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PubMedDate not supplied

Stochastic models of the Social Security trust funds.

Each year in March, the Board of Trustees of the Social Security trust funds reports on the current and projected financial condition of the Social Security programs. Those programs, which pay monthly benefits to retired workers and their families, to the survivors of deceased workers, and to disabled workers and their families, are financed through the Old-Age, Survivors, and Disability Insurance (OASDI) Trust Funds. In their 2003 report, the Trustees present, for the first time, results from a stochastic model of the combined OASDI trust funds. Stochastic modeling is an important new tool for Social Security policy analysis and offers the promise of valuable new insights into the financial status of the OASDI trust funds and the effects of policy changes. The results presented in this article demonstrate that several stochastic models deliver broadly consistent results even though they use very different approaches and assumptions. However, they also show that the variation in trust fund outcomes differs as the approach and assumptions are varied. Which approach and assumptions are best suited for Social Security policy analysis remains an open question. Further research is needed before the promise of stochastic modeling is fully realized. For example, neither parameter uncertainty nor variability in ultimate assumption values is recognized explicitly in the analyses. Despite this caveat, stochastic modeling results are already shedding new light on the range and distribution of trust fund outcomes that might occur in the future.

Actuarial Analysis↗
PubMed1982

Economic forecasting: effect of errors on OASDI fund ratios.

A broad range of economic assumptions are used to project the future income and outgo of the Social Security system. The assumptions adopted by the Board of Trustees of the Old-Age and Survivors Insurance and Disability Insurance (OASDI) Trust Fund were rather consistently on the optimistic side of the actual experience that emerged. This article examines the experience of several key economic indicators during the 1970's. Acknowledging that forecasting such quantities is an inexact science at best, the authors present a formula for making estimates of OASDI fund ratios, given the necessary assumptions. The formula is used to project fund ratios from 1981 to 1986. It shows where the fund would stand if forecasting errors were to continue at the magnitudes experienced in 1970-76.

Economics↗
PubMed1983

[Occupational rehabilitation of patients with mental or psychosomatic disorders. Study of 389 cases].

The study of all the patients sent to the PPU by the disablement insurance in 1975 and 1976 (389 cases). The comparison of the propositions made in medical reports and the actual allowances provided by the disablement insurance reveals the following data: in 326 cases (84%) out of 389, medical doctors only conclude to the presence or absence of a certain rate of disability (from 0 to 100%), to the exclusion of any rehabilitational measure. In 63 cases (16%) measures were proposed such as a professional rehabilitation or a placing in a specialized institution for insertion to a new profession. For this second group, only in 27 cases was the disablement insurance able to follow the medical propositions. Only in 3 cases the measures taken can be considered fully successful, and in 1 case partially successful. All the other measures taken failed. A first examination of the group of 326 cases (propositions only for disablement) which concerned 297 cases also shows a certain number of discordances between the medical propositions and the allowances provided by the disablement insurance. The majority of the discordances has to do with an undervaluation of the rate of disablement by the medical experts. Moreover, the examination of the diagnosis shows that readaptation measures are more easily proposed to patients with psychosomatic complaints, to young men, and allowances rather to women and to patients with obvious psychiatric disorders. The authors discuss some assumptions regarding these observations.

Adolescent↗
PubMed2006

[Medical assessment of psychosomatic illnesses in the field of short-term disability compensation insurance: advantages of a multidimensional structured guideline].

The aim of the medical report in the area of short-term disability claims caused by psychological and psychosomatic disorders is to make a valid prognosis on the further development of absenteeism and/or to estimate the return-to-work probability of the claimant. An analysis of the current practice of determining the validity of claims caused by psychosomatic illnesses shows that it is inadequate and unsatisfactory, mainly as a result of its reliance on a cross-sectional based judgement. The authors present a structured guideline (Multi-Axial-Psychodiagnostic for short-term disability claims, MAP-KTG), which supports, via a multi-dimensional diagnosis process, the validation of the psychological and psychosomatic symptoms of the claimant. It is also used to assess the amount of functional disability with a higher degree of accuracy. The determination of the prognosis, with regard to future work prospects, can be obtained by applying a list of empirically generated variables proven to be associated with the return-to-work probability.

Activities of Daily Living↗
PubMed1997

The work incapacity and reintegration study: results of the initial survey conducted in the United States.

The United States and six other countries (Germany, Denmark, Norway, Sweden, Israel, and the Netherlands) are participating in a cross-national study of work incapacity and reintegration under the auspices of the International Social Security Association. The purpose of the study is to identify those medical and nonmedical interventions that are most successful in helping persons disabled due to a back condition return to work. The study involves a baseline survey and two follow-up surveys over approximately 2 years. This article reports on the findings from the baseline survey conducted in the United States. It compares the responses of persons from four study groups (the Social Security Administration's Disability Insurance (DI) beneficiaries and Supplemental Security Income (SSI) recipients, and temporary disability insurance (TDI) recipients from two States--California and New Jersey). The article discusses the potential influence of certain characteristics on the capacity for work reintegration. Study findings suggest that the characteristics of TDI recipients with back disorders may differ in some respects from those of recently entitled DI or SSI beneficiaries with similar impairments, and that there may be some correlation between work resumption and factors such as education occupation, work-related demands, and the presence of other chronic diseases.

Adult↗
PubMed1999

Lifetime redistribution under the Social Security program: a literature synopsis.

This article provides a brief overview of the more important studies of lifetime redistribution under the Old-Age and Survivors Insurance (OASI) and Disability Insurance (DI) programs. Studies are categorized into two types, those that focus on redistribution across successive cohorts of workers or typical members of those cohorts and those that focus on the distribution of results across characteristics of interest within particular cohorts of workers. A list of related studies is provided at the end of the article for those interested in additional reading.

Aged↗
PubMed2005

Brief report: needlestick injury and inadequate post-exposure practice in medical students.

BACKGROUND: Medical students are at a particularly high risk for needlestick injury and its consequences because of their relative inexperience and lack of disability insurance. OBJECTIVE: To determine the risk of needlestick injury and the use of post-exposure prophylaxis among medical students. DESIGN: Internet-based survey. PARTICIPANTS: The 2003 graduating medical school class at the University of Toronto. MEASUREMENTS: Number of needlestick injuries, circumstances surrounding those incidents, and post-exposure actions. RESULTS: The response rate was 88% (157/178). Over one third (55/157) of respondents suffered at least 1 needlestick injury. In more than half the high-risk injuries, the students continued working and did not seek medical advice. Six students who suffered a needlestick injury began prophylactic human immunodeficiency virus medications. Of those students who suffered an injury, 15% had purchased disability insurance prior to the incident. CONCLUSIONS: Poor use of post-exposure procedures and a lack of disability insurance leave medical students at high risk for career and life-altering consequences from a needlestick injury.

Humans↗
PubMed1980

Receipt of multiple benefits by disabled-worker beneficiaries.

In 1971, 44 percent of workers who had been currently entitled to social security disability insurance (DI) benefits for 1 year or more also received benefits from at least one other source. Their average disability insurance benefit was higher than that of persons who received only DI benefits. On the average, total benefits to those receiving multiple benefits were double the amounts paid to those receiving only DI benefits. The combined benefits for the former produced median replacement rates about 50 percent larger than the median replacement rates for the latter. High replacement rates--defined here as more than 80 percent of predisability earnings replaced by benefit--predominate among those with multiple benefits. Considering replacement rates based solely on disability insurance benefits substantially understates the extent to which benefits from public and private programs actually replace predisability earnings. Replacement rates based solely on DI benefits are generally higher for those receiving DI benefits only than for persons receiving multiple benefits. Limiting DI benefits to the replacement rate from DI benefits alone is disadvantageous for persons who receive only DI benefits, compared with those who also receive other benefits.

Adult↗
PubMed2005

Labor market, financial, insurance and disability outcomes among near elderly Americans with depression and pain.

BACKGROUND: The economic burden of depression has been documented, but the role of comorbid conditions is unclear. Depression and comorbid pain are particularly common, are associated with worse clinical outcomes and require different care than "pure'' depression. Does this comorbidity account for a large share of the adverse social outcomes attributed to depression? AIMS OF STUDY: We analyzed the relationship between depression and comorbid pain, and labor market, financial, insurance and disability outcomes among Americans aged 55-65. METHODS: Cross-sectional data were used from Wave 3 of the Health and Retirement Survey, a nationally representative sample of individuals aged 55-65 surveyed in 1996. Multivariate regression analyses, controlling for socio-demographics and chronic health conditions, estimated the associations between depression and pain, and economic outcomes. Outcomes included: employment and retirement status, household income, total medical expenditures, government health insurance, social security, limitations in activities of daily living (ADLs), and health limitations affecting work. Primary explanatory variables included the presence of severe pain, mild/moderate pain, or absence of pain, with or without depression. RESULTS: Compared to depression alone, depression and comorbid pain was associated with worse labor market (non-employment, retirement), financial (total medical expenditures), insurance (government insurance, social security) and disability outcomes (limitations in ADLs, health limitations affecting work), after covariate adjustment (p <or= 0.01, except retirement with p < 0.1). Findings were even more disparate as level of pain severity increased. The simulated results showed that the magnitudes of the adverse effects were attributed disproportionally to individuals with comorbid pain and depression versus "pure'' depression. Of those with depression, 51% had comorbid pain. Yet, this subgroup of depressed individuals accounted for 59% of those not employed, 61% of those with government health insurance, 79% of those with limitations in ADLs, and 72% of those with health limitations affecting work. DISCUSSION AND LIMITATION: Depression with comorbid pain, not depression alone was responsible for a large part of the higher economic burden associated with depression. The study is limited by self-reported measures of pain, depression, and outcomes. It is cross-sectional and cannot identify causal effects of depression with pain. These findings may not be generalizable to other age groups. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The depressed with comorbid pain appear to experience greater burden through increased costs and worse functioning and may require different management than those with depression alone. The depressed with comorbid pain may benefit from treatment practices and guidelines that address the duality of these conditions throughout the process of care. IMPLICATION FOR HEALTH POLICIES: The depressed with comorbid pain were more likely to receive government support than depression alone. Given the central role of employer-sponsored health insurance in the U.S., they may have worse access to health care because they leave employment or retire earlier. With the evolving state of Medicare, broad formulary access to mental health treatments might be considered. IMPLICATIONS FOR FURTHER RESEARCH: Further research should focus on causality of depression and comorbid pain on economic outcomes. Depression research should consider the heterogeneity of this disorder in outcomes assessment.

Aged↗
PubMed1982

Why do people retire from work early?

This article examines the validity of a mortality study of early retirees by Dr. Eric Kingson. The Kingson study supports the hypothesis that men who retired early were very prone to have work-limiting conditions even though they were not awarded Disability Insurance benefits. This article maintains that Kingson's study is analytically faulty because of the procedure used to categorize the sample. In comparing groups of early retirees, Kingson combined two groups--(1) severely disabled persons who died before becoming eligible to receive Disability Insurance benefits and (2) early retirees who alleged work-limiting disability. He found that their combined mortality was higher than that of those who received Disability Insurance benefits. He then concluded that, for this reason, early retirees who alleged work-limiting disability really had such disabilities. However, this article contends that the mortality effects of the first group are so great as to mask any conclusions relevant to the two groups combined. The analysis here does not conclude that persons generally do not retire early because of poor health, but rather that the findings of Kingson's study, being based on faulty mortality analysis, are not conclusive.

Adult↗
PubMed2000

Waiting periods and health-related absenteeism: the need for program integration.

This article discusses evidence that the reduction of waiting period deductibles in disability insurance plans increases the amount of lost time utilized by insured workers and also increases the cost of sick leave. The authors posit that the evidence supports the need for an integrated disability insurance product, which could be offered at lower costs than the current system that provides fragmented lost time coverage.

Absenteeism↗