[Patients in a sanatorium for nervous disorders, with special reference to patients hospitalized through disability insurance].
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In the German disability insurance, exclusion clauses are the dominating approach to the underwriting of low back pain. This is due to a lack of clear prognostic factors, the nonexistence of severity classifications and the strong impact of individual and psychological circumstances. Considering various clinical, individual and psychological indicators, a new system is introduced to allocate the prognosis of lower back pain to four levels of severity. This approach makes it possible to use extra ratings instead of exclusion clauses of mild and moderate low back pain.
The Medical Observation Centres of the state Disability Insurance (COMAI) are specialized agencies serving the cantonal commissions of the Disability Insurance in Switzerland. Using data collected for each case examined by the COMAI, utilisation rates and rankings were established for each canton. Utilisation rates varied by a factor of 40 from one canton to the next. This observed variation is independent of the number of new cases presenting to the Disability Insurance and of the number of disability pensions granted. Rankings were also independent of denominators used to define utilisation rates. These results suggest possible non-uniform application of state directives concerning the use of the COMAI, and unequal access to these specialized agencies. The reasons for these variations are the object of a study now underway.
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