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PubMed1994

Protection against income loss during the first 6 months of illness or injury.

This note has reviewed the protection of workers against income loss during the first 6 months of illness or injury. The national income loss due to short-term sickness and disability during the first 6 months of illness, as expressed by pre-tax wages, was about $69.6 billion in 1991. Of this amount, about $46.5 billion (66.8 percent) was replaced by income-protection programs, including paid sick leave; group insurance; temporary disability insurance, under statutory State provisions; individual insurance; workers' compensation; general assistance; and the 6th month of the Social Security Disability Insurance program. In 1991, within the private sector, wage and salary workers lost $47.2 billion because of nonoccupational illnesses or injuries, of which $17.6 billion (or 37.3 percent) was replaced. Coverage against income lost because of illness in the U.S. workforce favors full-time professional and technical employees with longer service in large or medium firms, and especially favors public sector employees. The lowest level of coverage is provided to part-time employees with limited seniority who work in production and related areas in small, private establishments. About 70 percent of wage and salary workers in the private sector have some protection through their employment against earnings losses caused by short-term illness or injury; 44 percent of these workers have short-term disability insurance, and half have sick leave coverage.

Data Collection↗
PubMed1995

Postoperative course after inguinal herniorrhaphy. A case-controlled comparison of patients receiving workers' compensation vs patients with commercial insurance.

OBJECTIVE: To confirm our observation that patients with work-related hernias, when compared with self-employed patients, had longer recovery times and prolonged pain after hernia repairs, we reviewed our recent experience in a series of patients undergoing inguinal hernia repairs. DESIGN: The study design was matched retrospective case-control. Each patient receiving workers' compensation was age and sex matched with a control patient with commercial insurance whose repair was done during the same year. SETTING: All inguinal herniorrhaphies were performed at a single clinic by one of seven surgeons. PATIENTS: Twenty-two consecutive patients receiving workers' compensation and 22 patients with commercial insurance were studied. MAIN OUTCOME MEASURES: The postoperative courses in 22 consecutive patients with workers' compensation were compared with those in 22 control patients with commercial insurance. The principal factors compared were indications for surgery, type of hernia, surgical repair performed, the duration of postoperative pain, and the number of days off daily work. RESULTS: The average age in both groups was 46 years. Hernias in the workers' compensation group were more frequently symptomatic. The duration of postoperative pain (mean +/- SE) was 111.0 +/- 42.2 days for patients with workers' compensation and 17.8 +/- 7.9 days for patients with commercial insurance (P < .05). The number of days off work (mean +/- SE) was 33.5 +/- 4.6 days for patients receiving workers' compensation and 12.6 +/- 2.3 days for patients with commercial insurance (P < .001). CONCLUSIONS: We believe our results confirm the observation that type of insurance coverage influences post-operative recovery time after inguinal herniorrhaphy. Other studies measuring a patient's outcome after surgical procedures such as herniorrhaphy should include type of insurance coverage as a factor that might affect early return to work. Using multivariate analysis, the only variable independently affecting the duration of pain after hernia repair was the type of insurance coverage (P < .005).

Case-Control Studies↗
PubMedDate not supplied

To trim or replant: a matter of cost.

Many factors are involved in the decision whether to complete the amputation of an injured digit and trim the stump or to replant the amputated member. This paper compares the cost of these two treatments so that this financial aspect might be included among the many factors which influence the surgeon's decision. The cost of these treatments was separated into two aspects. First, the overall cost of the medical and surgical expenses was calculated. Second, the cost which the Israeli social security granted the injured worker due to the disability was calculated. By comparing the total surgical and medical costs of amputations and replantations, trimming is far less expensive than replantation. In the long run, the compensation the insurer owes the disabled trimmed patient is far higher than the compensation given to those who were successfully replanted, provided the injured worker has a certain number of working years to retirement and has a yearly income of a certain level. Thus, in most cases, replantation is recommended from the cost benefit aspect.

Amputation, Traumatic↗
PubMed2004

Consumer mobility in social health insurance markets : a five-country comparison.

During the 1990s, the social health insurance schemes of Germany, the Netherlands, Switzerland, Belgium and Israel were significantly reformed by the introduction of freedom of choice (open enrolment) of health insurer. This was introduced alongside a system of risk adjustment to compensate health insurers for enrolees with predictable high medical expenses. Despite the similarity in the health insurance reforms in these countries, we find that both the rationale behind these reforms and their impact on consumer choice vary widely.In this article we seek to explain the observed variation in switching rates by cross-country comparison of the potential determinants of health insurer choice. We conclude that differences in choice setting, and in the net benefits of switching, offer a plausible explanation for the large differences in consumer mobility.Finally, we discuss the policy implications of our cross-country comparison. We argue that the optimal switching rate crucially depends on the goals of the reforms and the quality of the risk-adjustment system. In view of this, we conclude that switching rates are currently too low in the Netherlands, and an active government policy to encourage consumer mobility seems warranted. In Germany and Switzerland, high switching rates call for an improvement of the rather poor risk-adjustment systems. Given low switching rates in Israel and Belgium, improving risk adjustment is less urgent, but still required in the long run.

Belgium↗