The heterogeneous impact of stricter criteria for disability insurance.

The Netherlands reformed its disability insurance (DI) scheme in 2006. Eligibility for DI became stricter, reintegration incentives became stronger, and DI benefits often became less generous. Based on administrative data on all individuals who reported sick shortly before and after the reform, difference-in-differences regressions show that the reform reduced DI receipt by 5.2 percentage points and increased labor participation and unemployment insurance (UI) receipt by 1.2 and 1.1 percentage points, respectively. It increased average monthly earnings and UI claims to overcompensate lost DI benefits. However, older individuals, women, individuals with temporary contracts, the unemployed, and low-wage earners did not compensate or compensated to a much smaller extent for the lost DI benefits. The effects are persistent during the 10 years after the reform.

[Clinical pathway for the physician throughout social insurances : what is worth to know ?] / Itinéraire clinique et assurances sociales : que doit savoir le·la médecin de premier recours ?

Medical practitioners are frequently confronted with social insurance as well as with their patients' health and safety issues. Through the journey of Pierre, an employee, victim of an accident at work, we propose to address some common problems by specifying certain aspects relating to the legal and administrative framework in order to better guide clinical practice on the means of intervention and their limits.

Les médecins praticien·ne·s sont fréquemment confronté·e·s aux assurances sociales ainsi qu'aux enjeux assécurologiques de leur·s patient·e·s. À travers le parcours de Pierre, salarié, victime d'un accident de travail, nous vous proposons d'aborder certaines problématiques courantes en précisant certains aspects relatifs au cadre légal et administratif afin de mieux orienter la pratique clinique sur les moyens d'intervention et leurs limites.

Road to Retirement: Not Necessarily the Road Less Traveled--Part I.

This article is the first of a three-part series that discusses the steps toward a successful retirement. This part reviews Social Security benefits, provides suggestions for selecting the timing for accepting Social Security benefits, and offers an explanation of individual retirement accounts. The article also acts as a checklist for retirement.

Effects of employer-sponsored health insurance costs on Social Security taxable wages.

The increasing cost of employer contributions for employee health insurance reduces the share of compensation subject to the Social Security payroll tax. Rising insurance contributions can also have a more subtle effect on the Social Security tax base because they influence the distribution of money wages above and below the taxable maximum amount. This article uses the Medical Expenditure Panel Survey to analyze trends in employer health insurance contributions and the distribution of those costs up and down the wage distribution. Our analysis shows that employer health insurance contributions increased faster than overall compensation during 1996-2008, but such contributions grew only slightly faster among workers earning less than the taxable maximum than they did among those earning more. Because employer health insurance contributions represent a much higher percentage of compensation below the taxable maximum, health insurance cost trends exerted a disproportionate downward pressure on money wages below the taxable maximum.

[Farewell to a great doctor and extraordinary believer, creator of Quality of Care: Dr. Héctor Aguirre Gas]. / Despedida a un gran médico y extraordinario creyente, creador de la Calidad de la Atención: Dr. Héctor Aguirre Gas.

From these lines a farewell is expressed to Dr. Héctor Gerardo Aguirre Gas, excellent doctor and great exponent of the Quality of Medical Care and Patient Safety, trained and servant in the medical services of the Instituto Mexicano del Seguro Social (IMSS), noble companion and friend. A man with universal ethical values and a straight and humble figure, active and bold behavior, committed to serving others.

Desde estas líneas se expresa una despedida al Dr. Héctor Gerardo Aguirre Gas, excelente médico y gran exponente de la Calidad de la Atención Médica y Seguridad del Paciente, formado y servidor en los servicios médicos del Instituto Mexicano del Seguro Social (IMSS), noble compañero y amigo. Un hombre con valores éticos universales y una figura recta y sencilla, proceder activo y audaz, empeñado en servir al prójimo.

[First steps of medical administration at the IMSS]. / Primeros pasos de la administración médica en el IMSS.

The creation of an institution as large as the Instituto Mexicano del Seguro Social (IMSS) required a lot of planning to manage all the benefits provided to the population. Thus, it is necessary to have health personnel with knowledge and experience in health services administration. This manuscript is an acknowledgment to doctors Manuel Barquín Calderón, Antonio Ríos Vargas and Carlos Zamarripa Torres, pioneers and recognized protagonists in the planning and organization (administration) of the IMSS medical services between 1945 and 1955, who also had rational initiatives and constructive, doing their duty. On the other hand, the Institute exposed and projected that medical-administrative activities were a complex task, and that its practice required specialized knowledge that could not be left to chance, empiricism, good will, beliefs or nonobjective imagination.

La creación de una organización tan grande como el Instituto Mexicano del Seguro Social (IMSS) requirió de mucha planeación para lograr administrar todas las prestaciones que se brindan a la población. Siendo así una necesidad contar con personal de salud con conocimientos y experiencia en administración en servicios de salud. El presente manuscrito es un reconocimiento a los doctores Manuel Barquín Calderón, Antonio Ríos Vargas y Carlos Zamarripa Torres, pioneros y protagonistas reconocidos en la planeación y organización (administración) de los servicios médicos del IMSS entre 1945 y 1955, quienes además tuvieron iniciativas racionales y constructivas, cumpliendo con su deber. Por otro lado, el Instituto expuso y proyectó que las actividades médico-administrativas eran una tarea compleja, y que su práctica necesitaba conocimientos especializados que no podían dejarse al azahar, al empirismo, a la buena voluntad, a las creencias o a la imaginación no objetiva.

The effects of expanding the generosity of statutory sick leave insurance: The case of a French reform.

This study evaluates the impact of the French reform of 11 January 2008 in the private sector, which modified the share of sick leave paid by the employer in addition to the social security benefit. The reform is comprised of two parts: the waiting period until complementary payment is made by the employer, reduced from ten to seven days; and the minimum required tenure to be eligible, reduced from three years to one year. In this study, we use the administrative panel data (Hygie) from 2006 to 2010 along with a new collective bargaining agreement (CBA) database. The latter was constructed by the authors in order to collect the parameters of complementary benefits for sick leave. We examined separately the effects of the waiting period part and the tenure part of the reform, using a difference-in-differences strategy with matching. When the waiting period is reduced, the number of sick days' increase significantly (+ 0.5 days). When the minimum tenure requirement is reduced, there is more impact on sick leave (+ 0.6 days on the number of sick days and + 0.9 pp on sickness probability). The effects of sick pay reform are different between men and women.

Postdoctoral employment and future non-academic career prospects.

Most recipients of doctorates leave universities some years after graduation, while little is known about their future non-academic career prospects. I report results from a novel microlevel database that links information about doctoral dissertations completed in Germany with doctorate recipients' social security records. The results, based on graduates' individual careers for five broader subject groups, indicate that postdoctoral periods do not result in a wage premium when changing to the non-academic sector.

How common is "parking" among Social Security Disability Insurance beneficiaries? Evidence from the 1999 change in the earnings level of substantial gainful activity.

Fewer Social Security Disability Insurance (DI) beneficiaries have their earnings suspended or terminated because of work than those who are actually working, partly because beneficiaries "park" earnings at a level below substantial gainful activity (SGA) to retain benefits. We assess the extent of parking by exploiting the 1999 change in the SGA earnings level from $500 to $700 monthly for nonblind beneficiaries using a difference-indifference analysis that compares two annual cohorts of beneficiaries who completed their trial work period, one that was affected by the SGA change and one that was not. Our impact estimates, along with results from other sources, suggest that from 0.2 to 0.4 percent of all DI beneficiaries were parked below the SGA level in the typical month from 2002 through 2006. The SGA change did not yield any difference in mean earnings, although it did result in a small reduction in months spent off of the rolls because of work.

[In memory of the first editor of the Revista Médica del IMSS]. / En recuerdo del primer editor de la Revista Médica del IMSS.

This article is dedicated to the memory of doctor Francisco Olvera Esnaurrizar (1929-2019), first editor of the Revista Médica del Instituto Mexicano del Seguro Social -Medical Journal of the Mexican Institute for Social Security- (1962-1973).

El presente artículo está dedicado a la memoria del doctor Francisco Olvera Esnaurrizar (1929-2019), primer editor de la Revista Médica del Instituto Mexicano del Seguro Social (1962-1973).

Clinical governance in New Zealand: perceptions from registered health professionals in health care delivery compared with social insurance.

Objective Effective clinical governance can improve delivery of health outcomes. This exploratory study compared perceptions of clinical governance development held by registered health professionals employed by two different but interrelated health organisations in the broader New Zealand (NZ) health system. Most staff in public sector healthcare service delivery organisations (i.e. District Health Boards (DHBs)) are registered health professionals, whereas these clinical staff represent a small minority (5%) in social insurance organisations (i.e. the Accident Compensation Corporation (ACC)). Given these different contexts, comparison of results from three surveys of clinical governance perceptions identified key learnings for the development of clinical governance. Methods The Clinical Governance Development Index (CGDI) was administered to registered health professional staff in NZ DHBs and ACC, at different time points. The data were explored, compared and reported. Results Responses to survey items completed by NZ DHB staff and registered health professionals employed by ACC were compared. For each administration, there was a similar profile of positive responses across the seven CGDI items. The 2020 ACC survey results for one item were clearly different. This item asked about perceptions of full and active involvement in organisational processes and decision making (i.e. clinical engagement). Conclusions Perceptions of registered health professionals working in the NZ public sector delivering health services were compared with those held by staff employed by a NZ social insurer predominantly commissioning and influencing care. The results indicated similar levels of clinical governance development. Clinical governance development in the ACC context can benefit from clear communication, building strong supporting structures and greater management-clinical provider partnerships. Clinical governance development drives health outcomes and regular measurement of developmental progress can provide momentum. There is room across the NZ health system to raise awareness and leverage clinical governance to deliver improved health outcomes. What is known about the topic? Little is known about the perceptions held by registered health professionals employed by social insurance organisations. There are no published comparative studies exploring differences in perceptions between registered health professionals across two different organisational contexts, both with a goal of improving health outcomes. What does this paper add? Effective clinical governance drives coordinated, quality systems that promote optimal health outcomes. Social insurance organisations predominantly commission healthcare providers to deliver health outcomes. Although registered health professionals employed by social insurance organisations represent a small total number of staff, their perspective on clinical governance, as reported via survey, indicated there is most to be gained in the development of partnerships between management and clinical providers. This exploratory study fills a gap in the existing clinical governance development literature and evidence base. What are the implications for practitioners? Any health organisation can leverage clinical governance to deliver improved health outcomes. Effective clinical governance interventions are targeted to specific organisational context and culture. For ACC, a clear definition, enhanced management-clinical provider partnerships and strong supporting structures or organisational arrangements can be further developed. The survey results indicated that a focus on management-clinical provider partnerships is a clear priority for ACC clinical governance development. Partnerships based in empowered collaboration require greater clinical engagement, as well as increased capability for aligning with organisational priorities. Effective clinical governance development requires attention to context and culture. It can improve delivery of health outcomes.

How Self-Employed Older Adults Differ by Age: Evidence and Implications From the Health and Retirement Study.

BACKGROUND AND OBJECTIVES: There has been increased attention in recent years on self-employment in later life, with about 1 in 5 workers past of the age of 50 working for themselves. This study aims to build upon previous documentation of the characteristics of self-employed older adults by estimating how these characteristics vary by age. RESEARCH DESIGN AND METHODS: Using 7 waves of the Health and Retirement Study with a sample of more than 16,000 working older adults, this study considers how the association between self-employment and sociodemographic characteristics; indicators of human, social, and financial capital; and risk tolerance differ between adults aged 50-61 and 62 years and older. Binary logistic regression and seemingly unrelated estimation are used to estimate and compare the characteristics by age group. RESULTS: Compared to wage-and-salary work and controlling for all other factors in the models, the oldest self-employed group was more likely to identify as Black, report lower health, and receive health insurance from several sources than the younger group. Further, the older group reported lower individual earnings from work yet higher total household income (less individual earnings) and was also less likely to formally volunteer at the highest commitment levels. DISCUSSION AND IMPLICATIONS: With some exceptions, these results indicate that the diversity of self-employed older adults within traditional retirement age is greater than among those before this age. Implications regarding how access to key safety net programs, such as Social Security retirement benefits and Medicare, may lead to this finding are discussed.

Return to work and sick leave patterns following a work injury among young adults: a study protocol of a Swedish multimodal study.

INTRODUCTION: There is a lack of studies that focus exclusively on return to work (RTW) and sick leave patterns following a work injury among young adults. This study aims to close the gap by contributing with knowledge regarding young adults' sick leave pattern after a work injury and their experience of RTW after a work injury in Sweden. METHODS AND ANALYSIS: The present study is a multimodal study, which will use Swedish national register data and qualitative data collection by photovoice. Injuries classified as work injuries according to the Swedish injury classification were included. Registry data will be retrieved from the Swedish National-based registers of Swedish Information System on Occupational Accidents and Work-related diseases, the Swedish Social Insurance Agency's database MicroData for Analysis of Social Insurance and the Swedish Longitudinal Integration Database for Health Insurance and Labour Market Studies. Persons who have registered a work injury at the Swedish Work Environment Authority in 2012 will be included. Sick leave patterns will be analysed using group-based trajectory models and multivariate analyses to explore how sick leave patterns have developed over 5 years. Subsequently, a participatory approach using photovoice method will be conducted to explore young adults' perceptions of barriers and facilitators in RTW after a work injury. Results from the photovoice group sessions will be analysed using a grounded theoretical approach. ETHICS AND DISSEMINATION: The study has been reviewed and approved by the Ethical Review Board (case number 2019/028-6) in Sweden. Results of the study will be disseminated through peer-reviewed journals, print and media presentation, conferences and via reports to the funding agency.

Risk rates of workplace accidents in Brazil: effect of the Accidental Prevention Factor (APF)? / Taxas de risco de acidentes de trabalho no Brasil: efeito do Fator Acidentário de Prevenção (FAP)?

Historically, the conflict of interests between employers and workers obliged the State to assume the role of regulating this relationship, instituting laws and overseeing the application of health and safety standards at work. The Accident Prevention Factor (FAP) is one of these guidelines. This article aims to analyze the correlations between the FAP and the risk rate for occupational accidents in Brazil in the period between 2006 and 2016. Ecological study, which analyzed the occupational accidents, registered in the Brazilian Social Security database in the period between 2006 and 2016. The analysis included the calculation of accident risk rates according to the Brazilian regions, divisions of the CNAE, reason/situation, ICD-10 chapters, sex and age. The comparison between results from the two periods was performed using the average risk rates from the two periods using Student t test, Spearman correlation and beta value. Basically, all rate series analyzed had a strong downward trend in the FAP period, contrary to what occurred in the immediately previous period.

A ocorrência de acidentes e de doenças relacionadas ao trabalho são expressões concretas da exposição dos trabalhadores aos riscos presentes no ambiente laboral. Historicamente o conflito de interesses entre empregadores e trabalhadores obrigou o Estado a assumir a função de regulação desta relação, instituindo leis e fiscalizando a aplicação das normas de saúde e segurança no trabalho. O Fator Acidentário de Prevenção (FAP) é uma dessas estratégias. O objetivo deste artigo é analisar a correlação entre as taxas de risco de acidentes de trabalho no Brasil antes (2006-2009) e depois (2010-2016) da vigência do FAP. Estudo ecológico com análise temporal de séries de taxas de acidentes de trabalho registrados nas bases de dados da Previdência Social no período 2006 e 2016. A análise incluiu o cálculo das taxas de risco de acidentes segundo grandes regiões brasileiras, divisões do CNAE, motivo/situação, capítulos do CID-10, sexo e idade. A comparação entre os resultados dos dois períodos foi realizada utilizando-se as taxas de risco médias com a aplicação do teste t de Student e da correlação de Spearman. Basicamente todas as séries de taxas analisadas obtiveram forte tendência de redução no período de vigência do FAP, ao contrário do que ocorreu no período imediatamente anterior.

Medical labour under neoliberalism: an ethnographic study in Colombia.

OBJECTIVES: In order to increase the knowledge about the impacts of neoliberal market forces on physician's labour, this article's objectives are to analyse how and why the labour of physicians is transformed by neoliberalism, and the implications of these transformations for patient care. METHODS: Ethnographic investigation is carried out through semi-structured interviews with 20 general practitioners at public and private facilities in Colombia. The interviews were contrasted with national studies of physician's labour since the 1960s. A "mock" job search was also simulated. The analysis was guided by Marxian frameworks. The study was approved by a Human Research Ethics Committee, and informed consent was obtained from all participants. RESULTS: The overpowering for-profit administration of the Colombian healthcare system imposes productivity mechanisms on physicians as a result of a deregulated labour market characterized by low salaries, reduced and self-funded social security benefits, and job insecurity. Overworked physicians with reduced autonomy become frustrated for not being able to provide the care their patients need according to clinical standards. CONCLUSIONS: Under neoliberal conditions, medical labour becomes exploitable and directly productive through its formal and real subsumption to Capital. The negative consequences of a progressive loss in physician's autonomy unveil the incompatibility between neoliberal health systems and people's health.

Social Security Disability Insurance Enrollment and Health Care Employment.

OBJECTIVE: To examine the relationship between Social Security Disability Insurance (SSDI) enrollment and health care employment. DATA SOURCES: State-year level data from government and other publicly available sources for all states (2000-2014). STUDY DESIGN: Population-weighted linear regression analyses model associations between each health care employment measure and each SSDI enrollment measure (i.e., SSDI overall, physical, or mental health enrollment rates), controlling for factors associated with health care employment, state fixed effects, and secular time trends. DATA COLLECTION: Data are gathered from publicly available sources. PRINCIPAL FINDINGS: A one standard deviation increase in SSDI enrollment per 100,000 population is associated with a statistically significant 2.6 and 4.5 percent increase in the mean employment rate per 100,000 population for health care practitioner and technical occupations and health care support occupations, respectively. The size of this relationship varies by the type of disabling condition for SSDI enrollment (physical versus mental health). CONCLUSIONS: Social Security Disability Insurance enrollment is significantly associated with health care employment at the state level. Quantifying the magnitude of this relationship is important given high SSDI enrollment rates as well as evolving policy and demographic shifts related to the SSDI program.

[Social security law and evidence-based health care in Germany]. / Sozialrecht und evidenzbasierte Gesundheitsversorgung in Deutschland.

The present contribution examines whether German Social Security Law requires or allows the German health care system to follow the principles of evidence-based health care. The discussion will be based on the relevant example of statutory health insurance (Book of Social Code V-SGB V). According to Sect. 2 SGB V health care provision has to follow medical standards, acknowledging medical progress. It has to be effective and efficient. Special therapies are not outlawed, but also have to follow these principles. Efficiency is defined (Sect. 12 SGB V) by the benefits being sufficient and necessary. The responsibility for achieving these goals and supplying the benefits for all people according to need lies with the health care insurance funds along with the physicians' associations (Kassenirztliche Vereinigung) and the hospitals (Sect. 70 SGB V). These organisations cooperate in the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA, Sect. 92 SGB V), where they have to hear organisations of patients and of the disabled also. The G-BA is allowed by law to exclude therapies not meeting the SGB V criteria. The Institute for Quality and Efficiency in Health Care (IQWiG) advises the G-BA and is also responsible for generating evidence. A major political and constitutional controversy has been triggered on the legitimation of the Federal Joint Committee. In its statute the G-BA recurs on evidence-based health care. It examines therapies according to the degree of available evidence and the usability of the evidence in the respective supply setting. The Federal Social Court (Bundessozialgericht, BSG) decided that the decisions of the G-BA could not be challenged for being medically incorrect. In 2005, the Federal Constitutional Court (Bundesverfassungsgericht-BVerfG) decided that a stricter control over the G-BA by the social courts was needed and that in the case of serious disease a lower evidence level might be sufficient. BSG and G-BA will continue to accept the results and methods of Evidence-based Medicine.

[Can total loss of ability to paid work mean a simultaneous maintenance of ability to paid work at wages exceeding 100%?]. / Czy calkowita utrata zdolnosci ci do pracy zarobkowej moze oznaczac równoczesnie zachowanie zdolnosci do zarobkowania w ponad 100%?

To illustrate and evaluate the efficiency of presently enforced limits of earning for pensioners and the percentage of working pensioners whose earnings are within the limits, the authors compared data from 2001 and 2005 that described declared income from paid work of pensioners with different grades of inability established by the Pita Branch of the Social Insurance Institute (ZUS). It was demonstrated that only 14.75% of all pensioners in the ZUS Pita Branch declared income from paid work, with 96.55% declaring income below 70% of the average national monthly earnings, 2.12%--between 70-130% of the average monthly earnings, and only 1.32% of individuals declaring income over 130% of the average salary. As it follows from the above analysis, the legal limits of allowable income were applicable to 3.34% of all working pensioners only, imposing limits on their earnings. If the number of professionally active pensioners nationwide subject to income restrictions due to earnings in excess of 70% of the average national monthly salary was compared to the total number of pensioners in the ZUS Pita Branch, the percentage of the latter was only 0.51% in 2005.