Workers' compensation for occupational respiratory diseases.

The respiratory system is one of the most important body systems particularly from the viewpoint of occupational medicine because it is the major route of occupational exposure. In 2013, there were significant changes in the specific criteria for the recognition of occupational diseases, which were established by the Enforcement Decree of the Industrial Accident Compensation Insurance Act (IACIA). In this article, the authors deal with the former criteria, implications of the revision, and changes in the specific criteria in Korea by focusing on the 2013 amendment to the IACIA. Before the 2013 amendment to the IACIA, occupational respiratory disease was not a category because the previous criteria were based on specific hazardous agents and their health effects. Workers as well as clinicians were not familiar with the agent-based criteria. To improve these criteria, a system-based structure was added. Through these changes, in the current criteria, 33 types of agents and 11 types of respiratory diseases are listed under diseases of the respiratory system. In the current criteria, there are no concrete guidelines for evaluating work-relatedness, such as estimating the exposure level, latent period, and detailed examination methods. The results of further studies can support the formulation of detailed criteria.

[Analysis of state costs of the social security benefits provided to the insured presenting with lung cancer and pulmonary diseases caused by external factors]. / Ocena wielkosci obciazen panstwa swiadczeniami z systemu ubezpieczen spolecznych dla ubezpieczonych chorych na nowotwory ukladu oddechowego i choroby pluc wywolane czynnikami zewnqtrznymi.

UNLABELLED: Lung cancer and pneumoconioses constitute two serious problems of contemporary medicine and a public health system. THE AIM: To analyze the costs associated with social security benefits provided to the insured presenting with lung cancer and pulmonary diseases (including pneumoconioses) caused by external factors. MATERIAL AND METHODS: The analysis was based on the data obtained from the Department of Statistics and Actuarial Forecasts of the Social Insurance Institution (SlI) in Warsaw. Structural diversity of the costs of the separate benefits available within the national health insurance system has been considered. Based on the data available in Poland costs associated with the incidence of lung cancer and pneumoconiosis were assessed taking into account sex and age of the insured as well as the administrative division of Poland. Additionally, mortality rates from the selected pulmonary diseases were analyzed. RESULTS: Costs of the pensions paid to the insured presenting with lung cancer amount to 81.11% of the total social security costs associated with these diseases, while the sick leave money paid to the insured lung cancer patients equal to 15.5% of the total costs. In the insured women, costs of the pensions paid due to occupational pulmonary diseases (predominantly pneumoconioses) constitute 41.1% and in the insured men--11.5% of the total 'occupational' pensions. CONCLUSIONS: Although the maximal incidence of lung cancer occurs in both men and women above their retirement ages the costs of the work incapacity pensions paid to lung cancer patients still exceed 81% of the total social security costs associated with these diseases. In the insured women, the cost of pensions paid due to occupational pulmonary diseases, most of which are pneumoconioses, ranks first among the costs of 'occupational' pensions received by these subjects, while in the insured men the respective cost ranks third (after injuries plus intoxications and cardiovascular diseases) among their 'occupational' pensions. Moreover, the results of the performed analyses indicate that data on the social insurance money allow to comprehensively evaluate the health status of the insured men and women as well as their quality of life and therapeutical, rehabilitational and prophylactic needs. These data can and should, therefore, be utilized in both clinical practice and for accomplishment of the public health tasks.

[Subject analysis of direct medical cost on pneumoconiosis patients with electronic records in an iron & steel enterprise].

OBJECTIVE: To study the distribution of the direct medical cost for the pneumoconiosis and to provide the clue for the trauma insurance. METHODS: 936 cases including 109,530 records were divided into several groups by the stages of pneumoconiosis and categories of the cost. The groups (stage I, stage II, stage I with tuberculosis and stage II with tuberculosis) were analyzed by descriptive statistics and non-parameter test. RESULTS: The medical cost of out-patient clinic was between 476.7 and 2307.9 yuan per patient per year. The hospitalization medical cost of stage I and II ranged from 3207.1 yuan to 7787.3 yuan per patient per year. There was no difference between stage I and II in statistically significant (P>0.05). CONCLUSION: The lower and upper inter-quartile range of the total medical cost per patient per year is from 3207.1 yuan to 7787.3 yuan. In the categories of the hospitalization cost, drugs and bed fees attain a higher proportion.

[Analysis of direct medical cost on pneumoconiosis patients with questionnaires in an iron & steel enterprise].

OBJECTIVE: To study the distribution of the direct medical cost for the pneumoconiosis and provide a clue for the compensation. METHODS: According to the electronic records for the medical cost of pneumoconiosis, 237 patients were investigated with questionnaires. Their medical cost was described by disability levels, types of work, the categories of tuberculosis, ages and length of work. RESULTS: In the 237 cases of questionnaires, there were 161 cases with complications, accounting for 67.9%, and the proportion of the emphysema in the complication cases was 21.1%. The proportion of the disability level IV for pneumoconiosis patients was about 55.7% in all cases. Their total medical cost ranged from 3946.5 yuan RMB to 8819.3 yuan RMB per patient per year, and the median was 6954.2 yuan RMB per patient per year. CONCLUSION: The disability levels can be considered as the standard for the pneumoconiosis compensation to a certain extent.

Occupational lung diseases among former goldminers in two labour sending areas.

OBJECTIVES: To compare and contrast the prevalence of pneumoconiosis in two groups of former migrant mineworkers in southern Africa, and to examine the effectiveness of the South African compensation system for occupational lung diseases. DESIGN: Comparison of two cross-sectional studies and follow-up data on compensation results. SETTING: The village of Thamaga, Botswana and the rural area of Libode, Eastern Cape, South Africa. SUBJECTS: Two hundred and thirty-four former underground mineworkers in Thamaga, and 238 in Libode. MAIN OUTCOME MEASURES: Prevalence and severity of pneumoconiosis, prevalence of radiological signs of tuberculosis (TB), Medical Bureau for Occupational Diseases (MBOD) certification committee decisions, and compensation results. RESULTS: Prevalence of pneumoconiosis > or = 2/1 was 15.4% in Libode and 13.6% in Thamaga. Significantly more Libode than Thamaga subjects (51.1% versus 29.0%) reported past TB treatment. Radiological signs of pulmonary TB were also more prevalent in Libode (33.3% v. 23.9%). Twenty-six per cent of Libode men and 16.1% of Thamaga men were certified with compensable disease. Libode payments were finalized within 30 months, whereas Thamaga cases only began receiving payments 52 months after medical examination, with 11 cases still pending 66 months after medical examination. CONCLUSION: There was a high prevalence of pneumoconiosis in both study groups. Many men were eligible for compensation but were previously uncompensated. The higher rate of compensable disease in the Libode group may relate to the higher prevalence of TB, as well as more active follow-up by the study group, including a large number of appeals. Socio-political changes in South Africa between 1994 and 1996 may also have influenced compensation results.

Health costs of occupational disease in New York State.

Occupational diseases and deaths are costly events. They are responsible for: 1) direct medical costs; 2) indirect costs, resulting from lost production, foregone opportunities, and diminished investment; and 3) non-economic costs, including pain and suffering, disrupted careers, and devastated families. To develop a partial estimate of the total costs of occupational disease in New York State, we have examined four categories of illness: occupational cancer, chronic respiratory disease and the pneumoconioses, cerebrovascular and cardiovascular disease, and end-stage renal failure. We base our partial estimate on the human capital approach to the costs of these illnesses. Using the best measures available, including both incidence and prevalence statistics, mortality records, and a variety of financial data, we employ two cost accounting techniques of the human capital approach, the incidence method, and the prevalence method. Our analysis shows that these four occupational illnesses are costing New York over $600 million per year. This figure is a pragmatic but conservative, lower-bound estimate of the relative magnitude of total economic costs of occupational disease in New York State. The largest proportion of these costs (80%) is due to occupational cancer. The failure of the health care system to recognize the costs of occupational disease precludes recognition of the economic benefits which would result from preventing these illnesses. This study, it is hoped, will stimulate advances in epidemiological and economic approaches to resolve this important measurement problem.

Why change? A look at the current system of disability determination and workers' compensation for occupational lung disease.

Under the current system of disability determination and workers' compensation for occupational lung disease, disabled workers or their survivors can reasonably count on being compensated. However, by rejecting established scientific truth in order to pay workers' compensation in circumstances where disability or death had not been due to occupation, the system has operated unfairly and has undermined public confidence and respect. To gain more scientific integrity and fairness, the system should be changed to provide for adjudication by scientifically informed disability boards. The adversary system sould be retained, however, as needed protection against bias, quackery, and mendacity.