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[Variations in referral to specialized medical centers of the Swiss disability insurance: role of the referring party].

The Commissions of the Swiss Disability Insurance (CDI), in order to evaluate the degree of disability which determines the right to benefits, can call upon Medical Observation Centers (MOCD) for a pluridisciplinary examination. The utilization rate of the MOCD, by the 28 CDI, varies by a factor of 1 to 50. The goal of this study is to identify the causes of this variation related to the differences in CDI practice. The CDI answered a mail survey. For analysis, they are allocated into 3 groups of equal size: Low, medium and high users of MOCD. There is no association between the use of the official and non-official criteria for referral to MOCD and utilization rate of the MOCD. The CDI have a false perception of their MOCD use; 40% of them underestimate it. Considering together the utilization rate of the substitutes and of the MOCD, variation still persists from 1 to 9 among the CDI. There is no difference in the reasons for non-referral to the MOCD according to the level of utilization. This study failed to identify the causes of the utilization differences of the MOCD by the CDI. Other factors should be examined.

Eligibility Determination↗

[Minimal early-childhood brain damage in the pediatric practice and disability insurance].

In modern practice the pediatrician is called upon daily to take preventive, curative and rehabilitative action in children with cerebro-organic and psychosocial risk factors: 1. Eearly diagnosis of handicaps by POLTIBAC on the occasion of individual vaccinations and infectious diseases. 2. Fitness programs for infants to improve the mother-child relationship and reduce frustrations in children's homes and day nurseries. 3. Psychohygiene and mini-psychotherapy of ambivalent mothers during every pediatric consultation. The pediatrician's second patient is the mother. 4. The self-help mentality in pediatrician, parents and educationists assumes increasing importance as economy cames to rule pediatric practice in view of the cost explosion in the health sector. 5. In the Canton of St. Gall increasing numbers of children with cerebral lesions have been registered with the Disablement Insurance since 1970: in 1972 12%, in 1973 14% and in 1974 19% of first-registered minors. Since 1961 all definitely cerebral motor disorders have been registered with the Disablement Insurance, and since 1971 the infantile psychoorganic syndrome and questionable minimal "dyskinesias" have also been registered. The diagnostic and therapeutic costs for infantile minimal brain lesions according to Disablement Insurance tariffs are computed.

Adolescent↗

Increased physician disability claims causing 'crisis'. High utilization of disability insurance may leave physician groups fewer options in the future.

With physician claims on the rise, disability insurers are adjusting rates, provisions and benefit plans that are offered to those in the medical field. Physicians are being hit the hardest, experiencing premium increases, benefit reductions and stricter qualifications for coverage. There are only a few carriers who have not changed their rate structures and benefit plans. Now is the time to review the quality of your disability programs and establish how your carrier is reacting to this trend.

Disability Evaluation↗

Federal old-age, survivors and disability insurance and Supplemental Security Income for the Aged, Blind, and Disabled; medical and other evidence of your impairment(s) and definition of medical consultant. Social Security Administration. Final rules.

We are revising the Social Security and Supplemental Security Income (SSI) disability regulations regarding sources of evidence for establishing the existence of a medically determinable impairment under title II and title XVI of the Social Security Act (the Act). We are doing this to clarify and expand the list of acceptable medical sources and to revise the definition of the term "medical consultant" to include additional acceptable medical sources.

Disability Evaluation↗

An intergenerational policy proposal for the 1990s: applying the temporary disability insurance model to family caregiving.

This paper proposes a new policy initiative to assist family caregivers at a time when major demographic shifts in both the family and the workplace have taken place. Women especially are in the position of having to balance both work and family responsibilities without proper assistance. The initiative is based on an expansion of the Temporary Disability Insurance (TDI) model, to include care of family members of all ages by providing an adequate wage replacement. The shifting dependency ratio, resulting in a shrinking caregiver pool, is discussed as well as existing policies and their short-comings. For example, no current policies provide paid leave. The evolution of TDI, including resistance to it, is examined. Finally, Massachusetts' abortive attempt at a comprehensive plan for employment-leave insurance is discussed in detail and policy recommendations are outlined.

Adult↗

Industry, occupation, and disability insurance beneficiary work return.

This article uses the New Beneficiary Data System to describe the first job held after award of Disability Insurance benefits, in terms of occupation and industry. It examines work activity within sectors of employment, and looks at the issues of whether work return in certain industries and occupations varies according to the demographic characteristics of the beneficiaries. The article also presents data on sector-specific employer accommodations that can aid in sustained work return. Postentitlement work was fairly evenly distributed across occupational and industrial sectors. Persons with higher levels of educational attainment were found to be in white-collar employment sectors. There were noticeable differences in the availability of employer accommodations across postentitlement occupations and industries.

Adolescent↗

Federal old-age, survivors, and disability insurance and supplemental security income for the aged, blind, and disabled; evaluating opinion evidence. Social Security Administration. Final rules.

We are revising the Social Security and Supplemental Security Income (SSI) regulations concerning the evaluation of medical opinions to clarify how administrative law judges and the Appeals Council are to consider opinion evidence from State agency medical and psychological consultants, other program physicians and psychologists, and medical experts we consult in claims for disability benefits under titles II and XVI of the Social Security Act (the Act). We are also defining and clarifying several terms used in our regulations and deleting other terms.

Expert Testimony↗

Old-age, survivors, and disability insurance and Supplemental Security Income for the aged, blind, and disabled; substantial gainful activity amounts; "services" for trial work period purposes--monthly amounts; student child earned income exclusion. Social Security Administration. Final rules.

We are revising the rules to automatically adjust each year, based on any increases in the national average wage index, the average monthly earnings guideline we use to determine whether work done by persons with impairments other than blindness is substantial gainful activity; provide that we will ordinarily find that an employee whose average monthly earnings are not greater than the "primary substantial gainful activity amount," has not engaged in substantial gainful activity without considering other information beyond the employee's earnings; increase the minimum amount of monthly earnings and the minimum number of self-employed work hours in month that we consider shows that a person receiving title II Social Security benefits based on disability is performing or has performed "services" during a trial work period, and automatically adjust the earnings amount each year thereafter; increase the maximum monthly and yearly Student Earned Income Exclusion amounts we use in determining Supplemental Security Income (SSI) Program eligibility and payment amounts for student children, and automatically adjust the monthly and yearly exclusion amounts each year thereafter. We are revising these rules as part of our efforts to encourage individuals with disabilities to test their ability to work and keep working. We expect that these changes will provide greater incentives for many beneficiaries to attempt to work or, if already working, to continue to work or increase their work effort.

Child↗

Old-age, survivors, and disability insurance and supplemental security income for the aged, blind, and disabled; substantial gainful activity amounts. Social Security Administration. Final rules.

We are revising the rules for determining when earnings demonstrate the ability to engage in substantial gainful activity (SGA). This rule change applies to Social Security disability benefits provided under title II of the Social Security Act (the Act) and Supplemental Security Income (SSI) benefits based on disability under title XVI of the Act. (Eligibility for benefits under titles II and XVI also confers eligibility for related Medicare and Medicaid benefits under titles XVIII and XIX of the Act.) Specifically, we are raising from $500 to $700 the average monthly earning guidelines used to determine whether work done by persons with impairments other than blindness is SGA. We are raising this level as part of efforts to encourage individuals with disabilities to attempt to work, and to provide an updated indicator of when earnings demonstrate the ability to engage in SGA. This increase reflects our assessment of the amount that roughly corresponds to wage growth since the last increase in 1990.

Eligibility Determination↗

Cross-coding from the Swiss Disability Insurance listing to the ICIDH.

It has been suggested that converting, via a process of cross-coding, the listing used by the Swiss Disability Insurance (SDI) for their statistics into codes of the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) would improve the quality and international comparability of disability statistics for Switzerland. Using two different methods we tested the feasibility of this cross-coding on a consecutive sample of 204 insured persons, examined at one of the medical observation centres of the SDI. Cross-coding is impossible, for all practical purposes, in a proportion varying between 30% and 100%, depending on the method of cross-coding, the level of disablement and the required quality of the resulting codes. Failure is due to lack of validity of the SDI codes: diseases are poorly described, consequences of diseases (disability and handicap, including loss of earning capacity), insufficiently described or not at all. Assessment of disability and handicap would provide necessary information for the SDI. It is concluded that the SDI should promote the use of the ICIDH in Switzerland, especially among medical practitioners whose assessment of work capacity is the key element in the decision to award benefits or propose rehabilitation.

Adult↗

Supplemental Security Income (SSI), Disability Insurance (DI), and substance abusers.

Federal legislation repealed Supplemental Security Income (SSI) and Disability Insurance (DI) for alcohol and drug abusers as of January 1997. This article outlines the context in which the legislation was passed and summarizes concerns resulting from the legislation. We discuss the effects of the legislation on treatment participation, financing, and availability, and the legislation's impact on individuals with dual mental health and substance abuse problems. We also consider the individual and societal implications of substance abusers' loss of monthly income and health insurance.

Adult↗

How raising the age of eligibility for Social Security and Medicare might affect the disability insurance and Medicare programs.

The normal age of retirement is scheduled to increase to 67 by 2022, and several proposals to increase it to age 70 are being considered. The Medicare eligibility age is not scheduled to increase under current law, but proposals to raise it in step with the retirement age were recently considered by the National Bipartisan Commission on the Future of Medicare (1999). This article examines how raising both the normal retirement age and the Medicare eligibility age would affect Social Security Disability Insurance (DI) eligibility, Medicare eligibility, and Medicare expenditures under two hypothetical policy scenarios. The first (the 2022 age-67 scenario) assumes that the eligibility age is raised to 67 by 2022, in step with the scheduled increase in the normal retirement age. The second (the 2040 age-70 scenario) assumes that the eligibility ages are increased to 70 by 2040. The findings are based on a summary of two reports. The earlier one (Wittenburg and others 1999) describes a series of microsimulation models developed from data in the Survey of Income and Program Participation (SIPP) and the Medicare Current Beneficiary Survey (MCBS). The base simulations in that report assume that the normal retirement and Medicare eligibility ages had already been increased in 1993, when the SIPP and MCBS respondents were observed. In the later report (Wittenburg, Stapleton, and Scrivner 2000), adjustment factors were developed to reflect future increases in Medicare expenditures, population growth, and increased participation in DI. The base simulations were then adjusted by those factors, yielding a final set of annual projections under the two policy scenarios. The hypothetical policy scenarios illustrate that the major cost reductions from jointly raising the Medicare eligibility age and the normal age of retirement would not be realized until after 2020, when the increases are fully phased in and a large portion of baby boomers have reached age 65. Although the projections provide important cost estimates, the equity and efficiency of those policies must be studied before the desirability of any specific proposal can be evaluated fully.

Age Factors↗

Evaluation of disability insurance savings due to beneficiary rehabilitation.

This article uses individual vocational rehabilitation case data and disability insurance (DI) benefit histories from the master beneficiary record file to compare the costs and savings to the DI trust fund associated with the beneficiary rehabilitation program. Using cost-benefit procedures and varying assumptions as to the impact of vocational rehabilitation services, the savings to the trust fund were found to range between $1.39 and $2.72 per $1.00 of cost for DI beneficiaries who completed their vocational rehabilitation service period in fiscal year 1975. Calculating savings according to the length of the savings period revealed that expenditures for vocational rehabilitation services to these beneficiaries would be fully repaid within 10 years after closure. It was also discovered that the loss of savings due to return to the DI rolls substantially exceeds the increased payroll tax revenue accruing to the trust fund from post-vocational rehabilitation employment.

Age Factors↗

The HIV-positive physician and disability insurance.

Occupational exposure to HIV is becoming a daily hazard in many emergency departments. Emergency physicians who are protected by disability insurance policies are likely to believe that if they are unable to continue working because of HIV-positive status, their disability policies will provide them with a source of income. Unfortunately, analysis of case law regarding claims under disability policies shows that the law is unlikely to consider an asymptomatic, HIV-positive physician disabled for purposes of payments under disability policies. Therefore, it is necessary for emergency physicians to make sure this issue is resolved before buying and relying on a disability policy so that an anticipated safety net will be operative over the full range of hazards that emergency physicians face.

Data Collection↗

Medicare and the Social Security Disability Insurance program.

This DataWatch traces changes over time in the age and health characteristics of persons awarded Social Security Disability Insurance (SSDI) benefits. SSDI beneficiaries are increasingly younger and more likely to be incapacitated by health conditions that at any age lengthen spells of disablement. These changes have had a significant impact on SSDI operations; they also have important implications for financing the Medicare program.

Adult↗

The effect of disability insurance on health care demand.

This paper examines the incentive effects of the growth in the Social Security Disability Insurance (DI) system in terms of its impact on individual health care demand. A simple model predicts that DI benefits will reduce the individual's demand for preventive health care (in order to increase their probability of acceptance) while the demand for acute care is not affected. Estimates of health care demand equations for males aged 58-63 confirm the non-effect of DI benefits on acute care, while significant (but small) negative effects of benefits on preventive care are found.

Health Services Needs and Demand↗