Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 902
Filtrar
1.
Lancet Psychiatry ; 7(10): 893-910, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32949521

RESUMO

Mental illness and substance use disorders in the workplace have been increasingly recognised as a problem in most countries; however, evidence is scarce on which solutions provide the highest return on investment. We searched academic and grey literature databases and additional sources for studies that included a workplace intervention for mental health or substance abuse, or both, and that did an economic analysis. We analysed the papers we found to identify the highest yielding and most cost-effective interventions by disorder. On the basis of 56 studies, we found moderate strength of evidence that cognitive behavioural therapy is cost-saving (and in some cases cost-effective) to address depression. We observed strong evidence that regular and active involvement of occupational health professionals is cost-saving and cost-effective in reducing sick leave related to mental health and in encouraging return to work. We identified moderate evidence that coverage for pharmacotherapy and brief counselling for smoking cessation are both cost-saving and cost-effective. Addressing mental health and substance misuse in the workplace improves workers' wellbeing and productivity, and benefits employers' bottom line (ie, profit). Future economic analyses would benefit from the consideration of subgroup analyses, examination of longer follow-ups, inclusion of statistical and sensitivity analyses and discussion around uncertainty, and consideration of potential for bias.


Assuntos
Serviços de Saúde do Trabalhador/economia , Serviços de Saúde do Trabalhador/métodos , Terapia Ocupacional/economia , Terapia Ocupacional/métodos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Terapia Cognitivo-Comportamental/economia , Terapia Cognitivo-Comportamental/métodos , Análise Custo-Benefício , Economia Médica , Humanos , Saúde Mental , Ensaios Clínicos Controlados Aleatórios como Assunto , Licença Médica/estatística & dados numéricos , Local de Trabalho
2.
Artigo em Inglês | MEDLINE | ID: mdl-32698470

RESUMO

The cost-benefit and cost-effectiveness of a work-directed intervention implemented by the occupational health service (OHS) for employees with common mental disorders (CMD) or stress related problems at work were investigated. The economic evaluation was conducted in a two-armed clustered RCT. Employees received either a problem-solving based intervention (PSI; n = 41) or care as usual (CAU; n = 59). Both were work-directed interventions. Data regarding sickness absence and production loss at work was gathered during a one-year follow-up. Bootstrap techniques were used to conduct a Cost-Benefit Analysis (CBA) and a Cost-Effectiveness Analysis (CEA) from both an employer and societal perspective. Intervention costs were lower for PSI than CAU. Costs for long-term sickness absence were higher for CAU, whereas costs for short-term sickness absence and production loss at work were higher for PSI. Mainly due to these costs, PSI was not cost-effective from the employer's perspective. However, PSI was cost-beneficial from a societal perspective. CEA showed that a one-day reduction of long-term sickness absence costed on average €101 for PSI, a cost that primarily was borne by the employer. PSI reduced the socio-economic burden compared to CAU and could be recommended to policy makers. However, reduced long-term sickness absence, i.e., increased work attendance, was accompanied by employees perceiving higher levels of production loss at work and thus increased the cost for employers. This partly explains why an effective intervention was not cost-effective from the employer's perspective. Hence, additional adjustments and/or support at the workplace might be needed for reducing the loss of production at work.


Assuntos
Serviços de Saúde do Trabalhador/economia , Saúde do Trabalhador/estatística & dados numéricos , Estresse Ocupacional/prevenção & controle , Licença Médica/economia , Análise Custo-Benefício , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Transtornos Mentais/prevenção & controle , Transtornos Mentais/reabilitação , Serviços de Saúde do Trabalhador/métodos , Retorno ao Trabalho , Licença Médica/estatística & dados numéricos
3.
Muscle Nerve ; 62(1): 60-69, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32304244

RESUMO

INTRODUCTION: The quality of electrodiagnostic tests may influence treatment decisions, particularly regarding surgery, affecting health outcomes and health-care expenditures. METHODS: We evaluated test quality among 338 adults with workers' compensation claims for carpal tunnel syndrome. Using simulations, we examined how it influences the appropriateness of surgery. Using regression, we evaluated associations with symptoms and functional limitations (Boston Carpal Tunnel Questionnaire), overall health (12-item Short Form Health Survey version 2), actual receipt of surgery, and expenditures. RESULTS: In simulations, suboptimal quality tests rendered surgery inappropriate for 99 of 309 patients (+32 percentage points). In regression analyses, patients with the highest quality tests had larger declines in symptoms (-0.50 point; 95% confidence interval [CI], -0.89 to -0.12) and functional impairment (-0.42 point; 95% CI, -0.78 to -0.06) than patients with the lowest quality tests. Test quality was not associated with overall health, actual receipt of surgery, or expenditures. DISCUSSION: Test quality is pivotal to determining surgical appropriateness and associated with meaningful differences in symptoms and function.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Eletrodiagnóstico/normas , Gastos em Saúde/normas , Serviços de Saúde do Trabalhador/normas , Medidas de Resultados Relatados pelo Paciente , Indicadores de Qualidade em Assistência à Saúde/normas , Adulto , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/economia , Eletrodiagnóstico/economia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Serviços de Saúde do Trabalhador/economia , Indicadores de Qualidade em Assistência à Saúde/economia , Resultado do Tratamento
4.
Rev Epidemiol Sante Publique ; 67(4): 247-252, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31235191

RESUMO

BACKGROUND: In France, complex cases of occupational disease (OD) are submitted to regional committees who are in charge of accepting, or rejecting, the claim. Their mean annual acceptance rate varies from one region to another, which may reflect differences in the cases, or discrepancies between committees. The objective of this study was to assess the comparability of the decisions of the committees on the basis of standardized cases. METHODS: Three experienced occupational physicians specialized in OD were asked to develop 28 clinical cases representative of claims for compensation usually seen in these committees. The cases, in the form of short vignettes, were submitted to the 18 French regional committees, asking if they would recognise each case as an OD. RESULTS: All committees participated. The acceptance rate (recognition of the case as an OD) varied, ranging from 18% to 70%. All the committees took the same decision for only 7 out of the 28 cases, but half accepted and half refused for 3 cases. For 10 cases, one quarter of the committees gave a decision different than the other 75%. The highest discordance rates were observed for the cases concerning musculoskeletal disorders and asbestos related diseases. CONCLUSION: The committees take very different decisions in terms of recognition of OD, especially for the most frequently compensated OD in France, i.e. musculoskeletal disorders and asbestos related diseases. This is a major source of injustice for the employees who seek compensation and there is a need to develop methods to harmonize decisions between committees.


Assuntos
Disparidades em Assistência à Saúde , Doenças Profissionais/diagnóstico , Doenças Profissionais/epidemiologia , Idoso , Ética Médica , Feminino , França/epidemiologia , Geografia , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/ética , Acesso aos Serviços de Saúde/normas , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/ética , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/economia , Doenças Profissionais/terapia , Serviços de Saúde do Trabalhador/economia , Serviços de Saúde do Trabalhador/ética , Serviços de Saúde do Trabalhador/organização & administração , Serviços de Saúde do Trabalhador/normas , Fatores Socioeconômicos , Indenização aos Trabalhadores
5.
J Man Manip Ther ; 27(5): 277-286, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31104572

RESUMO

Objectives: The escalating cost of low back pain (LBP) care has not improved outcomes. Our purpose: to compare costs between LBP care guided by a quality-assured mechanical assessment (MC) and usual community care (CC).Study Design: Administrative claims data analysis.Methods: Employees and dependents of a large self-insured manufacturer seeking care for LBP in 2013 chose between the company's primary care clinic (where MC was delivered) and community care.The claims of 5,036 were analyzed for one year following subjects' initial evaluation excluding only those with diagnostic codes for fractures, dislocations, or infections. MC included an advanced form of Mechanical Diagnosis & Therapy (MDT). CC varied based on each subjects' selection of providers. Primary outcome measure: one-year cost of each subject's care. Secondary: number of MRIs, spinal injections, and lumbar surgeries undertaken. The payer's proprietary risk-adjustment algorithm was utilized.Results: After risk adjustment, the average cost per MC subject was 51.48% lower than the CC average cost (p < .0279). The utilization of MRIs, injections, and surgeries was lower with MC by 49.75%, 39.44%, 78.38% with relative risks of 1.99, 1.64, and 4.73, respectively.Conclusions: This 51.5% cost-savings reflects the substantial reduction in downstream care-seeking with MC, including lower utilization of MRIs, injections, surgeries, and downstream care after six months from the initial visit. It is well documented that the MDT clinical examination typically elicit patterns of pain response that in turn identify how most can rapidly recover with self-care with no need for other intervention.Level of Evidence: 1b.


Assuntos
Serviços de Saúde Comunitária/economia , Dor Lombar/economia , Dor Lombar/terapia , Serviços de Saúde do Trabalhador/economia , Atenção Primária à Saúde/economia , Adulto , Estudos de Coortes , Redução de Custos , Feminino , Humanos , Injeções Espinhais/estatística & dados numéricos , Estudos Longitudinais , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/estatística & dados numéricos , Estados Unidos
8.
JAMA ; 321(15): 1491-1501, 2019 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-30990549

RESUMO

Importance: Employers have increasingly invested in workplace wellness programs to improve employee health and decrease health care costs. However, there is little experimental evidence on the effects of these programs. Objective: To evaluate a multicomponent workplace wellness program resembling programs offered by US employers. Design, Setting, and Participants: This clustered randomized trial was implemented at 160 worksites from January 2015 through June 2016. Administrative claims and employment data were gathered continuously through June 30, 2016; data from surveys and biometrics were collected from July 1, 2016, through August 31, 2016. Interventions: There were 20 randomly selected treatment worksites (4037 employees) and 140 randomly selected control worksites (28 937 employees, including 20 primary control worksites [4106 employees]). Control worksites received no wellness programming. The program comprised 8 modules focused on nutrition, physical activity, stress reduction, and related topics implemented by registered dietitians at the treatment worksites. Main Outcomes and Measures: Four outcome domains were assessed. Self-reported health and behaviors via surveys (29 outcomes) and clinical measures of health via screenings (10 outcomes) were compared among 20 intervention and 20 primary control sites; health care spending and utilization (38 outcomes) and employment outcomes (3 outcomes) from administrative data were compared among 20 intervention and 140 control sites. Results: Among 32 974 employees (mean [SD] age, 38.6 [15.2] years; 15 272 [45.9%] women), the mean participation rate in surveys and screenings at intervention sites was 36.2% to 44.6% (n = 4037 employees) and at primary control sites was 34.4% to 43.0% (n = 4106 employees) (mean of 1.3 program modules completed). After 18 months, the rates for 2 self-reported outcomes were higher in the intervention group than in the control group: for engaging in regular exercise (69.8% vs 61.9%; adjusted difference, 8.3 percentage points [95% CI, 3.9-12.8]; adjusted P = .03) and for actively managing weight (69.2% vs 54.7%; adjusted difference, 13.6 percentage points [95% CI, 7.1-20.2]; adjusted P = .02). The program had no significant effects on other prespecified outcomes: 27 self-reported health outcomes and behaviors (including self-reported health, sleep quality, and food choices), 10 clinical markers of health (including cholesterol, blood pressure, and body mass index), 38 medical and pharmaceutical spending and utilization measures, and 3 employment outcomes (absenteeism, job tenure, and job performance). Conclusions and Relevance: Among employees of a large US warehouse retail company, a workplace wellness program resulted in significantly greater rates of some positive self-reported health behaviors among those exposed compared with employees who were not exposed, but there were no significant differences in clinical measures of health, health care spending and utilization, and employment outcomes after 18 months. Although limited by incomplete data on some outcomes, these findings may temper expectations about the financial return on investment that wellness programs can deliver in the short term. Trial Registration: ClinicalTrials.gov Identifier: NCT03167658.


Assuntos
Comportamentos Relacionados com a Saúde , Promoção da Saúde , Nível de Saúde , Saúde do Trabalhador , Adulto , Comércio , Feminino , Gastos em Saúde , Promoção da Saúde/economia , Humanos , Masculino , Serviços de Saúde do Trabalhador/economia , Aceitação pelo Paciente de Cuidados de Saúde , Autorrelato , Inquéritos e Questionários , Estados Unidos , Local de Trabalho
9.
J Occup Environ Med ; 61(7): 597-604, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31022100

RESUMO

OBJECTIVE: The purpose of this paper is to describe and evaluate a web-based, educational Health Risk Calculator that communicates the value of investing in employee health and well-being for the prevention of work-related injuries, illnesses, and fatalities. METHODS: We developed and evaluated the calculator following the RE-AIM framework. We assessed effectiveness via focus groups (n = 15) and a post-use survey (n = 33) and reach via website analytics. RESULTS: We observed evidence for the calculator's usability, educational benefit, and encouragement of action to improve worker health and safety. Website analytics data demonstrated that we reached over 300 users equally in urban and rural areas within 3 months after launch. CONCLUSION: We urge researchers to consider the ways in which they can communicate their empirical research findings to their key stakeholders and to evaluate their communication efforts.


Assuntos
Promoção da Saúde/economia , Doenças Profissionais/economia , Serviços de Saúde do Trabalhador/economia , Saúde do Trabalhador/economia , Traumatismos Ocupacionais/economia , Indenização aos Trabalhadores/estatística & dados numéricos , Adolescente , Adulto , Idoso , Colorado/epidemiologia , Feminino , Grupos Focais , Humanos , Incidência , Internet , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , Doenças Profissionais/prevenção & controle , Saúde do Trabalhador/estatística & dados numéricos , Traumatismos Ocupacionais/epidemiologia , Traumatismos Ocupacionais/etiologia , Traumatismos Ocupacionais/prevenção & controle , Medição de Risco , Indenização aos Trabalhadores/economia , Adulto Jovem
10.
Am J Prev Med ; 56(4): 548-562, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30772152

RESUMO

INTRODUCTION: Workplace tobacco control interventions reduce smoking and secondhand smoke exposure among U.S. workers. Data on smoke-free workplace policy coverage and cessation programs by industry and occupation are limited. This study assessed smoke-free workplace policies and employer-offered cessation programs among U.S. workers, by industry and occupation. METHODS: Data from the 2014-2015 Tobacco Use Supplement to the Current Population Survey, a random sample of the civilian, non-institutionalized population, were analyzed in 2018. Self-reported smoke-free policy coverage and employer-offered cessation programs were assessed among working adults aged ≥18 years, overall and by occupation and industry. Respondents were considered to have a 100% smoke-free policy if they indicated smoking was not permitted in any indoor areas of their workplace, and to have a cessation program if their employer offered any stop-smoking program within the past year. RESULTS: Overall, 80.3% of indoor workers reported having smoke-free policies at their workplace and 27.2% had cessation programs. Smoke-free policy coverage was highest among workers in the education services (90.6%) industry and lowest among workers in agriculture, forestry, fishing, and hunting industry (64.1%). Employer-offered cessation programs were significantly higher among workers reporting 100% smoke-free workplace policies (30.9%) than those with partial/no policies (23.3%) and were significantly higher among indoor workers (29.2%) than outdoor workers (15.0%). CONCLUSIONS: Among U.S. workers, 100% smoke-free policy and cessation program coverage varies by industry and occupation. Lower smoke-free policy coverage and higher tobacco use in certain industry and occupation groups suggests opportunities for workplace tobacco control interventions to reduce tobacco use and secondhand smoke exposure.


Assuntos
Cobertura do Seguro/estatística & dados numéricos , Serviços de Saúde do Trabalhador/estatística & dados numéricos , Política Antifumo/legislação & jurisprudência , Abandono do Hábito de Fumar/legislação & jurisprudência , Local de Trabalho/legislação & jurisprudência , Adolescente , Adulto , Idoso , Feminino , Humanos , Cobertura do Seguro/economia , Masculino , Pessoa de Meia-Idade , Serviços de Saúde do Trabalhador/economia , Prevalência , Autorrelato/estatística & dados numéricos , Política Antifumo/economia , Fumar/efeitos adversos , Fumar/epidemiologia , Fumar/terapia , Abandono do Hábito de Fumar/economia , Abandono do Hábito de Fumar/estatística & dados numéricos , Poluição por Fumaça de Tabaco/prevenção & controle , Estados Unidos/epidemiologia , Local de Trabalho/economia , Local de Trabalho/estatística & dados numéricos , Adulto Jovem
11.
J Occup Environ Med ; 61(4): 318-327, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30688765

RESUMO

OBJECTIVE: To estimate the budget impact (BI) of funding pharmaco+behavioral therapies for smoking cessation from an employer perspective. METHODS: A hybrid economic model was applied to estimate the BI, which considered up to four cessation attempts over a 3-year horizon. The model estimated the costs of funding a cessation programme, and the mean savings due to avoided loss of productivity and absenteeism because of smoking cessation. RESULTS: 53.8% of smokers quit smoking. The programme, which costs &OV0556;394,468, would generate earnings of &OV0556;1,342,133; with &OV0556;644,974 in incremental net savings. These mean &OV0556;1.64 in return per each euro invested. Results show net benefits from two cigarettes smoked while working every day. CONCLUSIONS: Considering the avoided costs of loss of productivity and absenteeism, funding a smoking cessation programme of pharmaco+behavioral therapies would produce substantial savings for the employer.


Assuntos
Terapia Comportamental/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Serviços de Saúde do Trabalhador/métodos , Agentes de Cessação do Hábito de Fumar/economia , Abandono do Hábito de Fumar/métodos , Fumar/terapia , Absenteísmo , Adolescente , Adulto , Idoso , Terapia Comportamental/métodos , Terapia Combinada , Eficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Serviços de Saúde do Trabalhador/economia , Fumar/economia , Abandono do Hábito de Fumar/economia , Agentes de Cessação do Hábito de Fumar/uso terapêutico , Espanha , Adulto Jovem
12.
Am J Health Promot ; 33(2): 285-288, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29969913

RESUMO

PURPOSE: State-based smoking cessation telephone quitlines offer a cost-effective method of providing tobacco treatment at no cost to participants. The study objective was to assess the annual return on investment (ROI) to employers if they were to bear the entire responsibility from the Kentucky quitline. DESIGN: A retrospective design was used to estimate the annual ROI to employers from the Kentucky quitline. SETTING: The telephone quitline (1-800-QUIT-NOW) provided intake and follow-up data for all Kentucky participants who enrolled in the program from 2012 to 2014. PARTICIPANTS: All individuals aged 18+ who enrolled in the Kentucky quitline from 2012 to 2014. MEASURES: Successful tobacco cessation was assessed from follow-up surveys that took place after individuals completed the program. Cost savings to employers associated with tobacco cessation were gleaned from a published meta-analysis. The Kentucky quitline provided estimates for annual program expenses. ANALYSIS: The annual ROI was calculated as the difference between estimated annual cost savings due to smoking cessation and annual program expenses. RESULTS: From 2012 to 2014, 5425 individuals were enrolled in the quitline. The annual ROI to employers was estimated to be $998 680, with an ROI ratio of 6.2:1. CONCLUSIONS: Employers may receive a substantial ROI if they were to fund the Kentucky quitline. Study results may be used as evidence to support cost-sharing partnerships between public health agencies and employers to sustain funding for telephone quitlines.


Assuntos
Linhas Diretas/estatística & dados numéricos , Serviços de Saúde do Trabalhador/métodos , Abandono do Hábito de Fumar/métodos , Abandono do Uso de Tabaco/métodos , Análise Custo-Benefício , Linhas Diretas/economia , Humanos , Kentucky , Serviços de Saúde do Trabalhador/economia , Estudos Retrospectivos , Abandono do Hábito de Fumar/economia , Abandono do Uso de Tabaco/economia
13.
Int J Occup Med Environ Health ; 32(3): 353-361, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-30356227

RESUMO

OBJECTIVES: In the contemporary Western culture, working population health issues, stressed in various publications, have been perceived as a crucial part of public health. To deal with occupational health issues properly, occupational health services (OHS), aiming at the protection of the workers' health, are organized in many countries. The survey was to find the differences in occupational health systems that the European Economic Area countries use in order to execute prophylactic activities focused on diseases of affluence and how the OHS are used for health promotion actions. MATERIAL AND METHODS: The survey was conducted with the use of an on-line expert questionnaire. No deep statistical analysis was performed as for the designed aims of the study simple statistics were sufficient. RESULTS: All the reviewed countries have organized OHS. The funding mechanisms are based mainly on the financial involvement of employers. In the majority of countries, the main goal of the OHS is certification of the ability to work. Workplace surveillance aiming at the occupational risk assessment and health promotion activities that focus on work-related and/or occupational diseases are the most popular services provided within national systems. CONCLUSIONS: Occupational health professionals are well placed to perform actions directed at health promotion and prophylactics of a wide range of diseases - not only occupational/work-related, but also non-communicable, particularly life-style-related diseases of affluence. The engagement of the occupational medical services (OMS) in prevention of the non-work-related health issues would be valuable. However, it would be inevitable for employers to finance a wider range of services to a greater extent. Int J Occup Med Environ Health. 2019;32(3):353-61.


Assuntos
Promoção da Saúde/organização & administração , Doenças Profissionais/prevenção & controle , Serviços de Saúde do Trabalhador/estatística & dados numéricos , União Europeia , Política de Saúde , Humanos , Estilo de Vida , Saúde do Trabalhador/estatística & dados numéricos , Serviços de Saúde do Trabalhador/economia , Serviços de Saúde do Trabalhador/organização & administração , Inquéritos e Questionários , Local de Trabalho
14.
Scand J Work Environ Health ; 45(3): 308-311, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30365039

RESUMO

Objective This study aimed to estimate firm-level expenditures on occupational health and safety (OHS) for a representative sample of Canadian employers. Methods A cross-sectional survey of 334 employers with ≥20 employees in 18 economic sectors in the Ontario economy. Participants provided information on five dimensions of OHS expenditures: (i) organizational management and supervision; (ii) staff training in health and safety; (iii) personal protective equipment; (iv) professional services and, (v) estimates of the share of new capital investment that could be attributed to improved OHS performance. Expenditures for each of the five dimensions were summed for each organization and divided by the number of employees, resulting in an estimate of OHS expenditure per employee per year. Results The average OHS expenditure per worker per year was Can$1303 [95% confidence interval (CI) Can$1167-1454]. Expenditures were three times higher in the goods-producing sectors (Can$2417, 95% CI Can$2026-2809) relative to the service sectors (Can$847, 95% CI Can$777-915). The proportion of expenditures allocated to each of the five dimensions was generally consistent across economic sectors: 58% to organizational management and supervision, 22% to staff training in health and safety and 14% to personal protective equipment. On average, <5% of OHS expenditures per worker per year were allocated to professional services or estimated as the share of new capital investment attributed to OHS. Conclusions Employer expenditures on OHS are substantial. The results of this study are consistent with recent European estimates and strengthen understanding of the scale of employer financial expenditures to protect the health of workers.


Assuntos
Emprego , Gastos em Saúde , Serviços de Saúde do Trabalhador , Estudos Transversais , Humanos , Indústrias , Serviços de Saúde do Trabalhador/economia , Serviços de Saúde do Trabalhador/normas , Ontário , Equipamento de Proteção Individual
15.
Med Pr ; 69(6): 673-684, 2018 12 18.
Artigo em Polonês | MEDLINE | ID: mdl-30468207

RESUMO

This paper constitutes a continuation of the critical analysis of legal aspects of psychological examinations in some group of workers. In this part the appeal procedure, documentation, costs of examinations and supervision are discussed. The analysis has shown many deficiencies in regulations related to all aspects of psychological examinations. They arise from incoherence of legal regulations and the lack of regulations of some questions. This legal standing is restricted to occupational work and adversely affects the quality of supplied services. Therefore acts of law and regulations relevant to psychological examinations for the purpose of fitness-to-work certification need necessary adjustments. According to authors it is desirable to end the legal procedure amending the act of law on a profession of psychology and the self-government of psychologists, as well as to develop and implement executive regulations. Med Pr 2018;69(6):673-684.


Assuntos
Serviços de Saúde do Trabalhador/legislação & jurisprudência , Testes Psicológicos , Custos e Análise de Custo , Humanos , Serviços de Saúde do Trabalhador/economia
16.
Artigo em Inglês | MEDLINE | ID: mdl-30469425

RESUMO

An emerging issue in occupational health and safety (OHS) is that interventions increasingly have to demonstrate that they offer sufficient value for money. To this end, the last decennia have seen more and more economic evaluation methods being employed in this field. However, several recent publications have indicated that many of the published studies suffer from important shortcomings. This paper aims to highlight difficulties in assessing the value of OHS by use of current economic evaluation methods. First, a summary framework presents an overview of the costs and benefits relevant for OHS interventions. Next, three elements from this framework are selected that are at the same time crucial to OHS value, but also challenging to measure and monetise: Effects on worker productivity, 'intangible' benefits, such as reputation effects, and the influence of the broader legal⁻fiscal context in which an intervention takes place. The following sections then discuss the following research questions for each of these elements: Why is it difficult to exclude these factors from OHS economic evaluations? Why do they pose a challenge to the quality of economic evaluations in OHS? How can they be included, and what are the known advantages and disadvantages of the methods to measure these factors? Future work should investigate (and standardise) better methods to include these elements.


Assuntos
Análise Custo-Benefício/métodos , Serviços de Saúde do Trabalhador/economia , Humanos , Local de Trabalho
17.
Nihon Eiseigaku Zasshi ; 73(3): 413-420, 2018.
Artigo em Japonês | MEDLINE | ID: mdl-30270309

RESUMO

INTRODUCTION: From 2007, competitive bidding for procurement became widely employed by the Japanese Government, and health check providers for government workers are selected every year by this method. Deterioration of health check quality due to excessive price competition is a serious concern. The National Federation of Industrial Health Organization (Zeneiren) conducted an investigative research on the contracting of health check providers and occupational physicians in workplaces in 2015-2016 in an effort to prevent low-cost but low-quality health checks. The report of the research is available on the homepage of Zeneiren. In this paper, we provide a brief overview of the report, and deterioration of health check quality due to dumping by and switching of health check providers is discussed from economic and legal viewpoints. METHOD: Information was obtained from articles in print and on the Internet. RESULTS: A questionnaire survey of health check providers revealed that excessive discounts due to both competitive bidding and demand from companies commissioning health checks occurred on a routine basis, and some providers were concerned about worsening business conditions in the future. In a separate questionnaire survey of occupational physicians, it was discovered that they were able to evaluate the quality of health checks, whereas administrative officials responsible for selecting the providers were seldom able to adequately evaluate the health check quality, resulting in contracting providers of questionable quality, which in turn caused considerable dissatisfaction on the part of occupational physicians. Moreover, when health check providers were switched, the reporting format of health check results changed. The physicians did not favor such a change because of the considerably increased workload involved in coordinating past and current data and the risk of decreased occupational health service quality. DISCUSSION: Dumping makes the management of health check providers very difficult and is a cause of loss of social capital. If health check providers of good quality withdraw from the market, the supply of high-quality health checks decreases. This corresponds to external diseconomy caused by dumping on the part of the health check providers and loss of social surplus (economic surplus). CONCLUSIONS: To avoid deterioration of occupational health service due to low-quality health checks and changes in the reporting format, occupational physicians must actively engage in the selection of health check providers of good quality.


Assuntos
Serviços de Saúde do Trabalhador/economia , Medicina do Trabalho/economia , Exame Físico/economia , Médicos/economia , Garantia da Qualidade dos Cuidados de Saúde , Qualidade da Assistência à Saúde/economia , Humanos , Japão , Inquéritos e Questionários , Local de Trabalho
18.
Artigo em Inglês | MEDLINE | ID: mdl-30082646

RESUMO

BACKGROUND: Occupational safety and health issues are closely associated with the wellbeing and survival of every worker and family, as well as of society as a whole. It is a type of typical public issue and requires cooperative governance among different governing subjects. METHODS: According to the questionnaire investigation on 2179 subjects with different identities, the research explored the willingness to pay (WTP) for occupational safety and health and the degree of attention, with different identities, through the difference analysis and descriptive statistical analysis. The research studied the relationship between public attention and WTP through the methods of cross-analysis, correlation analysis, and regression analysis. RESULTS: (1) The public show a disregard attitude to occupational safety and health. (2) The public expect the government to fund and solve occupational safety and health problems rather than for themselves to pay directly. (3) Over 50% of questionnaire respondents defined occupational safety and health problems as being classified into two categories, namely, "no attention-government payment" or "no attention-refusal of individual payment", according to the analysis. (4) The level of attention paid to occupational safety and health can significantly predict the individual income WTP, item WTP, subject WTP, and event WTP. CONCLUSIONS: This research aimed to outline the implications for the governance of occupational safety and health.


Assuntos
Política de Saúde , Serviços de Saúde do Trabalhador/economia , Saúde do Trabalhador/economia , Opinião Pública , Atenção , China , Humanos , Análise de Regressão , Inquéritos e Questionários
19.
Med Care ; 56(6): 520-528, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29668650

RESUMO

BACKGROUND: Early magnetic resonance imaging (MRI) for acute low back pain (LBP) has been associated with increased costs, greater health care utilization, and longer disability duration in workers' compensation claimants. OBJECTIVES: To assess the impact of a state policy implemented in June 2010 that required prospective utilization review (UR) for early MRI among workers' compensation claimants with LBP. RESEARCH DESIGN: Interrupted time series. SUBJECTS: In total, 76,119 Washington State workers' compensation claimants with LBP between 2006 and 2014. MEASURES: Proportion of workers receiving imaging per month (MRI, computed tomography, radiographs) and lumbosacral injections and surgery; mean total health care costs per worker; mean duration of disability per worker. Measures were aggregated monthly and attributed to injury month. RESULTS: After accounting for secular trends, decreases in early MRI [level change: -5.27 (95% confidence interval, -4.22 to -6.31); trend change: -0.06 (-0.01 to -0.12)], any MRI [-4.34 (-3.01 to -5.67); -0.10 (-0.04 to -0.17)], and injection [trend change: -0.12 (-0.06 to -0.18)] utilization were associated with the policy. Radiograph utilization increased in parallel [level change: 2.46 (1.24-3.67)]. In addition, the policy resulted in significant decreasing changes in mean costs per claim, mean disability duration, and proportion of workers who received disability benefits. The policy had no effect on computed tomography or surgery utilization. CONCLUSIONS: The UR policy had discernable effects on health care utilization, costs, and disability. Integrating evidence-based guidelines with UR can improve quality of care and patient outcomes, while reducing use of low-value health services.


Assuntos
Dor Lombar/diagnóstico por imagem , Dor Lombar/economia , Imagem por Ressonância Magnética/economia , Doenças Profissionais/economia , Adulto , Feminino , Humanos , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/epidemiologia , Serviços de Saúde do Trabalhador/economia , Revisão da Utilização de Recursos de Saúde , Washington , Indenização aos Trabalhadores/economia
20.
Br Med Bull ; 126(1): 113-121, 2018 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-29684103

RESUMO

Background: Governments and employers' organizations have sustained focus on common mental disorders (CMD), how they impact a person's ability to gain or continue work, the costs of sickness absence, presenteeism and job loss, and the positive impact of work on wellbeing. Sources of data: Scientific literature, mainly systematic reviews and grey literature, i.e. publications not accessible through medical databases. Areas of agreement: CMD are a major cause of disability, unemployment and dependency on welfare benefits. Good and healthy work is important for maintaining mental health and for promoting recovery from mental disorders. Areas of controversy: Evidence is limited with respect to the effectiveness of workplace interventions to prevent CMD and especially with respect to work outcomes and work reintegration of those who have been off sick. Growing points: There is growing interest in, and an increasing number of, best practice guidelines for employers, that could be improved and shared more actively. Areas timely for developing research: There is need for high-quality studies of interventions that examine work outcomes in patients who have been unable to obtain or continue work because of CMD.


Assuntos
Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Serviços de Saúde do Trabalhador/estatística & dados numéricos , Saúde do Trabalhador , Retorno ao Trabalho/estatística & dados numéricos , Licença Médica/estatística & dados numéricos , Humanos , Transtornos Mentais/economia , Serviços de Saúde Mental/economia , Serviços de Saúde do Trabalhador/economia , Retorno ao Trabalho/economia , Licença Médica/economia , Local de Trabalho
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...