Evidence needs, training demands, and opportunities for knowledge translation in social security and insurance medicine: A European survey.

OBJECTIVE: To perform a European survey of the evidence needs and training demands of insurance medicine professionals related to professional tasks and evidence-based practice. DESIGN: International survey. SUBJECTS: Professionals working in insurance medicine. METHODS: Experts designed an online questionnaire including 26 questions related to 4 themes: evidence needs; training demands; evidence-seeking behaviour; and attitudes towards evidence-based medicine. Descriptive statistics were presented by country/conference and the total sample. RESULTS: A total of 782 participants responded. Three-quarter of participants experienced evidence needs at least once a week, related to mental disorders (79%), musculoskeletal disorders (67%) and occupational health (65%). Guidelines (76%) and systematic reviews (60%) were the preferred types of evidence and were requested for assessment of work capacity (64%) and prognosis of return-to-work (51%). Evidence-based medicine was thought to facilitate decision-making in insurance medicine (95%). Fifty-two percent of participants felt comfortable finding, reading, interpreting, and applying evidence. Countries expressed similar needs for reviews on typical topics. CONCLUSION: This study reveals evidence gaps in key areas of insurance medicine, supporting the need for further research, guidelines and training in evidence-based insurance medicine. Importantly, insurance medicine professionals should recognize that evidence-based practice is crucial in producing high-quality assessments.

Trends Over Time and Jurisdiction Variability in Supplemental Security Income and State Supplementary Payment Programs for Children With Disabilities.

CONTEXT: Nearly 1.2 million children with disabilities received federally administered Supplemental Security Income (SSI) payments in 2017. Based on a robust review of research and evaluation evidence and microsimulations, The National Academies of Sciences, Engineering, and Medicine committee identified modifications to SSI (ie, increasing the federal SSI benefit maximum by one-third or two-thirds) as 1 of 10 strategies that could reduce the US child poverty rate, improving child health and well-being on a population level. OBJECTIVE: Describing the availability and amount of SSI and State Supplementary Payment (SSP) program benefits to support families of children with disabilities may be a first step toward evaluating The National Academies of Sciences, Engineering, and Medicine-proposed modification to SSI as a potential poverty alleviation and health improvement tool for children with disabilities and their families. DESIGN: We used public health law research methods to characterize the laws (statutes and state agency regulations) governing the federal SSI program and SSP programs in the 50 states and District of Columbia from January 1, 1996, through November 1, 2018. RESULTS: The number of jurisdictions offering supplementary payments (SSP) was relatively stable between 1996 and 2018. In 2018, 23 US jurisdictions legally mandated that SSP programs were available for children. Among the states with SSP payment amounts in their codified laws, SSP monthly benefit amounts ranged from $8 to $64.35 in 1996 and $3.13 to $60.43 in 2018. CONCLUSION: Our initial exploration of SSI-related policies as a tool for improving the economic stability of children with disabilities and their families suggests that current SSPs, in combination with SSI, would not rise to the level of SSI increases proposed by The National Academies of Sciences, Engineering, and Medicine. Understanding more about how SSI and SSP reach children and work in combination with other federal and state income security programs may help identify policies and strategies that better support children with disabilities in low-income households.

Efectos de la afiliación al Seguro Social General en el Gasto de Bolsillo en Salud de los hogares. Ecuador 2014 / Effects of affiliation to General Social Security on household out-of-pocket health spending. Ecuador 2014

Introducción: La seguridad social se fundamenta en la entrega oportuna de servicios de salud, evitando la falta de protección y el empobrecimiento de las familias que se asocia de manera directa con excesivos gastos de bolsillo. Objetivo: Estimar el efecto que tiene la afiliación al Seguro Social General (SSG) en el Gasto de Bolsillo en Salud (GBS) en los hogares ecuatorianos para el año 2014. Metodología: El efecto se estimó mediante el análisis estadístico Propensity Score Matching y utilizando el programa Stata, sobre una muestra de 22,364 observaciones, de las cuales 7,509 son tratadas ­ hogares afiliados al SSG ­ y 14,855 son de control ­ hogares sin ningún tipo de afiliación ­, datos tomados de la encuesta de Condiciones de Vida realizada por el INEC para el año 2014. Como variable de resultado se utilizó a los gastos de bolsillo y como variable de tratamiento a los hogares en los que al menos, el jefe del hogar este afiliado al Seguro Social General. Resultados: Se encontró un efecto positivo entre la condición de afiliados al SSG y el GBS de los hogares, el afiliado tiene una propensión a realizar mayores gastos privados en salud que el no afiliado, incrementándose aún más si el jefe del hogar es de sexo masculino. Para los dos sexos, la similitud es únicamente en la covariable ingresos, sin embargo, cuando el jefe de hogar es de sexo femenino, las covariables significativas se incrementan. Conclusiones: Los afiliados al SSG muestran un incremento en los GBS lo que significaría una falta de protección financiera a pesar de los aportes mensuales realizados a la seguridad social.

Introduction: Social security is based on the timely delivery of health services, avoiding the lack of protection and impoverishment of families that is directly associated with excessive health expenditures. Objective: To estimate the effect that the General Social Security (SSG) affiliation has on Pocket Health Expenditure (GBS) in Ecuadorian households for the year 2014. Methodology: The effect was estimated using the Propensity Score Matching method and using the Stata program, on a sample of 22,364 observations, and only 7,509 are treated - SSG affiliated households - and 14,855 are control - households without any affiliation - data were taken from the Life Conditions survey conducted by the INEC for the year 2014. Health expenditures was used as result variable and households in which at least the head of the household is affiliated to General Social Security was used as treatment variable. Results: A positive effect was found between the condition of members of the SSG and the GBS of the households, the affiliate has a propensity to make higher private health expenses than the unaffiliated, increasing even more if the head of the household is male. For both sexes, the similarity is only in the income covariate, however, when the head of the household is female, the significant covariates increase. Conclusions: The members of the SSG show an increase in the GBS which would mean a lack of financial protection despite the monthly contributions made to social security.

Securing Social Security Solvency Addressing an important social determinant of the health of seniors and the American polity.

Adequate income is a social determinant of health. In the United States, only Social Security beneficiaries receive inflation-protected guaranteed income. Social Security needs another 1983 compromise in which stakeholders accepted "shared pain" to avoid insolvency. We propose indexing the benefit using the chained consumer price index (CPI) for all urban consumers and providing a one-time bonus of 8% to 10% for beneficiaries in their mid-80s, when needs become greater. The chained CPI has little impact when beneficiaries start receiving benefits, but older beneficiaries need protection. The estimated 75-year savings from this restructured benefit amount to 14.2% to 18% of Social Security deficits. Modest increases in payroll taxes and maximum earnings taxed should make up most of the shortfall. Including unearned income with wages and salaries subject to the 6.2% individual tax would produce much more revenue. The discussion explores the proposal's political feasibility, grounding in current policy and political science literature, and the role of income as a social determinant of health.

The Uneven Foci of Work Disability Research Across Cause-based and Comprehensive Social Security Systems.

This scoping review identified what kinds of work disability policy issues are critiqued in articles published in countries with cause-based versus comprehensive welfare systems. Drawing on a review of work disability policy research, we identified 74 English-language, peer-reviewed articles that focused on program adequacy and design. Articles on cause-based systems dwelled on system fairness and policies of proof of entitlement, while those on comprehensive systems focused more on system design complexities relating to worker inclusion and scope of medical certificates. Overall, we observed a clear difference in the nature of problems examined in the different systems. Gaps in work disability policy literature are identified, and challenges for comparative policy research are discussed.

Work-Related Outcomes in Self-Employed Cancer Survivors: A European Multi-country Study.

Purpose To describe: (i) patterns of self-employment and social welfare provisions for self-employed and salaried workers in several European countries; (ii) work-related outcomes after cancer in self-employed people and to compare these with the work-related outcomes of salaried survivors within each sample; and (iii) work-related outcomes for self-employed cancer survivors across countries. Methods Data from 11 samples from seven European countries were included. All samples had cross-sectional survey data on work outcomes in self-employed and salaried cancer survivors who were working at time of diagnosis (n = 22-261 self-employed/101-1871 salaried). The samples included different cancers and assessed different outcomes at different times post-diagnosis. Results Fewer self-employed cancer survivors took time off work due to cancer compared to salaried survivors. More self-employed than salaried survivors worked post-diagnosis in almost all countries. Among those working at the time of survey, self-employed survivors had made a larger reduction in working hours compared to pre-diagnosis, but they still worked more hours per week post-diagnosis than salaried survivors. The self-employed had received less financial compensation when absent from work post-cancer, and more self-employed, than salaried, survivors reported a negative financial change due to the cancer. There were differences between self-employed and salaried survivors in physical job demands, work ability and quality-of-life but the direction and magnitude of the differences differed across countries. Conclusion Despite sample differences, self-employed survivors more often continued working during treatment and had, in general, worse financial outcomes than salaried cancer survivors. Other work-related outcomes differed in different directions across countries.

Work-related illness, work-related accidents, and lack of social security in Colombia.

The impacts of neoliberal or market-based social security reforms in health have been extensively studied. How such reforms transformed employment-related insurance and entitlements, however, has received significantly less attention. This study aims to understand how the employment insurance system operates in Colombia and to assess how the experience of workers seeking social security entitlements relates to the system's structure. We conducted an ethnographic study of the Colombian Occupational Risk System between May 2014 and March 2016, with two main components: 1) analysis of the system itself through in-depth interviews with 32 people working in leadership positions and a systematic review of the system's most important legislation, and 2) a study of people who experienced problems receiving entitlements and were challenging the assessment of their work-related illness or accident. We conducted in-depth interviews with 22 people, followed up with half of them, and reviewed their case files. We found that difficulties accessing health care services, payments for medical leave, job reassignments, severance packages, and filing for pension benefits were common to all cases and resulted from overwhelming bureaucratic and administrative demands. Regional and national evaluation bodies dictate whether a given illness or accident is work-related, and establish a percentage of Loss of Wage Earning Capacity (LWEC). People's disabled bodies rarely reached the threshold of 50% LWEC to qualify for disability pensions. The lengthy process that workers were forced to endure to obtain work-related entitlements always involved the judiciary. The three competing for-profit financial sectors (health insurance, pension funds, and Occupational Risk Administrators) actively challenged workers' demands in order to increase their profits. We conclude that these for-profit sectors work contrary to the principles that sustain social security. Indeed, they push sick and disabled workers to unemployment, informality, economic dependence, and ultimately dire poverty.

The Social Security Administration's Compassionate Allowances Initiative: Condition Spotlight on Rubinstein-Taybi Syndrome.

The Social Security Administration (SSA) Compassionate Allowances List (CAL) was created in 2008, generating a mechanism within SSA for identifying diseases and other medical conditions that by definition meet social security's standards for disability benefits. Currently, over 200 conditions are included in this expedited review program, though few of them are neurodevelopmental in nature. Exploration of a novel method for inclusion of additional conditions on CAL was undertaken using one condition as an exemplar. Peer-reviewed literature available in academic databases was reviewed and used as empirical evidence to demonstrate whether Rubinstein-Taybi syndrome (RTS) invariably met the three disability criteria set forth by SSA. After in-depth exploration of the empirical literature, RTS was found to meet SSA's definition, suggesting this condition should receive consideration as an addition to the Compassionate Allowances Initiative.

Environment-Level Strategies to Support Independent Control of Finances: A Response to the SSA Review of Financial Capability Determination Review.

The Social Security Administration (SSA) recently completed an evaluation of the process by which representative payees are assigned. The SSA report is welcome, particularly for its focus on developing more accurate, real-world assessments of a person's financial capability and its recognition of the need for more flexible options for people with disabilities. Crucially, the report discusses the impact of the broader environment-specifically, conditions related to living in poverty. However, it provides no guidance about environmental interventions that could enable more beneficiaries to manage their funds without a payee. Innovative financial products could be offered to beneficiaries, and the retail industry could develop processes to support responsible financial management by people with mental illness. Changes to SSA benefits systems, including raising benefits levels and asset limits, could enable more beneficiaries to manage their funds independently.

Do personal assistance activities promote participation for persons with disabilities in Sweden?

PURPOSE: To examine how the right to participation according to Article 19 of the United Nations' Convention on the Rights of Persons with Disabilities (UNCRPD) is promoted by personal assistance use in Sweden across age, gender and eligible person categories. METHOD: Register data and data from a questionnaire were used (N = 15,289). Principal component analysis was performed and the internal consistency was tested. Descriptive statistics (χ2 test) were used across age, gender and eligible person categories and components. RESULTS: An uneven distribution of personal assistance across the components Health and Care; Home, Leisure and Social Interaction; and Daily Occupation was found. Significant differences in personal assistance reported were found between children and adults, men and women and between the three eligible person categories. CONCLUSIONS: The discrepancy between reported and expected outcome of personal assistance indicates that Article 19 of the UNCRPD has not been met. The unequal access to participation across age, gender and eligible person categories would seem to further signify that the Act concerning Support and Service for Persons with Certain Functional Impairments is promoting activities of a caring nature rather than fulfilling Article 19 of the UNCRPD, i.e. ensuring full participation in society. IMPLICATIONS FOR REHABILITATION Government assistance allowance were granted for predominantly health and care, i.e. basic needs presenting risk of undermining the intention of participation in society. Men reported more personal assistance use for activities promoting participation than women. The discrepancy found between reported and expected outcome of personal assistance underlines the importance of service providers and administrative officials being sensitive to policy intentions. There is a need of guidelines for service providers and administrative officials to promote disability rights of participation for persons eligible for personal assistance.

Improving Social Security's Financial Capability Assessments.

When Social Security beneficiaries are incapable of managing their benefits, the agency can appoint a representative payee to administer benefits on their behalf. A committee of the Institute of Medicine was asked by the Social Security Administration to review the process by which financial capability determinations are made and to recommend improvements. The committee's conclusions and recommendations include the following: giving priority to real-world financial performance in assessing capability, providing clearer instructions to informants, developing systematic approaches to identifying beneficiaries at risk of incapability, exploring the use of a supervised direct payment option, and instituting regular data collection to assist in improving operations.

[The IMSS and the CONRICyT]. / El IMSS y el CONRICyT.

In this editorial we make a review of the way the Instituto Mexicano del Seguro Social (IMSS) has established a relation between knowledge and its healthworkers to improve patient care. We also mention the agreement that IMSS and CONRICyT (National Consortium of Scientific and Technological Information Resources, according to its initials in Spanish) signed in 2013 to keep promoting knowledge among its workers.

En el presente editorial se hace un repaso de la manera como el Instituto Mexicano del Seguro Social (IMSS) ha establecido un nexo entre el conocimiento y sus trabajadores de la salud, a fin de que estos atiendan de una mejor manera a los derechohabientes del Instituto. También se menciona el convenio que el IMSS y el CONRICyT firmaron en 2013 para seguir promoviendo el conocimiento entre los trabajadores.

[Analysis of problems connected with formation of new social security system for workers].

The authors analyzed problems of operating system of workers' social security, among them - insurance payments are provided on basis of experts'lists of productions, work types, occupations without consideration of real work conditions on specific workplaces, health state and performance of workers. Solutions of the problems are suggested.

Assessing the short term health impact of the Great Recession in the European Union: a cross-country panel analysis.

BACKGROUND: There are great concerns and some initial country-specific, descriptive evidence about potential adverse health consequences of the recent Great Recession. METHODS: Using data for 23 European Union countries we examine the short-term impact of macroeconomic decline during the Great Recession on a range of health and health behaviour indicators. We also examine whether the effect differed between countries according to the level of social protection provided. RESULTS: Overall, during the recent recession, an increase of one percentage point in the standardised unemployment rate has been associated with a statistically significant decrease in the following mortality rates: all-cause-mortality (3.4%), cardiovascular diseases (3.7%), cirrhosis- and chronic liver disease-related mortality (9.2%), motor vehicle accident-related mortality (11.5%), parasitic infection-related mortality (4.1%), but an increase in the suicide rate (34.1%). In general, the effects were more marked in countries with lower levels of social protection, compared to those with higher levels. CONCLUSIONS: An increase in the unemployment rate during the Great Recession has had a beneficial health effect on average across EU countries, except for suicide mortality. Social protection expenditures appear to help countries "smooth" the health response to a recession, limiting health damage but also forgoing potential health gains that could otherwise result.

Reporting about disability evaluation in European countries.

PURPOSE: To compare the official requirements of the content of disability evaluation for social insurance across Europe and to explore how the International Classification of Functioning, Disability and Health is currently applied, using the rights and obligations of people with disabilities towards society as frame of reference. METHODS: Survey. We used a semi-structured questionnaire to interview members of the European Union of Medicine in Assurance and Social Security (EUMASS), who are central medical advisors in social insurance systems in their country. We performed two email follow-up rounds to complete and verify responses. RESULTS: Fifteen respondents from 15 countries participated. In all countries, medical examiners are required to report about a claimant's working capacity and prognosis. In 14 countries, medical reports ought to contain information about socio-medical history and feasible interventions to improve the claimant's health status. The format of medical reporting on working capacity varies widely (free text, semi- and fully structured reports). One country makes a reference to the ICF in their reports on working capacity, others consider doing so. CONCLUSION: Official requirements on medical reporting about disability in social insurance across Europe follow the frame of four features: work capacity, socio-medical history, feasibility of intervention and prognosis of disability. There is an increasing trend to make formal or informal reference to the ICF in the reports about working capacity. The four features and the ICF may provide common references across countries to describe disability evaluation, facilitating national and international research. Implications for Rehabilitation Reporting about disability in social insurance in different countries is about work capacity, social medical history, feasibility of intervention and prognosis of disability. Formats of reporting on work capacity vary among countries, from free text to semi-structured report forms to fully structured and scaled report forms of working capacity. The ICF could serve as a reference for describing work capacity, provided the ICF contains all necessary categories.