Objectives It is unclear to what extent assessments of work ability differ between disability claimants, their treating physicians, and multidisciplinary medical expert teams. Methods We compared ...assessments of work ability for consecutive disability claimants referred to a multidisciplinary assessment center in Switzerland over a 4-year period. Assessments were made for the last job (AJ) prior to claiming a disability benefit and an alternative job (AJ) thought to suit the claimant's physical and mental abilities. Mean differences (MD) in percentage work ability between assessments from claimants, physicians, and experts were then estimated in a linear regression model. Results The 3562 claims made during the study period were mostly due to musculoskeletal and depressive disorders. Assessments differed little between claimants and physicians LJMD 1.3% (95% confidence interval 95% CI 0.5-2.2%); AJ MD 11% (95% CI 10-12%). Experts on average assessed a claimant's work ability higher than either the claimant or physician, particularly in the AJ MD between expert and claimant 57% (95% CI 56-58%) and between expert and physician 46% (95% CI 45-48%). Conclusions Assessments of work ability differed substantially between experts in multidisciplinary medical teams and both claimants and their treating physicians. A careful evaluation of the disability assessment process is needed in an effort to reduce disagreement between expert teams and treating physicians and so improve acceptance of the process.
The launch of the National Disability Insurance Scheme (NDIS) in Australia announced changes to the ways people with disabilities and families access services. These changes cover delivery of early ...childhood early intervention to families with infants and young children with disabilities. In July 2013, the NDIS was rolled out nationally in three pilot sites. This funded phenomenological study was conducted in one pilot rollout site with administrators from two agencies delivering such services. Analysis of the data identified factors that challenged professional practice and personal philosophy. The findings suggest that the long-term financial viability of community agencies is at risk. A crucial dilemma emerged concerning parent choice: to what extent does a 'user pay' system impose limitations to services being delivered in a family centred way? Author abstract
The introduction of Australia’s National Disability Insurance Scheme (NDIS) has changed the way housing and support are delivered to Scheme participants. NDIS policy reform focuses on coordinated ...housing and support responses. These responses are guided by the Specialist Disability Accommodation (SDA) Rule, Framework and pricing and Supported Independent Living payments. To date, the National Disability Insurance Agency (NDIA) has only released limited data to understand SDA demand or inform market development. To understand changing housing and support approaches and the impact of NDIS housing policy on market responses, this research had three aims: (1) to examine the locations and characteristics of housing and support vacancies advertised for people with disability; (2) to investigate funding sources for, and providers of, these supported housing options; and (3) to examine the proportion and source of government, nonprofit and private sector funding for housing and support developments advertised. An audit was undertaken of all advertisements on the two main non‐government organisation Websites that list Australian supported housing vacancies. A total of 562 property adverts were reviewed in March 2019. Audit findings are considered in relation to the current NDIS policy context. Possible housing futures and market gaps for people with significant and permanent disability in Australia are discussed.
Congenital heart defects (CHD) represent a growing burden of illness among adults. We estimated the lifetime health, education, labor, and social outcomes of adults with CHD in the USA using the ...Future Adult Model, a dynamic microsimulation model that has been used to study the lifetime impacts of a variety of chronic diseases. We simulated a cohort of adult heads of households > 25 years old derived from the Panel Survey of Income Dynamics who reported a childhood heart problem as a proxy for CHD and calculated life expectancy, disability-free and quality-adjusted life years, lifetime earnings, education attainment, employment, development of chronic disease, medical spending, and disability insurance claiming status. Total burden of disease was estimated by comparing to a healthy cohort with no childhood heart problem. Eighty-seven individuals reporting a childhood heart problem were identified from the PSID and were used to generate the synthetic cohort simulated in the model. Life expectancy, disability-free, quality-adjusted, and discounted quality-adjusted life years were an average 4.6, 6.7, 5.3, and 1.4 years lower than in healthy adults. Lung disease, cancer, and severe mental distress were more common compared to healthy individuals. The CHD cohort earned $237,800 less in lifetime earnings and incurred higher average total medical spend by $66,600 compared to healthy individuals. Compared to healthy adults, the total burden of CHD is over $500K per adult. Despite being among the healthiest adults with CHD, there are significant decrements in life expectancy, employment, and lifetime earnings, with concomitant increases in medical spend.
•UI affects the labor market through job search, but also via other channels.•Search externalities reduce the effect of UI on unemployment.•Take-up behavior of other social programs affects the costs ...of UI.•Job separations (quits and layoffs) may respond to UI generosity.
The existing literature assumes that unemployment insurance (UI) affects the labor market through the job finding rate of eligible workers. Recent research has started to broaden the perspective. In this paper, I show evidence for UI effects through three other margins: (i) search externalities; (ii) take-up of other welfare state programs; and (iii) job separations. The evidence suggests that the analysis of optimal UI should take a more comprehensive view of how UI affects the labor market.
Public policies are products of politics, but they also feed back into the political system by shaping the actions and attitudes of members of the polity. To date, scholarly examinations of feedback ...processes have been mostly concerned with understanding the relationship between public policy and democracy; relatively little attention has been paid to connecting policy feedback to the practical questions that animate politics. This article examines policy feedback as it applies to efforts aimed at achieving universal health coverage in the United States—a widely held policy goal shared by a majority of American voters across partisan lines. I argue that in the contemporary political context, Medicaid—a pillar of the American healthcare system and the primary mechanism for insuring low-income and disabled citizens—can produce negative feedbacks that demobilize political action, destabilize advocacy groups, and deter coalition building. Together, these feedbacks undermine future possibilities for universal healthcare. After detailing these democratic dilemmas, I outline strategies for proactively addressing them.
We consider experience rating in the classic Markov chain life insurance setting. We focus on shrinkage estimation of group effects in an empirical Bayes and multivariate frailty extension, building ...on ideas from group life insurance and survival and event history analysis. Within this framework, we provide insights regarding the structure of the likelihoods and sufficiency of summary statistics such as occurrences and exposures. Simple shrinkage estimators, given by well-known credibility formulas, are obtained under quadratic loss for mutually independent conjugate Gamma priors. The applicability of these simple shrinkage estimators for disability insurance is illustrated in a numerical example using simulated data.
•We estimate that occupations have an important effect on disability risk.•We model the interaction of social disability insurance (SDI) and occupation choice.•We study how SDI affects welfare ...through risk sharing and productive efficiency.•Optimal SDI raises welfare for all agents, even those with zero disability risk.
Using retrospective data, we introduce evidence that occupational exposure significantly affects disability risk. Incorporating this into a general equilibrium model, social disability insurance (SDI) affects welfare through (i) the classic, risk-sharing channel and (ii) a new channel of occupational reallocation. Both channels can increase welfare, but at the optimal SDI they are at odds. Welfare gains from additional risk-sharing are reduced by overly incentivizing workers to choose risky occupations. In a calibration, optimal SDI increases welfare by 6.3% relative to actuarially fair insurance, mostly due to risk sharing.
PDF
