Healthcare coverage in the US and Japan: A comparison.

Understanding different models of healthcare worldwide and examining the benefits and challenges of those systems can inform potential improvements in the US. This article compares healthcare coverage in the US and Japan with respect to legislation, healthcare system models, eligibility of coverage, financial expenditures, health resources, and quality of care.

Ecclesiastical Endorsing Organizations. Final rule.

The Department of Veterans Affairs (VA) is amending its medical regulations by establishing in regulation the eligibility requirements that ecclesiastical endorsing organizations must meet in order to provide ecclesiastical endorsements of individuals seeking employment as VA chaplains, or of individuals who are seeking to be engaged by VA under contract or appointed as on-facility fee basis VA chaplains under the United States Code. VA considers veterans' spiritual care an integral part of their overall health care. As such, VA is committed to providing qualified VA chaplains to address the veterans' spiritual needs by engaging chaplains that are ecclesiastically endorsed. Ecclesiastical endorsement certifies that the individual is qualified to perform all the religious sacraments, rites, rituals, ceremonies and ordinances needed by members of a particular faith.

Federal and state benefits for transition age youth.

While all children face challenges as they become adults, children with chronic medical conditions or disabilities face unique barriers in their transition to adulthood. Children, especially those who are low income and have special needs, are eligible for a range of supports including income supports, health care coverage, vocational and educational supports. These supports are critical to sound health because they ensure access to necessary medical services, while also offsetting the social determinants that negatively affect health. Unfortunately, as children transition into adulthood, eligibility for these benefits can change abruptly or even end entirely. If medical providers have a better understanding of five transition key dates, they can positively impact their patients' health by ensuring continuous coverage through the transition to adulthood. The key dates are as follows: (1) transition services for students with an Individualized Education Program (IEP) must begin by age 16 (in some states such as Illinois, these services must be in place by age 14 1/2); (2) at age 18, eligibility for income supports may change; (3) at age 19, eligibility for Medicaid may change; (4) at graduation, eligibility for educational supports will end unless steps are taken to extend those benefits until age 22; and (5) when individuals prepare to enter the workforce, they will become eligible for vocational rehabilitation services. With an understanding of these key transition dates and how to partner with social services and advocacy organizations on behalf of their patients, medical providers can help to ensure that transition-age patients retain the holistic social services and supports they need to protect their health.

[The Königsteiner Empfehlung of 2012 - essential alterations and modifications]. / Die Königsteiner Empfehlung von 2012 - Wesentliche Neuerungen und Änderungen.

BACKGROUND: Since 1974, the recommendation for assessment of hearing impairment caused by noise - formerly known as "Königsteiner Merkblatt" (now: "Königsteiner Empfehlung") - has been representing the state of the art for the assessment of the occupational disease BK-No. 2301. It was updated several times, the last time in 2012. It provides a summary of the current medical knowledge. A new measurement for the entire working life - the Effective Noise Dose by Liedtke - was introduced. Otoacoustic emissions (OAE) are now the crucial tests in order to detect a hair cell dysfunction. As from now the tinnitus has to be put under a more comprehensive examination. On the strength of post experience the previous speech audiometry (Freiburger Test) is reliable, it was retrained. In future the indication for hearing aids will be oriented towards the aid guidelines of the legal health insurance. The questionnaire for the expert opinion was revised and the fee was adapted.

Dual-eligible reform: a step toward population health management.

Improved care coordination for dual eligibles has the potential to reduce hospitalizations and eliminate duplicative services. Finding common ground on program design for dual eligibles has proved difficult, and for some programs to date, the cost of care management has balanced out savings achieved. Partnering with an experienced Medicaid managed care plan could be the best strategy for market entry for all but the most experienced integrated delivery systems and health systems.

Absence from work and the medical sickness certificate.

Internet and dematerialization have greatly facilitated the medical profession. Contractual physicians and national health service doctors now have efficient tools for the electronic management of their routine administrative workload. A recent innovation is the medical sickness certificate issued by primary care providers and national health service physicians. Following postponements and uncertainties, procedures for the electronic completion and online transmission of the sickness certificate are now complete. The changes introduced by the so-called "Brunetta decree", however, have made its application difficult and continuous improvement to the system is needed, considering also the severe penalties imposed for violations. In the light of serious legal repercussions for health care professionals, this article examines various critical issues, highlighting the pitfalls and the network's enormous potential for ascertaining evidence of irregularities. The overheated debate on absenteeism due to illness, the diverse roles of national health physicians and self-employed doctors responsible for issuing a sickness certificate, and problems related to circumstances in which a doctor operates, are the key topics in this discussion. Computerization is an effective tool for optimizing public resources; however, it also seeks to ferret out, through the traceability of certification, abuse of medical certification, with severe penalties applied if certificates are discovered to contain misleading or untrue information.

[Diagnosing and expertizing asbestos-induced occupational diseases]. / Diagnostik und Begutachtung asbestbedingter Berufskrankheiten.

Due to latency periods that can last for decades, asbestos-related diseases show 18 years after the enforcement of the prohibition of asbestos application in Germany their highest numbers. In the centre of attention are asbestos-induced pleural fibroses, mesotheliomas, asbestoses, lung and laryngeal cancer. Diagnosing and expertizing these diseases causes difficulties, is hitherto non-uniform and does frequently not correspond to the current medico-scientific expertise. This induced the German Respiratory Society as well as the German Society of Occupational and Environmental Medicine in cooperation with the German Society of Pathology, the German Radiology Society and the German Society of Otorhinolaryngology, Head and Cervical Surgery, to develop the above mentioned guideline during seven meetings moderated by AWMF. The required thorough diagnosis is based on the detailed recording of a qualified occupational history. Since the sole radiological and pathological-anatomical findings cannot sufficiently contribute to the causal relationship the occupational history recorded by a general physician and a specialist is of decisive importance. These physicians have to report suspected occupational diseases and to advise patients on social and medical questions. Frequently, problems occur if the recognition of an occupational disease is neglected due to a supposedly too low exposure or too few ferruginous bodies or low fibre concentrations in lung tissue. The new S2k directive summarizing the current medico-scientific knowledge is for this reason, for diagnoses and expert opinions as well as for the determination of a reduced capacity for work a very important source of information.

[Bradytrophic tissue. Its histopathological diagnosis and value in trauma surgical and orthopedic expert opinions]. / Bradytrophe Gewebe. Histopathologische Diagnostik und Stellenwert bei unfallchirurgisch-orthopädischen Gutachten.

Expert opinions on the musculoskeletal system are generally required for statutory or private accident insurance purposes in a variety of legal areas and with varying rules of evidence. Since they are also intended for non-medical personnel, terminology needs to be defined and must be comprehensible by all parties. Bradytrophic tissue is the most frequently evaluated aspect of the musculoskeletal system. In this context, the term"degeneration" which was formerly used has been replaced by the term"tissue structure alteration", which takes matrix changes and cellularity into consideration. Thus the significance of histopathological diagnosis of bradytrophic tissue has been put in a new light. Histopathological diagnosis is carried out on the basis of various staining methods, scores and analyses depending on the diagnostic question.

[Recommendations for independent medical examinations of PTSD claimants]. / Empfehlungen für die Begutachtung von PTBS-Opfern.

In Germany, like in many Western countries, posttraumatic stress disorder (PTSD) is being diagnosed on an increased scale; it has become a major cost-producing factor of the healthcare and insurance industry. However, diagnosing PTSD may be problematic when it is primarily based on a symptom report. Although the forensic expert is expected to check the veracity of the symptoms reported, history taking, psychopathological assessment and diagnostic accuracy vary greatly among professionals. Thus, the diagnosis of PTSD often cannot be confirmed by later thorough inspection. Based on more than a decade of civil-forensic work in the area, the authors formulate recommendations for independent medical examinations in cases of claimed PTSD.

[Assisting the assessment of rehabilitation need by a self-administered questionnaire: problems and solutions]. / Selbstausfüllbogen zur Unterstützung der Begutachtung von Rehabedarf: Probleme und Lösungen.

Rehabilitation in Germany is an important sector of the medical system. Rehabilitation need of insurees who claim rehabilitation benefits is assessed by the financially responsible agency (mostly pension funds). Legal regulations allow little time for this decision so insurers aim at making decisions from the records only. Information on the specific case often is however insufficient. Self-administered questionnaires have been employed in the past to remedy that problem. In this article typical problems are illustrated which arise when administering additional questionnaires to assist the assessment, and solutions for these problems are shown. Important questions concern the instruments that should be used, technical problems of computer-aided assessment and processing of the data, and possible legal objections. Also, general problems and limitations of the approach are discussed.

[Appraisal of Lyme borreliosis]. / Begutachtung der Lyme-Borreliose.

Lyme borreliosis is due to infection with a tick-borne spirochete. The variety of signs and symptoms and also the laboratory tests of this multisystem illness often cause great problems in the appraisal of this disease. Frequently indispositions are associated with positive antibody tests for Borrelia burgdorferi. Terms as fibromyalgia or chronic fatigue syndrome are often connected with the diagnosis of Lyme disease. Outdoor workers such as farmers, foresters, hunters, woodcutters and gamekeepers in areas of endemic disease take a great occupational risk of infection with borreliosis. In the German health and social insurance the appraisal of this disease is of great importance. Affected working people can receive financial compensation. Not only serological investigations with the presence of specific antibodies, but also clinical findings must be considered.

[New stipulations for rehabilitation of mentally ill. Will return to normal life be facilitated?]. / Neue Bestimmungen für die Rehabilitation psychisch Kranker. Wird damit die Rückkehr in den Alltag erleichtert?

Current changes in the laws pertaining to mental disorders are mainly concerned with the redefinition in the Sozialgesetzbuch IX (SGB IX) [Social Law] of the term "disability", and the forthcoming introduction of the International Classification of Functioning, Disability and Health (ICF). Accordingly, the rehabilitation of the mentally disturbed will be based on an integrative bio-psychosocial treatment concept, which--in parallel with curative therapy--right from the beginning envisages measures aimed at reintegration of the patient into daily/occupational life. On the basis of the ICF, all patients with mental disorders of more than 6 months' duration may be classified by the medical services of the health insurance carriers as being in need of rehabilitation. Appropriate care-related structures in psychiatric and psychosomatic areas are to some extent already available.

[Sociotherapy in German social law. Indication, contents, and aspects of public health]. / Soziotherapie gemäss Paragraph 37a SGB V. Psychiatrische Indikation, Leistungsbeschreibung und sozialrechtlicher Hintergrund.

In German mental health services, the ill-defined term "sociotherapy" has been used to designate nonmedical, social, and work-related components of the care process. Recently, a new component of outpatient/community mental health care called "sociotherapy" (according to Paragraph 37a of the Fifth German Social Code) which is funded by the public health insurance system has been introduced and is now in the process of being implemented. The paper describes (a) patients eligible for the service and (b) the aims and scope of this case management module. The key objectives are to motivate patients with schizophrenia to utilise mental health services and antipsychotic medication and to liaise with psychosocial services. Therefore, sociotherapy is distinct from (a) multidisciplinary inpatient care for people with severe mental illness, (b) assertive community treatment, (c) community care provided by social workers or community psychiatric nurses, and (d) family interventions. So far there has been little evaluation of sociotherapy.