[The new treatment procedure of the German statutory accident insurance: From the perspective of a community hospital]. / Die neuen Heilverfahren der DGUV: Aus der Sicht eines Städtischen Krankenhauses.

The requirements of the German statutory accident insurance (DGUV) for the new treatment procedure were presented on 1 January 2013 in a new catalogue. The implementation of the certification of hospitals for the very severe injury procedure (SAV) by the DGUV should have been completed by 2014. These requirements placed high demands on trauma-oriented hospitals because of the high structural and personnel prerequisites. The background to the new organization was the wish of the DGUV for quality improvement in patient treatment in hospitals for patients with very severe occupational and occupation-related trauma by placement in qualified centers with high case numbers. No increase in income was planned for the hospitals to cope with the necessary improvements in quality. After 2 years of experience with the SAV we can confirm for a community hospital that the structural requirements could be improved (e.g. establishment of departments of neurosurgery, plastic surgery and thoracic surgery) but the high requirements for qualification and attendance of physicians on duty are a continuous problem and are also costly. The numbers of severely injured trauma patients have greatly increased, particularly in 2015. The charges for the complex treatment are not adequately reflected in the German diagnosis-related groups system and no extra flat rate funding per case is explicitly planned in the DRG remuneration catalogue. The invoicing of a center surcharge in addition to the DRG charges has not been introduced.

[New regulations for inpatient treatment of the statutory accident insurance: From the perspective of a university medical center]. / Neuordnung des stationären Heilverfahrens der Gesetzlichen Unfallversicherung: Aus Sicht einer Universitätsklinik.

BACKGROUND: New regulations of the German statutory accident insurance for inpatient treatment have been introduced. The aims of the new regulations are to improve cost-effectiveness and the quality of medical care. The introduction of the injury type catalogue and the severe injuries type procedure (SAV) has led to a concentration of resources. The purpose of these innovations is an increase in the quality of treatment of patients with complex injuries. CONCLUSION: The introduction of the new regulations resulted in a centralization of medical care in order to optimize the quality of treatment of complex injuries from occupational accidents. Hence, the high demands concerning infrastructure and human resources expected of a level one university medical center are taken into account.

Cooperation between the occupational health insurance and physicians practicing occupational dermatology: optimization potential in quality assurance.

BACKGROUND: Quality assurance is a task of the medical profession, but it is also a duty of the occupational health insurance (OHI). Data on the interaction quality between physicians practicing occupational dermatology and the OHI are limited. MATERIAL AND METHODS: An online survey was performed in 854 German members of the Working Group on Occupational and Environmental Dermatology in October 2013. Items included demographic data, a judgment on the cooperation between the dermatologists and OHI companies, an economic grading of the current compensation scheme, and prioritization of optimization tasks. RESULTS: 182 members (21.3 % of the invited population) participated in the survey. The cooperation with the OHI companies was judged as "very good" by 10.8 %, as "good" by 56.7  %, as "satisfactory" by 24.2 %, as "sufficient" by 7.0 % and as "inadequate" by 1.3 %. 93.4 % of the interviewed mentioned problems and improvement potentials in the cooperation of their practice or clinic with OHI companies. Main points of criticisms were reimbursement (44.7 %), followed by impairments of the treatment options (36.5 %) and the delay or scope of the treatment in the dermatologist's procedure (29.4 %). CONCLUSIONS: While most physicians practicing occupational dermatology give a positive judgment of their cooperation with OHI companies, quality optimization potentials exist regarding the reimbursement of dermatological services, especially regarding time-intensive counselling in the prevention of occupational skin diseases, in the enablement of diagnostic and therapeutic procedures according to current guidelines and in a timely preventive intervention to use the therapeutic window before chronification of skin diseases may occur.

Occupational skin diseases.

Occupational skin diseases are the most commonly reported notifiable occupational diseases. In Germany, 23 596 out of a total of 71 263 reported occupational diseases in 2010 were classified as occupational skin diseases (BK No. 5101: "severe or recurrent skin diseases which have forced the person to discontinue all occupational activities that caused or could cause the development, worsening, or recurrence of the disease"). Contact dermatitis (allergic, irritant) of the hands is the most common skin disease and atopic skin diathesis is often an important co-factor. The number of work-related skin diseases is many times higher than the number of notified occupational dermatoses. This CME article explains the legal framework of occupational diseases, the tasks and obligations of the legal statutory work insurance. Typical allergens and irritants of high risk professions are also presented as are the important steps from diagnosis to compensation. Early prevention of occupational skin diseases is very important to avoid severe chronic hand eczema. Therefore the "dermatologist's report" is crucial. Other occupational dermatoses (outside of BK 5101) are briefly mentioned. In recent years the number of notifications of occupational skin cancer due to occupational UV-irradiation has increased. According to recent epidemiological findings, there is a significant and consistent positive association between occupational UV-irradiation and squamous cell carcinoma. Therefore, an important criterion for a new occupational disease is fulfilled.

[Which services do companies need to retain employability in their workforce?--help offered by the German Pension Insurance]. / Welche Hilfen benötigen Betriebe und Unternehmen beim Erhalt der Beschäftigungsfähigkeit ihrer Mitarbeiter--Was kann die Rentenversicherung tun?

German Pension Insurance as a provider of services in rehabilitation has reacted to demographic changes in society, both strategic and practical. The implementation of services for companies including support of company return to work management and prevention services for employees with specific health-related burdens offer the chance to identify an endangerment of earning capacity at an early stage. Workplace-orientated medical rehabilitation increases the focus on the job and the workplace in rehabilitation under the pension insurance scheme, both in selecting the right service for a client as well as in the service itself. Employers, employees and pension insurance together benefit from close cooperation.

Design of a RCT evaluating the (cost-) effectiveness of a lifestyle intervention for male construction workers at risk for cardiovascular disease: the health under construction study.

BACKGROUND: Of all workers in Dutch construction industry, 20% has an elevated risk of cardiovascular disease (CVD). A major risk factor for CVD risk is an unhealthy lifestyle. The aim of our study is to design a lifestyle intervention for construction workers with an elevated CVD risk, and to evaluate its (cost-) effectiveness. METHODS/DESIGN: In a RCT, 692 participants will be randomised to either the control or the intervention group. The control group will receive usual care. For the intervention group, a lifestyle intervention has been designed based on interviews and current literature. The intervention will last 6 months and will comprise 3 face-to-face and 4 telephone contacts, consisting of individual counselling aimed at increasing daily physical activity (PA) and improving dietary behaviour, and/or smoking cessation. Counselling will take place at the Occupational Health Service (OHS), and will be done according to motivational interviewing (MI). Additional written information about healthy lifestyle will also be provided to those in the intervention group. At baseline, after 6 and after 12 months, measurements will take place. Primary outcome variables will be the lifestyle behaviours of concern, i.e. daily PA, dietary intake, and smoking status. Secondary outcome variables will be body mass index (BMI), systolic and diastolic blood pressure, total and HDL blood cholesterol, Hba1c and cardio-respiratory fitness (CRF). Sickness absenteeism and cost-effectiveness will be assessed as well. Multilevel analysis will be performed to compare all outcome measures between the intervention group and the control group. DISCUSSION: By improving lifestyle, CVD risk may be lowered, yielding benefits for both employee and employer. If proven effective, this lifestyle intervention will be implemented on a larger scale within the Occupational Health Services in construction industry. TRIAL REGISTRATION: Current Controlled Trials ISRCTN60545588.

[Costs of occupational diseases and accidents at work in Poland]. / Koszty chorób zawodowych i wypadków przy pracy w Polsce.

BACKGROUND: The costs of occupational diseases and accidents at work in the state members of the European Union keep at a level of several percent of their gross national product (GNP). Employees, employers and the society as a whole have to incur this financial burden. Therefore, all social partners should be involved in the improvement of health and safety in the work environment through their concerted efforts. It should be pointed out that information in the field of economy is an inherent instrument of all activities. It allows to estimate economic consequences of occupational diseases and accidents at work as well as to formulate future strategies. The aim of this study was to estimate and assess the range of the expenditure of money on occupational diseases and accidents at work in Poland in 2004. MATERIAL AND METHODS: The algorithm for estimating economic consequences of occupational diseases and accidents at work was developed, taking into account, e.g., the selected components of the costs, the estimation of economic consequences for the national economy, and the costs incurred by employers and social insurance institutions. In addition, the model for estimating economic consequences and defining the range of expenditure of money on occupational diseases and accidents at work relative to indicators of socioeconomic situation of the country was constructed. Economic consequences are understood as costs incurred by the health care and social insurance systems in Poland, institutions, companies, and individual employees. RESULTS: The following cost components were estimated: the average-annual costs of lost production, sickness benefits, social insurance benefits and those incurred by enterprises related with accidents at work and occupational diseases. CONCLUSIONS: Due to the lack of complete, reliable information essential for estimating economic consequences, a number of assumptions and study limitations were accepted. The range of identified and estimated costs of occupational diseases and accidents at work was set relative to GNP and to the value added in the national economy. Bearing in mind that the costs of occupational diseases and accidents at work are underestimated, it can be concluded that their share in values characteristic of the national economy do not depart from average values recorded in European countries.

The threat to scientific integrity in environmental and occupational medicine.

Over the last century, environmental and occupational medicine has played a significant role in the protection and improvement of public health. However, scientific integrity in this field has been increasingly threatened by pressure from some industries and governments. For example, it has been reported that the tobacco industry manipulated eminent scientists to legitimise their industrial positions, irresponsibly distorted risk and deliberately subverted scientific processes, and influenced many organisations in receipt of tobacco funding. Many environmental whistleblowers were sued and encountered numerous personal attacks. In some countries, scientific findings have been suppressed and distorted, and scientific advisory committees manipulated for political purposes by government agencies. How to respond to these threats is an important challenge for environmental and occupational medicine professionals and their societies. The authors recommend that professional organisations adopt a code of ethics that requires openness from public health professionals; that they not undertake research or use data where they do not have freedom to publish their results if these data have public health implications; that they disclose all possible conflicts; that the veracity of their research results should not be compromised; and that their research independence be protected through professional and legal support. The authors furthermore recommend that research funding for public health not be directly from the industry to the researcher. An independent, intermediate funding scheme should be established to ensure that there is no pressure to analyse data and publish results in bad faith. Such a funding system should also provide equal competition for funds and selection of the best proposals according to standard scientific criteria.

Measurement of baseline shoulder function in subjects receiving workers' compensation versus noncompensated subjects.

The purpose of this study was to ascertain whether a measurable difference existed in normative scores for the American Shoulder and Elbow Surgeons (ASES) questionnaire between subjects who had an active workers' compensation claim (WC) with no known shoulder injury and subjects without a compensation claim (non-WC). Subjects with non-shoulder-related orthopaedic injuries were recruited from a suburban orthopaedic sports medicine clinic and an urban occupational medicine clinic. They were asked to complete a composite questionnaire that consisted of demographic information and the ASES questionnaire. There were no significant differences in the ASES scores between subject groups. There were significant differences between subject groups with regard to work hours (P = .0001), work demands (P = .0001), and tobacco use (P = .0001). Subject group was also significantly associated with education level (P = .0001), marital status (P = .0001), work demands (P = .0001), gender (P = .0001), and sports participation (P = .0314). The ASES score was significantly affected by marital status (P = .0476), sports participation (P = .0008), and age (P = .0129).

[Justification for screening laboratory tests not related to occupational exposure ordered by occupational medicine physicians: an analytical study]. / Problemy zasadnosci zlecania przez lekarzy medycyny pracy skryningowych badan laboratoryjnych, które nie sa zwiazane z narazeniem zawodowym.

The aim of the study was to analyze whether laboratory tests not related with occupational exposure ordered by occupational medicine physicians are justified. In Poland, prophylactic standards in occupational medicine are determined by law and the minimum range of laboratory tests and consultations by specialists is laid down. The extension of its range to include screening in all workers is disputable. The authors analyze the usefulness of the most common laboratory tests performed in screening (blood count, erythrocyte sedimentation rate, lipid profile, glucose in blood, urine). In part of those examinations, the benefit to a patient, e.g., the detection of a pathology, is questionable if they are not supported by a thorough analysis of the patient's state of health and risk factors.

[Cost analysis of task implementation at the regional occupational medicine centers]. / Analiza kosztów realizacji wybranych zadan wojewódzkich osrodków medycyny pracy.

In this paper, the considerations on setting the costs of the tasks to be implemented by provincial occupational medicine centers (POMCs) are continued (Med Pr 2001; 3: 197-201). Under the research project carried out by the Nofer Institute of Occupational Medicine, the method of setting costs has been elaborated and implemented in selected POMCs. At the implementation stage, a set of forms to collect and process data on costs involved was prepared. These forms together with the instruction were distributed among the selected centers. The data collected were analyzed, and the conclusions concerning the factors responsible for shaping relevant costs in POMCs, as well as the barriers hindering the implementation of this new method were formulated. The introduction of new principles of isolating so called "cost phases" was necessary only for setting full costs of health promotion and postgraduate education programs. The method of setting values for the remaining POMC costs has been implemented without its modification. The collected data on costs show that the wages of physicians and medium-level personnel affects mostly the costs of tasks in a given center, however, indirect costs also have a substantial share in unit costs. In addition, the range of specialistic consultations and diagnostic tests performed in or outside POMCs also exert some effect on the differentiation of unit costs.

[Financing of regional occupational health service centers: structure and financial criteria in years 2000-2001]. / Poziom, struktura i kryteria finansowania wojewódzkich osrodków medycyny pracy w latach 2000-2001.

The rational planning and financing of occupational health services at the national level have to be based on an appropriate system of information about individual units and their financial status that could illustrate their financial administration. This is required not only in view of the internal needs of public money management, but also in view of the national health accounts. The major task in this regard is to assess the level and structure of financing to individual units and to check the soundness of criteria used in the process of supplying financial means. The results of such an analysis can be a valuable source of information for planning carried out also by the institutions which provide funds to cover the cost of tasks performed by individual units. The aim of the project implemented by the Nofer Institute of Occupational Medicine was to collect, process and analyze data on the level and structure of financing of provincial occupational medicine centers. In this paper, the objectives, methodology and analytical tools are discussed. The results and structural data on the level and structure of financing of regional occupational health services centers covering a two-year period are presented. At the same time, the criteria for allocating funds were identified, which made it possible to evaluate the situation and to propose new solutions.

Evaluation of the Washington State Workers' Compensation Managed Care Pilot Project II: medical and disability costs.

OBJECTIVES: This study examined the effect of managed care on medical and disability costs as part of an evaluation of the Washington State Workers' Compensation Managed Care Pilot (MCP). METHODS: One hundred twenty firms (7,041 employees) agreed to have their injured workers treated in managed care plans. Managed care introduced two changes from the fee-for-service (FFS) delivery system currently used by injured workers in Washington State: experience- rated capitation and a primary occupational medicine delivery network. The FFS control group included injured workers employed at 392 firms (12,000 employees). Medical and disability costs were compared for 1,058 injuries in the managed care group and 1,159 injuries in the FFS group occurring between April 1995 and June 1996. Univariate and multivariate statistical methods were used to analyze the effects of managed care on medical and disability costs. RESULTS: The mean unadjusted medical cost per injury ($587) for the managed care group was 21.5% lower (P = 0.06) than for the FFS group ($748). Adjustment for differences in worker and firm-level characteristics through multivariate analysis had little effect on the unadjusted results, except that the difference in costs between managed care and FFS groups became statistically significant (P<0.01). The major cost differences were for outpatient surgery (cost per surgery) and ancillary services (pharmacy, x-ray, physical therapy, and all other costs). In addition, disability costs, particularly percent on time loss and time-loss cost per injury, were significantly lower (P<0.01) in the managed care group. CONCLUSIONS: The results from the MCP suggest that substantial savings in workers' compensation medical and disability costs may be realized using the type of managed care intervention designed for this study. Delivering occupational health services through managed care arrangements whose design is based on an integrated, occupational health-centered delivery model may offer a viable approach for improving delivery systems, reducing costs and encouraging greater attention to disability prevention.

Perícia e processo trabalhista / Medical inspection and labor process

Faz histórico da medicina e do direito do trabalho, o que auxilia na compreensäo da evoluçäo das relacöes trabalhistas.Analisa a rotina reclamatória nas Juntas de Conciliaçäo e Julgamento, esclarece a NR 15 e 16.Aborda condiçöes e equipamentos de trabalho.