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Compensation status and symptoms reported by patients with chronic pain.

This study examined the initial symptoms of patients with chronic pain who were (n = 70) or were not (n = 52) involved in some aspect of the compensation system--worker's compensation, litigation, or Social Security Disability Insurance. Analyses indicated that compensation patients were discriminable from noncompensation patients (p less than 0.0001). Compensation patients were younger and less likely to be female; they also tended to report fewer surgeries, shorter pain durations, and more vocational and sexual disability. Finally, they perceived their medical conditions to be more severe than had been diagnosed by physicians. The groups did not seem to differ in severity of pain or psychologic distress. These data are consistent with studies indicating that compensation patients are not "symptom magnifiers," although the data do indicate that the life disruptions reported by these patients may be greater than those reported by patients not involved in compensation systems.

Adult↗

Compensating for biased selection in health insurance.

The focus of interest in HMOs is shifting from simple encouragement of their growth to the design of systems allowing for choice among alternative plans. Problems of adverse and favorable selection of enrollees may prevent effective multiple choice. A trial system, including enrollee surveys and risk pools, is proposed to create incentives for delivery systems to compete on the basis of efficiency and services rather than on selection.

Choice Behavior↗

["The same disease"--a problematic legal concept].

The legal concept "the same disease" according to a clause in the German Social Code, is questioned as a problematic one. This is compared with the broad interpretation of this concept in actual practice by those specialists who are engaged in expertising concerning limitation of claims by insured persons for compensation payment, since legal interpretations may reduce the possibilities of the statutory insurance body to reject such claims or to declare that no further payments will be made. This article has been written to stimulate a conceptional clarification and greater uniformity in expertising.

Diagnosis, Differential↗