing and testing such promising new methods of examination. However, it at the same time warns against the uncritical use of these expensive methods of examination, the informative value and the scientific validity of which are in some respects still not sufficiently well established.

Accidents, Traffic↗
PubMed2001

Access to care and functional status change among aged Medicare beneficiaries.

OBJECTIVES: This study examined whether the extra-individual factors of better access to care and supplementary health insurance coverage can prevent, delay, or reverse transitions from functional independence to disability over time. METHODS: Six years of the Medicare Current Beneficiary Survey were pooled, yielding 40,793 transition periods for community residents aged 66 or older. Multinomial logit models of transitions among functional states were estimated, with functional improvement, functional decline, and mortality as outcomes. RESULTS: Insurance coverage and better access to care increased survival chances and reduced the odds of transitions from independence to disability by roughly 30%. Access and supplementary insurance did not appear to affect transitions from less disabled to more disabled states or affect functional improvement. DISCUSSION: The findings support the hypothesized role of extra-individual environmental factors in Verbrugge and Jette's conceptual scheme of the disablement process. Access to care is suggested to make the most difference in delaying or slowing down functional decline among functionally independent elderly persons. Transitions from less severe to more severe states of disability or to death appear to be influenced more by the natural course of chronic diseases, underlying health status, and medical instability.

Activities of Daily Living↗
PubMedDate not supplied

Statistical models of outcome in malpractice lawsuits involving death or neurologically impaired infants.

The objective was to determine whether factors could be identified in medical and legal records that are associated with the successful defense of obstetrical malpractice cases involving the death or neurological impairment of infants. Obstetrical claims (169) closed by PROMUTUAL between January 1, 1990, and December 31, 1994, were retrospectively abstracted and analyzed to identify associations between medical and legal factors, and the medicolegal outcome. Multivariable analysis identifies that the use of pitocin, diagnosis of asphyxia, a delay in delivery, and the use of multiple defense expert witnesses decreased the chances of a successful defense. Two statistical models explaining indemnity payment were developed. The first, based on medical outcome, showed an increased indemnity payment when a case involved major neurological deficits, diagnosis of asphyxia, newborn seizures, later year of delivery, and participation of a particular defense firm. Perinatal or childhood death and the use of pitocin were indicators of a decrease in payment. The second model was based on long-term care requirements. In this model, indicators of increased indemnity payment were: nonreassuring intrapartum fetal heart rate tracing, later year of delivery, intensity of long-term care required, and participation of a particular defense law firm. Perinatal or childhood death, the use of pitocin, and settlement date increasingly removed from the occurrence date were the determinants of decreased payments in this model. Finally, the presence of major neurological deficits, the prolongation of a case, and the involvement of multiple law firms and defense witnesses increased the expense charged to and paid by the insurance company. Using the medical, legal, and financial data relevant to 169 obstetrical cases closed by one malpractice insurance carrier between 1990 and 1994, statistical models with potential predictive values for future malpractice claims involving neurologically impaired infants were constructed. These models may help determine in advance the chance a future case has for successful defense and the likely amount of expense and indemnity dollars that will be paid out to settle and defend it.

Adolescent↗
PubMed1988

[Do patients with active chronic polyarthritis get "basic therapy"?].

The determination of the adequacy of an individual therapeutical regimen is part of the process evaluation of medical care. To evaluate the adequacy of individual antirheumatic therapy, we developed a five step procedure: 1. Assessment of the patient's health status; 2. assessment of his/her former and current therapy; 3. determination of the adequate antirheumatic therapy following an explicit norm; 4. formal comparison of current and adequate treatment; 5. clinical evaluation of possible differences between norm and reality. Due to methodological reasons we concentrated on the current treatment of rheumatoid arthritis (rA) patients with remission inducing drugs (RIDs; e.g. Chloroquine, Gold). The study analyzed the RID treatment of 75 rA-sufferers; 25 patients were referred to our outpatient department for the first time in late 1986; 25 patients were recruited from a social-medical study covering employed but actually disabled members of a major health insurance (AOK) in Hannover; 25 subjects were derived from an ongoing population study ("prevalence and care of rheumatoid arthritis in Hannover"). Only 9 out of 49 (18%) patients with an active disease, formally in need of treatment, were currently treated with RIDs. Thus 40 out of 49 (82%) seemed to be under an inadequate treatment. From the clinical point of view this formal judgement was assumed to be false positive in 5 and false negative in 15 cases. In relation to the clinical judgements we found for the formal procedure a sensitivity of 0.70 with a specificity of 0.80 and an overall agreement of 73% (kappa 0.44).

Adult↗
PubMed1987

[The significance of dust in the evaluation of the potential health risk in chemical industry plants].

According to statistics, occupational diseases (and respiratory disorders in particular) are rare. Occupational disease accounted for only 1.5% of all job-related disabilities registered with the Swiss Accident Insurance Institute (SUVA) in 1984. Skin disorders (37.1%) are the leading form of occupational disease, followed by disturbances of the locomotor apparatus (36%) arising from physical causes. Pneumoconiosis (quartz, asbestos) accounts for 2.8% of cases. Chronic disorders of the respiratory tract brought about by irritant or toxic gases are buried away under the heading of 'chronic poisoning' (7.8%). Bronchitis caused by organic dust (0.3%) is listed under 'other disorders' (13.9%). It is shown that, depending on the type of chemical manufacturing involved, major significance is attached to the role of dust as a potentially dangerous substance and thus to monitoring and prevention at source. Attention is particularly drawn to the hazard posed by lipophilic dust (aromatic amines, organic phosphates, etc.) which can easily pass through intact skin and penetrate into the body unnoticed. Uptake of toxic agents through the skin is not registered by the devices used to test air quality, but can only be ascertained by detection of toxic substances or metabolites in the urine or the blood (biological monitoring). Finally, it is pointed out that--in general--MAC or BEI limits have not been stipulated for biologically active dust, with the exception of a few values for insecticides. The 'general upper limit' of 6 mg/m3 for inert dust is of no use in the monitoring of dust from biologically active products.(ABSTRACT TRUNCATED AT 250 WORDS)

Allergens↗
PubMed1990

Disability, direct cost, and payment issues in injuries involving woodworking and wood-related construction.

Treatment cost and payment patterns and disability for work, home, and recreation activities were examined for 495 consecutive persons seen as primary care patients over one year in Northern Vermont with injuries associated with woodworking, wood related construction, and home repair activities and materials. These primary care patients were from a larger sample of 601 persons with such injuries who received either primary or tertiary care. Mean total charges were $530 and $342 respectively for work and nonwork related injuries, with highest costs for back and arm injuries, and injuries involving powered equipment and elevations. At six months post injury, patients averaged 11.6 days of disability for work, 10.3 days for home activities, and 13.1 days for recreation. Overwhelmingly, this disability was experienced by nonhospitalized patients. Median charges and disability days were far lower, reflecting the fact that the majority of injuries were minor and only 6% resulted in hospitalization. Only 29% of hospital charges for injuries at work were paid by workmen's compensation, and a third either were unpaid or were paid by the injured party. Self-employed contractors and carpenters, in particular, lacked coverage by workmen's compensation.

Accidents, Occupational↗
PubMed1988

The impact of DRGs on the cost and quality of health care in the United States.

The prospective Payment System (PPS) represents a fundamental change in the way the United States government reimburses hospitals for medical services covered under Medicare, a federal health care insurance program for the elderly and disabled. PPS replaced the retrospective cost-based system of payment for Medicare services with a prospective payment system. Under PPS, a predetermined specific rate for each discharge dictates payment according to the diagnosis related group (DRG) in which the discharge is classified. The PPS was intended to create financial incentives that encourage hospitals to restrain the use of resources while providing high-quality inpatient care. Both objectives appear to have been met under PPS. Hospital utilization has declined, average length of stay has fallen, and the locus of care has shifted from the inpatient setting to less costly outpatient settings. The growth in inpatient hospital benefits has slowed and the impending insolvency of the Medicare trust fund has been forestalled. Studies have found no deterioration in the quality of care rendered to Medicare beneficiaries. Neither the mortality rate nor the rate of re-admission (presumably related to premature discharge) increased under PPS. Indeed, PPS appears to have enhanced the quality of inpatient care by discouraging unnecessary and potentially harmful procedures, and by encouraging the concentration of complex procedures in facilities in which the high frequency of these procedures promotes efficiency. Incentive-based reimbursement also appears to have contributed to the growth in alternative delivery systems, such as HMOs and PPOs, which contain costs by maintaining a high volume of a limited range of services. The success of the PPS/DRG system in controlling costs and promoting quality in this country suggests its application in other countries, either as a method of reimbursement or as a product line management tool.

Diagnosis-Related Groups↗
PubMed1988

Current problems and prospects with the Japanese compensation system for pollution-related health damage.

The Japanese compensation system for pollution-related health damage, which resulted from experiences in the 1960s and 1970s with severe cases of environmental pollution, has recently come to a crisis. This article presents scientific evidence associated with the establishment of the system and analyzes the polluters' criticism of the system. The current controversy illustrates the difficulty of applying epidemiological methods to nonspecific health effects and demonstrates the strength of industrial resistance against environmental policy in Japan.

Air Pollutants↗