Physicians\u2019 attitudes to disability pension \u2013 impact of diagnosis: an experimental study

Ashley Mcallister,Patrick Corrigan,Allison Milner,Bo Burström,Monika Engblom

doi:10.1186/s12913-020-06043-2

Ashley Mcallister, Patrick Corrigan + Show 3 more

Open Access

https://doi.org/10.1186/s12913-020-06043-2

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Abstract

BackgroundThe purpose of this study is to increase understanding of physicians’ attitudes towards disability pension applicants, and the impact of diagnosis. We hypothesize that physicians are more likely to think that patients with physical illnesses should get a disability pension than those with mental illness or alcohol dependence. Disability pension is an important source of income for those unable to work because of a disability and type of diagnosis should not impact accessing these benefits.MethodsWe conducted an experiment with a 2 by 3 factorial structure in Sweden. Each physician was randomly assigned one of six patient vignettes, with the same background description but with a different diagnosis. Each vignette had a diagnosis of either depression, alcohol dependence or low back pain, and was about a man or a woman. Logistic regression was used to examine the odds of a physician reporting that a patient should get a disability pension. Effects are reported in terms of odds ratios (ORs).Results1414 Swedish registered physicians in psychiatry or general practice (24% response rate) completed the survey. Physicians assigned the alcohol dependent vignette had OR 0.45 (95% CI: 0.34 to 0.60) for perceiving that a patient should get a disability pension compared to physicians assigned the low back pain vignette. Physicians assigned the depression vignette had OR 1.89 (95% CI: 1.42 to 2.50) for perceiving that a patient should get a disability pension compared to physicians assigned the low back pain vignette.ConclusionThe patient diagnosis was associated with the physicians’ response regarding if the patient should get a disability pension. A physician’s perception is likely to impact a patient’s access to disability pension.

Highlights

The purpose of this study is to increase understanding of physicians’ attitudes towards disability pension applicants, and the impact of diagnosis
The results show that physicians were slightly less likely to think the female vignette should get a disability pension compared to the male vignette but the results were not statistically significant
In this experimental study, we investigated the association between patient diagnosis and whether a physician thinks the patient should get a disability pension in Sweden

Summary

Introduction

The purpose of this study is to increase understanding of physicians’ attitudes towards disability pension applicants, and the impact of diagnosis. The role of diagnosis in disability pension In the disability pension process, a diagnosis is important as it establishes a medical reason for reduced work capacity It is unclear in the literature whether the type of diagnosis may matter in this process. Most studies conclude that physical disabilities are at the top of this hierarchy, followed by mental illnesses alcohol, and other dependences at the bottom [6, 7]. We examine alcohol dependence, recurrent depression, and lower back pain with sciatica (hereto referred to as low back pain) These diagnoses represent a significant burden of disease [8,9,10] and are subject to clinical ambiguity [3]. Hatcher and Arroll [11] argue that such conditions constitute “a clinically, conceptually and emotionally difficult area” making them interesting conditions to explore whether the diagnosis matters in the disability pension process

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