Digitally Assisted Standard Diagnostics in Insurance Medicine (DASDIM): psychometric data in psychiatric work disability evaluations

PURPOSE

Insurers often commission psychiatric experts to evaluate the eligibility of workers with mental disorders for disability benefits, by estimating their residual work capacity (RWC). We investigated the validity of a standardized, computer-based battery of established diagnostic instruments, for evaluating the personality, cognition, performance, symptom burden, and symptom validity of claimants.

METHODS

One hundred and fifty-three claimants for benefits were assessed by the assembled test battery, which was applied in addition to a conventional clinical work disability evaluation.

RESULTS

A principal component analysis of the test and questionnaire battery data revealed six factors (Negative Affectivity, Self-Perceived Work Ability, Behavioral Dysfunction, Working Memory, Cognitive Processing Speed, and Excessive Work Commitment). Claimants with low, medium, and high RWC exclusively varied in the factor Negative Affectivity. Importantly, this factor also showed a strong association to psychiatric ratings of capacity limitations in psychosocial functioning.

CONCLUSIONS

The findings demonstrate that the used test battery allows a substantiation of RWC estimates and of psychiatric ratings by objective and standardized data. If routinely incorporated in work disability evaluations, the test battery could increase their transparency for all stakeholders (insurers, claimants, medical experts, expert case-coordinators, and legal practitioners) and would open new avenues for research in the field of insurance medicine.Implications for rehabilitationThe residual work capacity (RWC) estimation by medical experts is internationally good practice, but plagued by a relatively low interrater agreement.The current study shows that psychiatric RWC estimates and capacity limitation ratings can be substantiated by data from objective, standardized psychometric instruments.Systematically using such instruments might help to improve the poor interrater agreement for RWC estimates in work disability evaluations.Such data could also be used for adopting vocational trainings and return-to-work programs to the individual needs of workers with mental health problems.

Barriers, Facilitators and Experiences Linked to a Work-Related Case Management in Individuals with Substance Abuse Disorders

Individuals with substance abuse disorders experience trouble with the return to work or finding a stable workplace. At the same time, unemployment has negative effects on substance abuse. Work-related case management programs are often used to support the return to work in individuals with substance abuse disorders. This paper describes the experiences, perceived barriers, and facilitators, and their possible relations of people participating in a 12 month case management in Germany to support the return to work and to stabilize their workplace. For this purpose n = 15 interviews with the case management participants were conducted between December 2020 and September 2021. Data analysis followed a content analysis. The category system emerged is based on both the literature and the interview data. We describe several barriers and facilitators such as work motivation, experience with the case manager, and experience with the social security system. Furthermore, possible relationships between different barriers and facilitators are described. It will further be described how facilitators, especially the case manager, can help to overcome barriers, and how this might affect the intervention outcome.

Optimal Strategies for Reducing Number of People in the Social Security System

Providing social security to the population in need has become a major expenditure for many governments. Reducing the number of dependents in the social security system and maintaining a dynamic economically active population is a high priority concern for policymakers. A good understanding of the dynamics of the social security system—specifically, who enters and who exits the system—would be helpful for formulating effective interventions. Here, we made use of the data of Hong Kong’s Comprehensive Social Security Assistance (CSSA), which is currently a basic welfare scheme in Hong Kong that provides supplementary payments to households that cannot support themselves financially. We proposed a stochastic model to examine the in- and out- movement in the CSSA scheme and conducted elasticity analyses. The elasticity analyses allowed us to identify the potential target groups of people that would lead to the largest reduction in the number of the CSSA recipients in the system. This analytical method can also reveal whether policies would be more effective in preventing people from entering the CSSA system or helping them leave the CSSA scheme. Our analyses suggest that targeting those aged 30–49 with children would have the largest impact. Additionally, we found that policies that aim to prevent this group from entering the CSSA system would be more effective in reducing the number of CSSA recipients compared with policies that aim to help them exit. In contrast, for the younger age group of 10–29, policies that help them leave CSSA would be more effective than policies that prevent them from entering CSSA. Providing employment for those unemployed in this younger group would be more effective. The results indicate that by tailoring measures to specific subgroups, the overall number of CSSA recipients would be reduced, thereby improving the efficiency of Hong Kong’s social security system, which has accounted for more than 16.5% of Hong Kong government expenditure in 2018, amounting to more than HKD 92 billion.

An analysis of the current condition of the medical insurance system in Japan

The social security system, including the national health insurance system, in Japan has been maintained at a world-class level since 1974. However, an increase in the number of elderly people, and a decrease in the working generation, caused by a declining birthrate, represents a serious issue for the system both in the present and future. This report analyzes the key problems in the current insurance system and also considers how they can be handled in the future.

General practitioners' perceptions of working with the certification of sickness absences following changes in the Swedish social security system: a qualitative focus-group study

BACKGROUND

Many physicians in Sweden, as well as in other countries, find the matter of certification of sickness absence (COSA) particularly burdensome. The issuing of COSAs has also been perceived as a work-environment problem among physicians. Among general practitioners (GPs) are the highest proportion of physicians in Sweden who experience difficulties with COSA. Swedish authorities have created several initiatives, by changing the social security system, to improve the rehabilitation of people who are ill and decrease the number of days of sick leave used. The aim of this study was to describe how GPs in Sweden perceive their work with COSA after these changes.

METHODS

A descriptive design with a qualitative, inductive focus-group discussion (FGD) approach was used.

RESULTS

Four categories emerged from the analysis of FGDs with GPs in Sweden: 1) Physicians' difficulties in their professional role; 2) Collaboration with other professionals facilitates the COSA; 3) Physicians' approach in relation to the patient; 4) An easier COSA process.

CONCLUSIONS

Swedish GPs still perceived COSA to be a burdensome task. However, system changes in recent years have facilitated work related to COSA. Cooperation with other professionals on COSA was perceived positively.