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3.
Aust Occup Ther J ; 67(1): 39-48, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31659756

RESUMO

INTRODUCTION: With the introduction of the National Disability Insurance Scheme (NDIS) in Australia, occupational therapy graduates need to be adequately prepared to support service users in this new policy context. There is, however, limited research informed by service users themselves to inform contemporary occupational therapy curriculum redesign. The aims of this study were: (a) to explore the experience of occupational therapy service provision from the perspective of service users with lived experience of disability; (b) to gain an understanding of the perceptions of people with lived experience of disability regarding the NDIS and whether it will change how they work with occupational therapists; (c) to gain an understanding of the perspectives of people with lived experience of disability regarding the NDIS, and how this influences curriculum content for occupational therapy education. METHODS: A pragmatic qualitative design, underpinned by the constructivist paradigm was utilised. Demographic surveys and semi-structured interviews were completed with 10 participants who were purposively recruited. Peer debriefing and use of an audit trail were undertaken to enhance the rigour of the analysis. RESULTS: Three themes were identified: (a) Occupational therapists as gatekeepers for equipment provision; (b) experience of the NDIS (Knowledge and understanding of the NDIS; Uncertainty regarding the NDIS; Choice and control in the NDIS); (c) curriculum content for occupational therapy. CONCLUSION: The insights provided by the people with lived experience in this study inform key areas of focus for occupational therapy curriculum to adequately prepare graduates to work in the evolving NDIS environment. Involving service users in an authentic manner in curriculum design, content delivery and student assessment is crucial for "real-world" applicability of student education.


Assuntos
Pessoas com Deficiência/psicologia , Pessoas com Deficiência/reabilitação , Seguro por Invalidez/organização & administração , Programas Nacionais de Saúde/organização & administração , Terapia Ocupacional/organização & administração , Adulto , Austrália , Feminino , Controle de Acesso/organização & administração , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Fatores Socioeconômicos
4.
Cienc. tecnol. salud ; 7(1): 26-38, 2020.
Artigo em Espanhol | LILACS | ID: biblio-1120141

RESUMO

La presente es una ponencia presentada durante la realización del Seminario de Enfermedad Renal Crónica no Tradicional, celebrado en ciudad de Guatemala en junio de 2019. El mismo busca el enfoque de tal enfermedad desde una perspectiva económica de costos, y previsión en la seguridad social, buscando el ahorro de prestaciones pecuniarias en materia de discapacidad para los trabajadores de arduas tareas agrícolas estacionales, principalmente en la costa sur. El enfoque se efectúa desde el ámbito de la Economía Preventiva, y las experiencias en costos sociales del autor, concluyendo que tal enfermedad se encuentra en ascenso y amerita de políticas de salud curativa y preventiva, para impedir la discapacidad de trabajadores agrícolas muy jóvenes, quienes gracias a una resolución especial de la Junta Directiva del Instituto Guatemalteco de Seguridad Social (Igss), son cubiertos.


This paper is based on a lecture given at the Seminar on Chronis Kidney Disease of Unknown Cause, celebrated in Guatemala City, in June 2019. The focus is placed on the perspective of the preventive economy framework and the discipline of social and economic costs, this time associated with heat stress of labor in agricultural activities, and the measures taken by the Social Security Institute of Guatemala, aiming to protect the seasonal workers. The critic nature of the analysis allows to present some recommendations for the future of the social protection policies in Guatemala.


Assuntos
Humanos , Masculino , Feminino , Previdência Social , Insuficiência Renal Crônica/economia , Desenvolvimento Sustentável , Seguro por Invalidez , Custos e Análise de Custo , Insuficiência Renal Crônica/prevenção & controle , Guatemala
5.
J Law Med ; 28(1): 145-164, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33415897

RESUMO

One of Australia's biggest reforms - the National Disability Insurance Scheme (NDIS) - is intended to provide people with choice and certainty of access to disability supports. It replaced an underfunded, unfair, fragmented and inefficient "system". However, recently, the NDIS has received criticism in regard to access and the provision of supports. These issues, addressed elsewhere, have arguably arisen due to concerns about cost. This article pre-empts these concerns by bridging a gap between the extra-legal academic literature concerning the NDIS and the sparse literature concerning NDIS law. It does so by providing a detailed exposition of the NDIS legal framework embedded in the relevant interdisciplinary extra-legal literature. It concludes that if the NDIS is to succeed it cannot be dominated by concern with the financial sustainability of the system.


Assuntos
Pessoas com Deficiência , Seguro por Invalidez , Austrália , Humanos
6.
Public Health Res Pract ; 29(4)2019 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-31800650

RESUMO

OBJECTIVE: Using a case study, we aim to report on the compatibility of funding and policy settings under Australia's National Disability Insurance Scheme (NDIS) with the delivery of evidence based, recovery-oriented psychosocial services. Type of program or service: We reflect on the impact of the NDIS on a psychosocial rehabilitation service run by Woden Community Service (WCS), one of the major service providers in the Australian Capital Territory, and specifically its Transition to Recovery (TRec) program. METHODS: We examine NDIS funding and policy settings and consider the recovery-oriented practices underpinning psychosocial programs like TRec. The construct of the program, its staffing and related issues are considered. The article draws on a formal evaluation of TRec conducted in 2015. RESULTS: The NDIS is having a seismic impact on Australia's psychosocial sector. Despite its positive evaluation, the future of the TRec program is problematic. Practically, service exit points have disappeared, reducing the program's capacity to properly transition clients between services and effectively increasing the likelihood of relapse. More generally, current NDIS policies are threatening the fidelity of WCS's approach to recovery practice. LESSONS LEARNT: This case study highlights tension between a new public insurance scheme primarily aimed at better managing consistent conditions and circumstances, and the recovery philosophy which has emerged in relation to episodic mental illness. This has implications for psychosocial services nationwide. The psychosocial rehabilitation sector has always been a peripheral element of Australia's mental health service mix. The advent of the NDIS offers hope that this may change. However, WCS's experience suggests that the NDIS must reconsider how best to foster recovery-oriented practice in mental health. This should be part of a more fundamental reconceptualisation of the role of psychosocial rehabilitation services in contemporary mental health care, not just for NDIS recipients. This work is urgent if Australia is to nurture its already rare psychosocial rehabilitation workforce and not see it dissipate.


Assuntos
Doença Crônica/terapia , Seguro por Invalidez/organização & administração , Transtornos Mentais/terapia , Reabilitação Psiquiátrica/organização & administração , Austrália , Humanos
7.
Work ; 64(3): 569-577, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683498

RESUMO

BACKGROUND: Expert employment information helps life insurers to decide total and permanent disability claims. The employability assessment model was developed a decade ago by rehabilitation counselors and has not been critically examined. OBJECTIVE: This exploratory descriptive study aims to elicit key issues of employability assessment within Australian life insurance. METHODS: Ten rehabilitation advisors with knowledge of employability assessment in the total and permanent disability sector participated in a single focus group. They each nominated issues of concern about employability assessment. These issues were collated then discussed within the group. Qualitative thematic analysis was used to identify key issues. RESULTS: The predominant theme was the forensic nature of employment evidence. There were three categories of key issues. First, assessment providers- their training, qualifications, experience, and role. Second, methodology- approaches that provide most realistic information about a claimant's likelihood of work. Third, policy definitions that illustrate reliance on legal interpretation of employability. CONCLUSIONS: To withstand legal scrutiny, the credentials of providers, assessment methodology, and quality of forensic reports are key issues which need to be addressed. This foundational study will contribute to broader research on this topic, with implications particularly for rehabilitation, life insurance, and claimants.


Assuntos
Avaliação da Deficiência , Pessoas com Deficiência/reabilitação , Revisão da Utilização de Seguros , Seguro por Invalidez , Austrália , Grupos Focais , Humanos , Pesquisa Qualitativa , Reabilitação Vocacional
8.
JAMA Netw Open ; 2(11): e1915638, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31730188

RESUMO

Importance: Patients qualifying for Medicare disability have the highest rates of opioid use compared with older Medicare beneficiaries and commercial insurance beneficiaries. Research on opioid overdose deaths in this population can help identify appropriate interventions. Objective: To assess the rate of opioid overdose death and to identify its associated risk factors. Design, Setting, and Participants: This cohort study included a 20% national sample of Medicare enrollees aged 21 to 64 years whose initial Medicare entitlement was based on disability and who resided in 50 US states and Washington, DC, in 2012 to 2016. Data analyses were performed from March 15, 2019, through September 23, 2019. Exposures: Fifty-five chronic or potentially disabling conditions were selected from the Centers for Medicare & Medicaid Services Chronic Disease Data Warehouse. Main Outcomes and Measures: Opioid overdose death rate estimated from Medicare National Death Index linkage data. Results: Among 1 766 790 Medicare enrollees younger than 65 years who qualified for Medicare because of disability, the mean (SD) age was 52.2 (10.2) years, and 866 914 (49.1%) were women. These enrollees represent 14.9% (95% CI, 14.9%-15.0%) of the entire Medicare population and accounted for 80.8% (95% CI, 78.9%-82.7%) of opioid overdose deaths among all Medicare enrollees. Opioid overdose mortality in this population increased from 57.4 per 100 000 (95% CI, 53.9-61.0 per 100 000) in 2012 to 77.6 per 100 000 (95% CI, 73.5-81.8 per 100 000) in 2016. Results from the stepwise logistic regression model revealed that 3 categories of conditions are associated with opioid overdose death: substance abuse, psychiatric diseases, and chronic pain. Among the 11.1% (95% CI, 11.0%-11.2%) of adults with disability who had all 3 conditions, the rate of opioid overdose death was 363.7 per 100 000 (95% CI, 326.7-402.6 per 100 000), which is 23.4 times higher than the rate for individuals with none of the conditions (15.5 per 100 000; 95% CI, 11.6-20.1 per 100 000). Conclusions and Relevance: This study identifies differences in opioid overdose mortality among subgroups of Medicare enrollees younger than 65 years who qualify for Medicare because of disability. Understanding the heterogeneity of medical and psychiatric conditions associated with opioid use and misuse is key to developing specific, data-driven interventions targeted to each subgroup of high-risk populations.


Assuntos
Overdose de Drogas/mortalidade , Seguro por Invalidez , Transtornos Relacionados ao Uso de Opioides/mortalidade , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Medicare , Pessoa de Meia-Idade , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
9.
BMJ Open ; 9(11): e032793, 2019 11 19.
Artigo em Inglês | MEDLINE | ID: mdl-31748310

RESUMO

OBJECTIVES: This study aimed to measure the burden of work-related upper limb amputation in Korea over a 10-year period and assess its trend. DESIGN: Ecological study. SETTING: National level data in Korea between 2004 and 2013. PARTICIPANTS: 49 535 subjects who claimed Korea industrial accident compensation insurance due to upper limb amputation. MAIN OUTCOME MEASURES: The disability-adjusted life years (DALYs) were calculated by sex, age and the site of amputation using annual incidence. RESULTS: The burden of work-related upper limb amputations in Korea reached its peak in 2007 and decreased thereafter. Males showed a higher burden of disease. Finger amputations showed a decreasing trend from 2007, whereas arm amputations continued to show an increasing trend. An increasing trend was found among participants older than 50 years. CONCLUSIONS: The decrease in the burden of finger amputations may be attributable to the lower incidence as a result of policy efforts. The increase in the burden of arm amputations was particularly noticeable among the elderly population over 50 years old. This could be attributable to the high proportion of the elderly population working in the manufacturing sector and the lack of policy efforts regarding major amputations in Korea. Future regulatory efforts are needed to prevent amputations.


Assuntos
Acidentes de Trabalho/economia , Acidentes de Trabalho/tendências , Amputação Traumática/economia , Traumatismos do Braço/economia , Efeitos Psicossociais da Doença , Traumatismos dos Dedos/economia , Adolescente , Adulto , Amputação Traumática/epidemiologia , Traumatismos do Braço/epidemiologia , Feminino , Traumatismos dos Dedos/epidemiologia , Política de Saúde , Humanos , Incidência , Revisão da Utilização de Seguros , Seguro por Invalidez , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , República da Coreia/epidemiologia , Estudos Retrospectivos , Adulto Jovem
10.
Tex Med ; 115(10): 36-38, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31613378

RESUMO

Elderly woman. Low-income. Chronic pain. Needs to see a rheumatologist. Needs physical therapy. Struggling to pay rent. Has no insurance. Has no disability coverage. As a family physician at a federally qualified health center (FQHC) in Austin, Sharad Kohli, MD, sees a lot of cases like this. In similar health care settings, the patient might face two bad choices: wage bureaucratic war to obtain better health care benefits or simply give up. At People's Community Clinic, Dr. Kohli referred her to an in-house lawyer who successfully appealed her denial of disability insurance. "[The lawyer] got her a significant income, which allowed her to pay her rent and also helped her get insurance through Medicaid and Medicare," Dr. Kohli said. "And then she was able to see the rheumatologist and the physical therapist." This kind of success helps explain why medical-legal partnerships (MLPs) like the one at People's Community Clinic came about in 1993 and began expanding nationally after 2001. Texas has 10 MLPs - all in large or medium-size cities and all tied either to hospitals or FQHCs like People's Community Clinic, according to the National Center for Medical-Legal Partnership in Washington, D.C. Texas MLPs stand among 333 nationwide.


Assuntos
Serviços de Saúde Comunitária , Seguro por Invalidez/legislação & jurisprudência , Advogados , Medicaid/legislação & jurisprudência , Medicare/legislação & jurisprudência , Médicos , Parcerias Público-Privadas , Humanos , Pobreza , Texas , Estados Unidos
11.
Rural Remote Health ; 19(3): 5337, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31554407

RESUMO

INTRODUCTION: Australia's National Disability Insurance Scheme (NDIS) is the catalyst for a significant shift in the delivery of disability services to people with a disability and their families, including those residing in rural and remote parts of Australia. Allied health services in rural areas of Australia are often limited, existing services are characterised as being of a generalist nature and demand for services often exceeds service capacity. This shift in the delivery of disability services with the rollout of NDIS could have a poignant impact on the rurally based allied health providers delivering these services. The aim of this study was to explore in depth the experiences of providing clinical services under the NDIS in a rural area. METHODS: Accessing the publicly available NDIS register, the authors purposively sampled service providers delivering services in rural or remote areas of the state of New South Wales (NSW). Participants consented by email to participate in a semi-structured interview during which they were asked about their lived experience providing services under the NDIS in rural NSW. Data collection and analysis were guided by phenomenology of practice. Interviews were audio-recorded and transcribed verbatim, and data were then thematically analysed. RESULTS: Eight service providers were interviewed, representing the disciplines of occupational therapy, nutrition and dietetics, speech pathology and physiotherapy. The locations of their service delivery varied across a range of rural and remote areas of NSW. Data analysis yielded three themes: (1) 'Beyond my depth', which described service providers' limited influence on the funding process their clients were now required to navigate as participants of the NDIS; (2) 'A sea of uncertainty', which described the inconsistencies demonstrated by the NDIS and its impact on service providers; and (3) 'Drowning in the wave', which described increases in service demand and changes to case mix as experienced by service providers. Additionally, the essence of providing services within the NDIS in a rural area was identified as 'Powerless facing the wave of change'. CONCLUSION: These findings offer insights into the particular challenges for rural clinicians in providing services under the NDIS. While there is improved funding support for people with a disability, this places additional pressure on rural clinicians who are already likely to be working at or beyond their workload capacity. Issues with recruitment and retention of new clinicians into rural and remote areas appear to be ongoing, which was identified as compounding the impact of the NDIS on existing service providers. Supporting the rural and remote workforce appears critical to avoid de-registration of existing NDIS service providers.


Assuntos
Pessoas com Deficiência/reabilitação , Disparidades em Assistência à Saúde/estatística & dados numéricos , Seguro por Invalidez/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , População Rural/estatística & dados numéricos , Austrália , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Pesquisa Qualitativa
12.
BMJ Open ; 9(9): e029836, 2019 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-31530605

RESUMO

OBJECTIVES: The aim was to investigate differences in the prescription of antidepressants during the transition to disability pension (DP) comparing DP due to back pain with DP due to other musculoskeletal and DP due to other somatic diagnoses. DESIGN: A population-based cohort study with follow-up 3 years before and after the event. Estimated prevalence and adjusted ORs with 95% CIs for antidepressant prescription were computed for the 7-year window (ie, t-3 to t+3) around the DP by generalised estimating equations for repeated measures. SETTING AND PARTICIPANTS: This Swedish population-based nationwide study with registry data included individuals aged 18-64 years, with DP due to back pain (n=2011), DP due to other musculoskeletal (n=3548) or DP due to other somatic diagnoses (n=11 809). PRIMARY OUTCOME MEASURES: Prescription of antidepressants. RESULTS: Before DP, the prevalence of prescription of antidepressants was stable in DP due to back pain, but increased for the other DP groups. Similarly, the likelihood of prescription increased only marginally before DP due to back pain (ORs from 0.86 at t-3 to 1.10 at t-1), but clearly in DP due to musculoskeletal (from 0.42 to 1.15) and somatic diagnoses (from 0.29 to 0.98). Both prevalence measures and risks remained at the elevated levels after DP. CONCLUSIONS: Pathways to DP due to musculoskeletal and somatic diagnoses seem to be partly driven by adverse mental health, which remains at a higher level after DP. The increasing prescription of antidepressants prior to DP suggests that special attention should be paid to mental health for prevention of DP. The period after DP needs attention to avoid deterioration of mental health.


Assuntos
Antidepressivos/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Seguro por Invalidez/estatística & dados numéricos , Dor Lombar/epidemiologia , Pensões/estatística & dados numéricos , Adolescente , Adulto , Estudos de Coortes , Comorbidade , Feminino , Humanos , Modelos Logísticos , Masculino , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/epidemiologia , Sistema de Registros , Fatores de Risco , Transtornos Somatoformes/epidemiologia , Suécia/epidemiologia , Adulto Jovem
13.
Ann Rheum Dis ; 78(11): 1472-1479, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31427438

RESUMO

OBJECTIVES: To describe and explore differences in formal regulations around sick leave and work disability (WD) for patients with rheumatoid arthritis (RA), as well as perceptions by rheumatologists and patients on the system's performance, across European countries. METHODS: We conducted three cross-sectional surveys in 50 European countries: one on work (re-)integration and social security (SS) system arrangements in case of sick leave and long-term WD due to RA (one rheumatologist per country), and two among approximately 15 rheumatologists and 15 patients per country on perceptions regarding SS arrangements on work participation. Differences in regulations and perceptions were compared across categories defined by gross domestic product (GDP), type of social welfare regime, European Union (EU) membership and country RA WD rates. RESULTS: Forty-four (88%) countries provided data on regulations, 33 (75%) on perceptions of rheumatologists (n=539) and 34 (77%) on perceptions of patients (n=719). While large variation was observed across all regulations across countries, no relationship was found between most of regulations or income compensation and GDP, type of SS system or rates of WD. Regarding perceptions, rheumatologists in high GDP and EU-member countries felt less confident in their role in the decision process towards WD (ß=-0.5 (95% CI -0.9 to -0.2) and ß=-0.5 (95% CI -1.0 to -0.1), respectively). The Scandinavian and Bismarckian system scored best on patients' and rheumatologists' perceptions of regulations and system performance. CONCLUSIONS: There is large heterogeneity in rules and regulations of SS systems across Europe in relation to WD of patients with RA, and it cannot be explained by existing welfare regimes, EU membership or country's wealth.


Assuntos
Artrite Reumatoide/economia , Seguro por Invalidez/legislação & jurisprudência , Saúde do Trabalhador/legislação & jurisprudência , Reumatologistas/estatística & dados numéricos , Licença Médica/legislação & jurisprudência , Adulto , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação da Capacidade de Trabalho , Adulto Jovem
14.
J Occup Environ Med ; 61(11): 877-886, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31425324

RESUMO

OBJECTIVE: To evaluate obesity-related costs and body mass index (BMI) as a cost predictor among privately insured employees by industry. METHODS: Individuals with/without obesity were identified using the Optum Health Reporting and Insights employer claims database (January, 2010 to March, 2017). Direct/indirect costs were reported per-patient-per-year (PPPY). Multivariate models were used to estimate the association between obesity and high costs (more than or equal to 80th percentile) by industry. RESULTS: Overall (N = 86,221), direct and absenteeism/disability cost differences between class I obesity (BMI 30.0 to 34.9) and reference were $1,775 and $617 PPPY, respectively (P < 0.05). Among employees with obesity (BMI more than or equal to 30), highest total costs were observed in the government/education/religious services, food/entertainment services, and technology industries. Class I obesity increased the odds of high costs (more than or equal to 80th percentile) within each industry (odds ratios vs reference = 1.09-5.17). CONCLUSIONS: Obesity (BMI more than or equal to 30) was associated with high costs among employees of major US industries.


Assuntos
Absenteísmo , Índice de Massa Corporal , Custos de Cuidados de Saúde/estatística & dados numéricos , Indústrias/estatística & dados numéricos , Seguro por Invalidez/economia , Obesidade/economia , Demandas Administrativas em Assistência à Saúde , Adolescente , Adulto , Feminino , Hospitalização/economia , Humanos , Seguro Saúde , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Presenteísmo/economia , Estudos Retrospectivos , Estados Unidos , Indenização aos Trabalhadores/economia , Adulto Jovem
15.
Phys Med Rehabil Clin N Am ; 30(3): 499-509, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31227126

RESUMO

When health providers become involved in impairment evaluation, they inevitably encounter administrative systems that adjudicate disability determinations. Those determinations take place in varied systems, each with its own terminology and processes, which can lead to confusion and frustration. Understanding historical and administrative context reduces potential for iatrogenic harm due tocaused by needless disability. The key to better health outcomes for patients involved in disability benefit systems is to understand the health benefits of work, advocate for the best health interests of patients rather than for specific administrative outcomes, and to communicate clearly and objectively with both patients and benefit administrators.


Assuntos
Avaliação da Deficiência , Pessoas com Deficiência/legislação & jurisprudência , Seguro por Invalidez , Pessoas com Deficiência/psicologia , Emprego , Comunicação em Saúde , Humanos , Seguro por Invalidez/legislação & jurisprudência , Defesa do Paciente
16.
Phys Med Rehabil Clin N Am ; 30(3): 511-522, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31227127

RESUMO

Approximately 1 in 4 adults in the United States have a disability that affects major life activities. This article provides a brief historical perspective of disability determination, and revisits the conceptual foundation for understanding the current models of disablement and their general application to the major US disability systems and nuances thereof. The expectations placed on the physician-expert examiner and why the physiatrist is ideally equipped to function in this role are discussed. The article is intended to provide a heightened awareness of the medicolegal framework, potential pitfalls, and other ramifications of such undertakings.


Assuntos
Avaliação da Deficiência , Pessoas com Deficiência/classificação , Pessoas com Deficiência/legislação & jurisprudência , Pessoas com Deficiência/psicologia , Pessoal de Saúde/ética , Pessoal de Saúde/legislação & jurisprudência , Humanos , Seguro por Invalidez , Modelos Psicológicos , Terminologia como Assunto
17.
BMC Public Health ; 19(1): 805, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234807

RESUMO

BACKGROUND: The connection between choice, control and health is well established in the literature on the social determinants of health, which includes choice and control of vital health and social services. However, even in the context of universal health and social care schemes, the ability to exercise choice and control can be distributed unequally. This paper uses the case of the Australian National Disability Insurance Scheme (NDIS) to examine these issues. The NDIS is a major policy reform based on an international trend towards personalisation in social care. It aims to increase choice and control over services and supports for people who have or acquire a permanent disability, thereby boosting citizen empowerment and improving health and social outcomes. METHODS: The research is a structured review of empirical evidence on the administration and outcomes of the NDIS to identify how social factors constrain or enable the ability of individuals to exercise choice within personalised care schemes. RESULTS: We show how social determinants of health at the individual level can collide with the complexity of policy delivery systems to entrench health inequalities. CONCLUSION: Many social policy reforms internationally focus on improving empowerment through enabling choice and control. However, if administrative systems do not take account of existing structural inequities, then such schemes are likely to entrench or grow social inequality. Our research indicates that more attention must be given to the design of policy delivery systems for personalisation schemes to ensure health equity.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Equidade em Saúde/tendências , Disparidades nos Níveis de Saúde , Avaliação de Processos e Resultados em Cuidados de Saúde , Medicina de Precisão/tendências , Austrália , Reforma dos Serviços de Saúde , Humanos , Seguro por Invalidez , Participação do Paciente , Determinantes Sociais da Saúde
18.
Psychiatr Serv ; 70(8): 714-727, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31035896

RESUMO

OBJECTIVE: The Social Security Administration's Representative Payment Program appoints payees as financial managers for individuals determined incapable of managing their funds. The aim is to afford stability and increase clients' ability to meet health and behavioral priorities. This systematic review examined literature on the effect of representative payee services on identified outcomes. METHODS: A search of academic databases and gray literature was conducted in November 2015 and repeated in December 2017. Included studies had a comparison group; excluded studies examined services other than representative payee. Primary outcomes included substance use, symptoms of mental illness, housing stability, quality of life, and other health-specific outcomes. Secondary outcomes included the client-payee relationship and client satisfaction with services. RESULTS: Eighteen articles met inclusion criteria. Studies assessing primary outcomes found several positive and few negative effects of representative payee services. Studies examining secondary outcomes indicated that receipt of such services may affect the client-provider relationship, increase conflict and violence, and increase clients' perceptions of financial leverage (i.e., a payee's use of control over funds to encourage, incentivize, or otherwise coerce certain behaviors). Most studies were of poor or moderate quality. Studies spanned nearly two decades, and results may have been confounded by the evolution of service delivery modalities. CONCLUSIONS: Representative payee services are largely beneficial or neutral in terms of health and behavior outcomes. Negative findings mainly involved the client-payee relationship. Given that more than five million individuals have a representative payee, assessing the impact of these services with more rigorous research designs is worthwhile.


Assuntos
Seguro por Invalidez/estatística & dados numéricos , Transtornos Mentais/terapia , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Previdência Social/estatística & dados numéricos , United States Social Security Administration/estatística & dados numéricos , Humanos , Estados Unidos
19.
J Epidemiol Community Health ; 73(8): 717-722, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31036606

RESUMO

BACKGROUND: Denmark and Sweden have implemented reforms that narrowed disability benefit eligibility criteria. Such reforms in combination with increasing work demands create a pincer movement where in particular those with moderate health problems might be unable to comply with work demands, but still not qualify for permanent disability benefits, ending up with temporary means-tested or no benefits. This paper examines whether this actually happened before and after the reforms. METHODS: The Survey of Health, Ageing and Retirement in Europe (SHARE) study waves 1-2 and 4-6 in Denmark and Sweden for the age group 50-59 years (N=5384) was used to analyse changes in employment rates and benefits among people with different levels of health before, during and after disability benefit reforms. Interaction between time and health in relation to employment versus permanent or temporary benefits was used as a criterion for whether our hypotheses was confirmed. RESULTS: Overall, employment rates have increased in the age group, but only among the healthy. The OR for receiving temporary or no benefits increased from 1.25 (95% CI: 0.81 to 1.90) before to 1.73 (95% CI: 1.14 to 2.61) after policy reforms for the 29% with moderate health problems and from 2.89 (95% CI: 1.66 to 5.03) to 6.71 (95% CI: 3.94 to 11.42) among the 11% with severe health problems. The interaction between time and health was statistically significant (p<0.001). CONCLUSION: People with impaired health and workability are forced into a life with temporary means-tested or no benefits when pressed by rising work demands and stricter disability benefit eligibility criteria.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Emprego/estatística & dados numéricos , Seguro por Invalidez/tendências , Dinamarca/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Suécia/epidemiologia
20.
J Health Econ ; 66: 1-17, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31071646

RESUMO

Taiwanese Labor, Government Employee, and Farmer Insurance programs provide 5 to 6 months of salary to enrollees who undergo hysterectomies or oophorectomies before their 45th birthday. These programs create incentives for more and earlier treatments, referred to as inducement and timing effects. Using National Health Insurance data between 1997 and 2011, we estimate these effects on surgery hazards by difference-in-difference and bunching-smoothing polynomial methods. For Government Employee and Labor Insurance, inducement is 11-12% of all hysterectomies, and timing 20% of inducement. For oophorectomies, both effects are insignificant. Enrollees' behaviors are consistent with rational choices. Each surgery qualifies an enrollee for the same benefit, but oophorectomy has more adverse health consequences than hysterectomy. Induced hysterectomies increase benefit payments and surgical costs, at about the cost of a mammogram and 5 pap smears per enrollee.


Assuntos
Histerectomia/economia , Seguro por Invalidez/economia , Adulto , Fatores Etários , Feminino , Humanos , Histerectomia/estatística & dados numéricos , Seguro/economia , Seguro por Invalidez/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Modelos Econométricos , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/estatística & dados numéricos , Ovariectomia/economia , Ovariectomia/estatística & dados numéricos , Medição de Risco , Taiwan
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