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.

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.

[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.

Youth transitioning out of foster care: an evaluation of a Supplemental Security Income policy change.

Youths with disabilities face numerous challenges when they transition to adulthood. Those who are aging out of foster care face the additional challenge of losing their foster care benefits, although some will be eligible for Supplemental Security Income (SSI) payments after foster care ceases. However, the time needed to process SSI applications exposes those youths to a potential gap in the receipt of benefits as they move between foster care and SSI. We evaluate the effects of a 2010 Social Security Administration policy change that allows such youths to apply for SSI payments 60 days earlier than the previous policy allowed. The change provides additional time for processing claims before the applicant ages out of the foster care system. We examine administrative records on SSI applications from before and after the policy change to determine if the change has decreased the gap between benefits for the target population.

Outcome variation in the social security disability insurance program: the role of primary diagnoses.

Based on the adjudicative process, the author classifies claimant-level data over an 8-year period (1997-2004) into four mutually exclusive categories: (1) initial allowances, (2) initial denials not appealed, (3) final allowances, and (4) final denials. The ability to predict those outcomes is explored within a multilevel modeling framework, with applicants clustered by state and primary diagnosis code. Variance decomposition suggests that medical diagnoses play a substantial role in explaining individual-level variation in initial allowances. Moreover, there is statistically significant high positive correlation between the predictions of an initial allowance and a final allowance across the diagnoses. This finding suggests that the ordinal ranking of impairments between these two adjudicative outcomes is widely preserved. In other words, impairments with a higher expectation of an initial allowance also tend to have a higher expectation of a final allowance.

Guidelines for assessment of work disability: an international survey.

BACKGROUND: Assessments of long-term work disability are carried out by social insurance physicians (SIPs) and are little supported with evidence or instruments. Guidelines are hardly ever used in social insurance medicine. Developments in social insurance medicine might be slow as insurance is different from clinical medicine. AIMS: We explored the comparability of assessments in social insurance medicine in different countries and asked what guidelines were in official use. METHODS: Eighteen European countries were invited. A questionnaire on assessments practices was sent to national experts. A comparative table was presented to all contributors. Countries with guidelines were visited. Guidelines were categorised according to their purpose and their contents were compared. The results were presented to experts of the participating countries for validation. RESULTS: Fourteen countries participated. Functional capacity assessment was common. Guidelines for SIPs were reported to be officially in use in Germany, Ireland, the Netherlands and Switzerland. Twenty-two guidelines were medical and eleven were procedural. Medical guidelines mainly treated the same topics. Procedural guidelines were more variable. CONCLUSION: Assessment of work disability is comparable between countries. Medical and procedural guidelines should be further developed and tested on their value in practice. The procedural guidelines need to be published in a clear and comparable manner. The legal security of claimants would be endorsed by this. Germany and the Netherlands are most experienced and could take the lead in international development.

Social health insurance: to each according to his needs; from each according to his means--but what might that mean?

Despite the substantial literature on the financing and benefit incidence of social health insurance, the principles underlying such schemes are little debated. This article examines one of these key principles: to each according to his needs; from each according to his means. The authors discuss both sides of this principle at a conceptual level. On the needs side, they examine the issue of vertical equity. The approach of "communitarian claims" is proposed, both for eliciting the components of need and for determining the relative weights to be attached to the vertical dimensions of equity in health service delivery. On the means side, the authors also look to communitarian claims to assist in determining who should bear what burden in paying for social health insurance. They argue that with respect to the concept of "from each according to his means," it is useful to incorporate an element of willingness to pay, but meaning here the community's willingness to pay.

Revisions to rules of conduct and standards of responsibility for representatives. Final rules.

We are revising our rules of conduct and standards of responsibility for representatives. These revisions further clarify our expectations regarding representatives' obligations to competently represent their clients and constitute official notice concerning our requirements and procedures. We are also updating other rules about the representation of parties. These changes are necessary because our current regulations are insufficient to address some representative conduct that is inappropriate, but has technically fallen outside the scope of our regulations. These changes will allow us to better protect the integrity of our administrative process, ensure that claimants receive competent and effective representation, and further clarify representatives' responsibilities in their dealings with us and with claimants.

Insurance and prevention: ethical aspects.

In recent decades, prevention policies--i.e., insurance policies constructed to give incentives to investments in prevention and thereby reduce reliance on insurance--have been much discussed both with regard to different kinds of market insurance and, albeit primarily within a European context and in relation to an ongoing discussion about the need for a shift towards an "active" welfare state, with regard to social insurance. The present contribution identifies normative issues that deserve attention in relation to a general introduction of prevention policies in market insurance and social insurance. It is argued that the importance of these normative issues suggests that arguments and distinctions drawn from moral and political philosophy should play a more prominent role both in the debate on the shift towards an active welfare state and the use of prevention policies in market insurance.

Barriers in implementation of evidence-based practice: Supported employment in Swedish context.

PURPOSE: The aim of this paper is to identify initial barriers influencing implementation of supported employment (SE). SE, according to the individual placement and support (IPS) approach, has been recognised as an evidence-based method to help people with severe mental illness to find regular employment. DESIGN/METHODOLOGY/APPROACH: A systematic implementation evaluation of the first randomised controlled SE (IPS) trial in Sweden was conducted in August 2008 and August 2009. Data were collected on a regular basis from SE employment specialists, process heads, clients and representatives from mental health care units and vocational services (social insurance and public employment offices) using interviews, non-participant observations and document analysis. FINDINGS: SE employment specialists reported that existing regulations for social insurance and employment regulations presented major obstacles to implementation. Difficulties were reported in cooperation with handling officers at the vocational services. Scepticism towards persons with mental illness was common and employers expected to receive subsidies if they hired a person with mental illness. SE participants expressed fear of losing their social benefits. ORIGINALITY/VALUE: The results illuminate a collision between an innovative evidence-based practice and the existing systems for social benefits and work rehabilitation.

Caregiver credits in France, Germany, and Sweden: lessons for the United States.

Recently, analysts in the United States (US) have proposed adopting caregiver credits, or pension credits, provided to individuals for time spent out of the workforce while caring for dependent children and sick or elderly relatives. The primary objective of these credits, used in almost all public pension systems in the European Union, is to improve the adequacy of old-age benefits for women whose gaps in workforce participation typically lead to fewer years of contributions, lower lifetime average earnings, and consequently lower pensions. This article examines caregiver credits in the context of future reforms to the US Social Security system, with attention given to the adequacy of current spouse and survivor benefits and how changing marital patterns and family structures have increased the risk of old-age poverty among certain groups of women. It then analyzes caregiver credit programs in selected countries, with particular focus on design, administration, and cost.

Nan Hayworth: Home care advocate and rising star in the U.S. Congress.

Some people say that Nan Hayworth is the quintessential 21st century woman. This is because she is blessed with enormous gifts and because she carries out her many roles with enthusiasm and grace. Among these are wife, mother, businesswoman, community leader, physician and Member of Congress.

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.

Client predictors of employment outcomes in high-fidelity supported employment: a regression analysis.

Research on vocational rehabilitation for clients with severe mental illness over the past 2 decades has yielded inconsistent findings regarding client factors statistically related to employment. The present study aimed to elucidate the relationship between baseline client characteristics and competitive employment outcomes-job acquisition and total weeks worked during an 18-month follow-up-in Individual Placement and Support (IPS). Data from 4 recent randomized controlled trials of IPS were aggregated for within-group regression analyses. In the IPS sample (N = 307), work history was the only significant predictor for job acquisition, but receiving Supplemental Security Income-with or without Social Security Disability Insurance-was associated with fewer total weeks worked (2.0%-2.8% of the variance). In the comparison sample (N = 374), clients with a diagnosis of mood disorder or with less severe thought disorder symptoms were more likely to obtain competitive employment. The findings confirm that clients with severe mental illness interested in competitive work best benefit from high-fidelity supported employment regardless of their work history and sociodemographic and clinical background, and highlight the needs for changes in federal policies for disability income support and insurance regulations.

[Quality assurance of rehabilitation by the German pension insurance: an overview]. / Ein aktueller Überblick zur Reha-Qualitätssicherung der Rentenversicherung.

The German pension insurance has in recent years developed a comprehensive programme for quality assurance in rehabilitation, and has implemented the programme into routine practice. Different aspects of rehabilitation are evaluated with differentiated instruments. Issues dealt with inter alia include the quality of rehabilitative care in a narrower sense, the structure and organisation of the rehabilitation centres, as well as quality from the patients' perspective. On the whole, positive results predominate. Big differences in quality however have been found between the rehabilitation centres. The data collections and data evaluations carried out make a continuous process of quality assurance reporting possible for use by rehabilitation centres and pension insurance agencies. This will enable targeted initiatives for quality improvement. The methods and procedures of quality assurance are enhanced at regular intervals, and the scope of quality assurance is extended. Thus, rehab quality assurance is also expanded to cover ambulant rehabilitation or rehabilitation of children and young people.

Analysis of court criteria for awarding disability benefits to patients with Crohn's disease.

BACKGROUND & AIMS: Chronic disability and its consequences for social life and employment are important but often neglected aspects of Crohn's disease. No specific scores have been developed to evaluate chronic disability in patients with Crohn's disease; the medical criteria used by government authorities to award disability benefits have not been analyzed. We aimed to determine the courts' criteria for awarding disability benefits to patients with Crohn's disease in Spain. METHODS: We systematically searched case law databases in Spain's regional Supreme Courts to identify sentences regarding awards of disability benefits to patients with Crohn's disease. Selected decisions were reviewed to extract variables related to the awarding of benefits. Univariate and multivariate analyses were performed to determine which variables predicted the awarding of benefits. RESULTS: Two hundred eighty sentences were reviewed. The rate of judicial decisions in favor of the claimants varied considerably between the various tribunals. Multivariate analysis showed that adequate description of the disease (odds ratio, 8.6), fecal incontinence (odds ratio, 8.9), the number of associated diseases (odds ratio, 2.3), and the presence of an ostomy (odds ratio, not estimable) were independent predictors of the awarding of Social Security benefits. CONCLUSIONS: The amount of Social Security benefits awarded to patients with Crohn's disease varied depending on the tribunal. The most important predictors of a court's disability award were the adequate description of the patient's disease, fecal incontinence, associated diseases, and presence of an ostomy.

Mortality ascertainment of women veterans: a comparison of sources of vital status information, 1979-2002.

BACKGROUND: To support health research on the unique cohort of women with a history of military service, this study assessed the completeness of mortality ascertainment for Texas women veterans in Department of Veterans Affairs (VA) and non-VA databases. METHODS: We examined female veteran-specific mortality ascertainment comparing the VA Beneficiary Identification and Records Locator Subsystem Death File (BIRLS DF), VA Patient Treatment Files (PTF), and Social Security Administration-Death Master File (SSA-DMF) with Texas death certificate data. Databases were deterministically cross-linked, using female sex and social security numbers. Deterministic and probabilistic linkage methods were also compared. RESULTS: Of 6,297 decedents identified by death certificates, SSA-DMF, BIRLS DF, and PTF databases identified 97.5% collectively and 94%, 77%, and 5% individually. Compared with Texas death certificates, sensitivity of VA and SSA databases improved with increasing age. CONCLUSIONS: This study highlights that although the VA and SSA administrative databases have less complete ascertainment for younger decedents, combined these electronic databases provide nearly complete ascertainment for women veterans. Challenges related to large female-specific cross-linkage studies are explored, and a need to examine methods for female-specific health research studies in the general population is identified.

[Principles recommended to reassure the identification of the patient, the request of analysis and the report of biological results]. / Principes recommandés pour sécuriser l'identification du patient, de la demande d'analyse et du compte rendu des résultats biologiques.

The collection of a reliable identity is required for the constitution of any medical file, and biological file in particular. The regulation concerning the rights of the patient, the organization of the Social Security, and the respect of the private life must be applied. The biologist must comply with the GBEA with a special attention when it comes to transfusion. Each individual is unique and should be identified by a single number. Maximum precautions are essential as for the data confidentiality. Adapted procedures (Charter of patient collection of the identity, procedure of bringing together of the identities) with traceability of all the operations are essential but non-sufficient preliminaries. The identitovigilance recommended by the CNIL, must be implemented as well as all other already vigilances required by the law. In this context, the biologist must be particularly active. He must ensure the correct collection of the data, the description of the anomalies and the redundant data, and take into account the corrections. By its transverse position, he plays an important part and must be part of the cells of identitovigilance. It must respect its specific requirements for the corrections of identities and must be informed for any modification taking place after the biological validation. The principal recommendations making it possible to ensure the reliability of the identification of the patient and the biological file were joined together in this article by a working group from the National College of Biochemistry of the Hospitals (CNBH).