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Workers' health in Israel.

BACKGROUND: Occupational hazards are important causes of morbidity, mortality, and disability in the community. This article presents a review of workers' health in Israel. METHODS: Data were collated from the Occupational Health Institute of the University of Tel Aviv, the National Insurance Institute, the Occupational Health Departments of the General Sick Fund, and the Institute of Safety and Hygiene of the Ministry of Labor and Welfare. International comparisons are based on data derived from the WHO Health for All database for the European region. RESULTS: Levels of most biological and chemical exposures in 1996 were found to be in accordance with the standards, except for dust, gases, pesticides, and noise exposure. In 1996, 4.3% of the working population received injury compensation from the National Insurance Institute. 78% of workers' claims approved in 1992-1994 were for injuries to the back and spine. 93% of new cases of occupational diseases and injuries reported in 1996 by the occupational health service of the largest Health Fund were due to noise-induced hearing impairments. In 1996, there were 87 reported deaths following work accidents; about 50% of them were falls that occurred in the construction industry, and 26% of fatalities were among foreign workers. Rates of work accidents, average days of incapacity per accident, and fatalities have been increasing since 1991. Rates of occupational accidents and of occupational fatalities are higher than the European Community average. CONCLUSIONS: Rates of occupational diseases and of injury compensation among workers are increasing, despite the efforts and resources invested in the prevention of work accidents and the promotion of workers' health. These findings indicate the necessity for further research and efforts toward the prevention of injuries and the promotion of occupational health in Israel.

Humans↗

[Insurance medicine in routine forensic medicine].

When the forensic doctor is confronted with a query coming from the insurance medicine, he will perhaps realize, that he has suddenly reached the boundaries of his knowledge. Statutory regulations are partly not yet available and partly contested. This accounts for the fact, that sometimes ten or more expert opinions are formulated for one and the same litigation. In the present paper some themes are randomly selected and reviewed in accordance with scientific findings. Investigated with references pertaining to current points at issues, are the following controversial subjects: a) Victim compensation law b) Nursing insurance law c) Transplantation law d) Acceleration trauma e) Lightning casualties f) Heroin (drug criminality) g) Age determination h) Insurance fraud The practice shows, that the physician's need to search for causality is restricted by juridical thought, be it by legal enactments or by the superior courts' guiding principles.

Disability Evaluation↗

The economic consequences of medical injuries. Implications for a no-fault insurance plan.

BACKGROUND: There has been little research into the actual economic consequences of medical injuries. This inhibits informed discussion of alternatives to malpractice litigation. For example, the cost of no-fault medical accident insurance has been thought to be prohibitive. METHOD: As part of a comprehensive analysis of medical injury and litigation, we interviewed a random sample of 794 individuals who had suffered medical adverse events in New York hospitals in 1984 and used their responses to calculate the cost of injuries. We then estimated the costs of a simulated no-fault insurance program that would operate as a second payer to direct insurance sources and would compensate for all financial losses attributed to medical injury. RESULTS: The estimated costs that would be paid by a simulated no-fault program were $161 million for medical care, $276 million for lost wages, and $441 million in lost household production, or a total of $878 million in 1989 dollars for the cohort of patients who were injured in 1984. CONCLUSION: Although our estimate does not include administrative costs, it nonetheless indicates that a no-fault program would not be notably costlier than the more than $1 billion New York physicians now spend annually on malpractice insurance.

Adult↗

Disability; is it permanent?

Too often cases of industrial injuries are submitted for permanent disability rating before maximum recovery is attained and the condition is permanent and stationary. This is frequently a situation that is detrimental to the injured working man, since his physical disability might be further reduced by additional treatment, and his future earning power and economic status thus be improved. Also it may be detrimental to the insurance carrier and/or employer, since in some instances it results in increased permanent disability award payments for portions of the condition which are not truly permanent. Inadequate medical reports also are a frequent cause of unfair awards. The necessary factors used to arrive at proper conclusions, the errors that have been observed and the importance of this problem are discussed.

Persons with Disabilities↗

Workers' compensation: coverage, benefits, and costs, 1982.

Workers' compensation provides medical care and income maintenance protection to workers disabled from work-related injury or illness. This program is of considerable interest to the Social Security Administration (SSA) from several perspectives. For example, since 1965 Social Security Disability Insurance (DI) benefits and workers' compensation payments have been integrated. Information on the experience under workers' compensation provides a framework for examining questions concerning gaps and overlaps in the Nation's social insurance system. In addition, since December 1969 SSA has administered claims filed through 1973 under part B of the Black Lung program--the program providing income maintenance protection to coal miners disabled by pneumoconiosis. The workers' compensation experience reported here consists of information on benefits for work-related injury and disease, including data on the combined benefits paid under the entire Federal Black Lung program administered by the Labor Department and SSA.

Coal Mining↗

Cost and determinants of morbidity from work related disabling injuries in Taiwan.

OBJECTIVES: To estimate the cost and determinants of morbidity from work related disabilities. METHODS: 114 people who lived in metropolitan Taipei and who had received disability compensation from the Labor Insurance Bureau from March to June, 1991 were randomly selected. There were 77 workers interviewed through a questionnaire that inquired about possible loss of productivity including the duration of morbidity, the ability to return to work, and any change in monthly income upon returning to work. RESULTS: The mean (SD) duration of a stay in hospital was 29 (39) days, median: 15 days. The average duration between discharge from the hospital and returning to work was 111 (146) days, median: 45 days. The main determinants of the duration of the stay in hospital were the number of stays in hospital and the severity of the injury. A multivariate linear analysis showed that old age and the severity of injury determine the durations of morbidity. An ordinal logistic regression analysis showed that the severity of injury, size of the factory, and age determined the magnitude of future productivity loss. Based on these models, it was estimated that the total duration of morbidity (in hospital and at home) due to occupational disability was 660,000 person-days each year. When the percentage of the decrease in income because of permanent disability was converted into a loss of work days, the annual morbidity costs were about 19,000-26,000 person-years between 1985-1990. CONCLUSION: The morbidity cost was about five times as high as the lump sum payment that a worker usually received for disability compensation. We conclude that morbidity cost should be evaluated carefully in the future for the establishment of accurate and fair disability compensation payments.

Accidents, Occupational↗

Profile of denials of durable medical equipment for SCI patients by third party payers.

The difficulty in obtaining approval for payment of durable medical equipment by third party payers has impeded the rehabilitation program and discharge planning of many spinal cord patients throughout the country for many years. To gain some insight as to the number and level of patients affected, the kinds of equipment denied, the reasons given for the denial, which third party payers were mostly involved and how the patient and his/her family managed to cope or resolve this problem, a survey was undertaken. Letters were sent to 259 members of the American Spinal Injury Association (ASIA) asking them to list representative cases where requests for equipment deemed necessary were denied. Twenty-eight responses from different institutions were received from sixteen states describing 110 patients and 180 pieces of durable medical equipment denied in 1984 and 1985. Manual wheelchairs, motorized wheelchairs, shower/commode chairs, and environmental control units were the four most common equipment items denied by the third party payers. Government agencies ie., Medicaid, Medicare, Vocational Rehabilitation Departments and State Crippled Children's Services were the most frequent deniers, comprising 54% of the total sample. They were followed by private insurance (31%) and Workman's Compensation (3%). By far, the two most common reasons given for denials were: it was not covered by the insurance policy (38%) and it was not medically necessary (30%). Ninety (90) pieces of equipment (50%) were eventually obtained, most often by charity, or through the patient's family resources.

Data Collection↗

The workers' compensation system: worker friend or foe?

BACKGROUND: The workers' compensation system was designed to help injured workers who have substantial medical expenses and perhaps have lost a great deal of income. This study determines both similarities and differences in how workers experience their interactions with the workers' compensation systems in Florida and Wisconsin. METHODS: Ethnographic open-ended interviews with 204 workers from Florida and 198 workers in Wisconsin were conducted. All the workers had back injuries in 1990 and were either paid workers' compensation temporary disability benefits for at least 4 weeks or received permanent disability benefits or compromise settlements. RESULTS: Some interactions with the workers' compensation system were positive. However, the majority of respondents in both states experienced their encounters with the workers' compensation system as cumbersome, frustrating, and demeaning. CONCLUSIONS: Mistrust, stigmatization, payment delays, and refusal of insurer personnel to pay benefits contribute to workers' negative experiences with the workers' compensation system. These insurer behaviors raise the costs to injured workers of workers' compensation benefits and thus may reduce the propensity of eligible workers to apply for benefits.

Accidents, Occupational↗