Disability Insurance Research Articles

The impact of pension reform on employment, retirement, and disability insurance claims

We evaluate the 2011 comprehensive reform of Norwegian early retirement institutions using a parsimonious random utility choice model. Conditional on employment at age 60, we estimate a three-state conditional logit model to explain the realized labor market state at age 63 among the alternatives of employment, retirement, and disability program participation. The reform radically changed work incentives and/or pension access age for some (but not all) workers, such that the influence of economic incentives can be identified based on reform-generated variation only. We find that improved work incentives caused employment rates to rise considerably at the expense of early retirement and exit through disability insurance. Improved liquidity through a lower age to access own pension funds on actuarially neutral terms caused a small increase in employment and a large drop in disability program participation. Properly designed pension reforms thus need to take the interplay between old-age pension and disability insurance programs into account.

Assessing the Pathophysiology, Morbidity, and Mortality of Obstructive Sleep Apnea.

The basic definitions of obstructive sleep apnea (OSA), its epidemiology, it's clinical features and complications, and the morbidity and mortality of OSA are discussed. Included in this treatise is a discussion of the various symptomatic and polysomnographic phenotypes of COPD that may enable better treatment and impact mortality in persons with OSA. The goal of this article is to serve as a reference for life and disability insurance company medical directors and underwriters when underwriting an applicant with probable or diagnosed sleep apnea. It is well-referenced (133 ref.) allowing for more in-depth investigation of any aspect of sleep apnea being queried.

Is the delivery of National Disability Insurance Scheme in Australia through quasi markets achieving the right outcomes in vision rehabilitation services? A qualitative study

Purpose Despite being a pioneering social initiative worldwide, Australia’s National Disability Insurance Scheme (NDIS) still presents unresolved issues for individuals with vision-related disability regarding its processes and outcomes. This study evaluates how well the NDIS markets are perceived to achieve efficiency, responsiveness, choice, quality, and equity within the vision rehabilitation sector, and identified factors facilitating or hindering desired outcomes. Materials and methods This qualitative study conducted 22 semi-structured interviews involving individuals with vision disability, service providers, peak-body and professional-body representatives, and an NDIS planner. Results Findings across stakeholder groups show minimal variation. The NDIS’s quasi-market approach has improved participants’ choices over ways to utilise and manage their funding and consequently provided them with a sense of control and empowerment. However, inefficiencies persist due to insufficient competition, workforce shortages, price caps, information asymmetry, high transaction costs, gaming behaviour, inadequate staff training, complex and lengthy processes, and eligibility concerns. Supportive factors include effective advocacy, pragmatic regulations to maintain quality, opportunities for innovation, and service providers’ motivation for cost-effectiveness. Conclusions While NDIS markets have made significant strides in enhancing participants’ choice and control, our findings underscore the need for continued refinement to achieve broader social objectives and long-term sustainability for individuals with vision-related disability.

Educated but on Social Security Disability Insurance: Minorities’ Diminished Returns

Educated but on Social Security Disability Insurance: Minorities’ Diminished Returns

Which Way? Experiences of Aboriginal and Torres Strait Islander People Who Are Deaf or Hard of Hearing Attaining Supports to Meet Their Interwoven Socio-Cultural, Health and Disability-Related Needs and Aspirations Within the Context of Australia’s National Disability Insurance Scheme

Which Way? Experiences of Aboriginal and Torres Strait Islander People Who Are Deaf or Hard of Hearing Attaining Supports to Meet Their Interwoven Socio-Cultural, Health and Disability-Related Needs and Aspirations Within the Context of Australia’s National Disability Insurance Scheme

Monitoring community antibiotic consumption in Belgium: reimbursement versus retail data (2013-22).

In Belgium, monitoring antibiotic consumption relies on reimbursement data, which is obtained with a time delay and does not account for over-the-counter or nonreimbursed products. This study aims to bridge this gap by comparing reimbursement and retail data for primary care to understand variations and assess the accuracy of current surveillance methods. Reimbursement data were obtained from the National Institute for Health and Disability Insurance, and retail data were obtained from IQVIA for the period 2013-22. The community consumption of systemic antibiotics was expressed in defined daily doses (DDD-WHO ATC/DDD Index 2023) per inhabitants per day (DID). Relative differences in DID (RDs) based on the two data sets were computed and validated through Bland-Altman plots and correlation analysis. The sales of antibiotics declined from 22.89 DID (2013) to 20.50 (2022), with a steep drop during the COVID-19 pandemic-from 21.31 DID in 2019 to 16.55 DID in 2020-and a subsequent rebound. Reimbursement data slightly underestimated consumption compared to retail data, with RDs ranging from 2% (2013) to 9% (2022) when including quinolones and from 2% to 4% when excluding them. Bland-Altman plots showed high agreement between reimbursement and retail estimates, identifying quinolones as outliers. Our findings suggest that reimbursement data are generally reliable for monitoring antibiotic consumption, but incorporating retail data is crucial for accurate assessments. The use of retail data can facilitate timely interventions and inform public health strategies to effectively address antimicrobial resistance.

Making the most of a captive audience: Do specialist teams in custodial settings offer a way to assist people to access the NDIS?

AbstractWhile the National Disability Insurance Scheme (NDIS) has been operating in Australia for 10 years, numerous eligible people with disability have not accessed the scheme, many of whom are in prison. The South Australian Government, in partnership with the National Disability Insurance Agency (NDIA), implemented a pilot programme to assist people in prison to access the NDIS as having NDIS supports on release may reduce the risk of returning to custody. This qualitative study, drawing on interviews with 20 stakeholders, explores the enablers and barriers of assisting people with disability in prison access the NDIS. Our findings show that while custodial settings provide opportunities to assist people with disability to have their eligibility for the NDIS assessed, prisons are difficult settings in which to undertake subsequent assessment and planning processes to determine the supports available on release. People with disability exiting prison also face significant challenges accessing suitable accommodation and support services, particularly when their needs are complex. Further work is required to ensure planning and assessment processes meet the needs of this group. The findings provide useful insights to both justice and other institutional settings and respond to many of the questions raised by recent public inquiries and reviews.

Veteran Affairs disability compensation: Likely the U.S.’s largest disability program, but what do we know about its impacts on service‐disabled veterans?

AbstractThe last few decades have seen rapid growth in the size of the Veterans Affairs Disability Compensation (VADC) program, which provides tax‐free cash benefits to veterans with disabilities connected to military service. Given this recent growth, VADC is on pace to eclipse Social Security Disability Insurance (SSDI) to become the largest U.S. disability program by expenditures. Although there are decades of causal research on the design and impacts of SSDI, there is no comparable body of evidence for VADC. In this Policy Insight, we discuss how causal evidence was produced for Social Security‐administered disability programs and why there is a lack of this evidence for VADC. Chief among the explanations is a lack of VADC data access available to the broader researcher community, access that Social Security facilitates for the programs it administers. However, even with this access, the proliferation of benefits and services targeted to service‐disabled veterans implies that existing earnings loss studies and causal estimates of the impact of VADC benefit receipt on any given outcome of interest likely are mismeasurements of true effects. We conclude with recommendations for restructuring approaches to research design to accurately estimate impacts of VADC benefits as well as the wide array of other programs supporting service‐disabled veterans.

Early Childhood Intervention under the Australian National Disability Insurance Scheme: Characteristics and Recruitment Practices of Service Providers

AbstractThe National Disability Insurance Scheme (NDIS) constitutes a major policy reform for Australian people with disabilities. Despite its ten-year implementation, little is known about the characteristics of the workforce delivering Australia’s NDIS early childhood intervention services (ECI). The present study sought to identify the range of skills, knowledge, and experience of ECI professionals as listed in recruitment advertisements, and their alignment with best practice guidelines. Provider data were extracted from 246 advertisements for ECI roles over a 5-month period and assigned into various categories. Interrater reliability was determined by randomly selecting 65 of the 246 of the advertisements, which were coded independently by two researchers and assigned to service provider categories. Significant changes have occurred in the qualities of professionals providing ECI services under the NDIS, and their adherence to best practice guidelines. The limited emphasis on best practice in the recruitment process may result in an ECI workforce that is not well equipped to deliver specialised and inclusive support to young children with disabilities and their families.

Assessing and enhancing legal literacy in cancer care: A nationwide analysis of a training intervention for healthcare workers.

6 Background: We previously showed the significant extent to which legal barriers requiring appropriate navigation are encountered by patients with cancer and their caregivers. Despite this, structured training on legal topics is not offered for healthcare workers (HCW). We performed a nationwide analysis to ascertain baseline legal knowledge in HCWs, and investigate the impact of a training program aimed at improving knowledge gaps in legal, financial, and social services navigation. Methods: This is a retrospective analysis of HCWs participating in legal and financial training sessions from 2021-2023 led by attorneys from Triage Cancer, a nonprofit organization providing free education on legal issues that impact individuals with cancer. Pre-training surveys assessed baseline knowledge, comfort, and frequency with which HCWs counseled patients with cancer, on legal barriers. Impact of training was evaluated via surveys at 1 week and 6 months post-training. Survey scores were descriptively analyzed to summarize changes in knowledge compared to baseline. Paired t-tests evaluated self-rated competence before and after legal training. Results: The pre-intervention survey was completed by 2141 HCWs who were primarily White (63.9%), female (89.8%), and social workers (39.3%) during the most recent survey year. HCWs served patients of ≥20 cancer types including breast (33.4%), hematologic (12.7%), and lung (6.9%), and reported assisting patients with health insurance options (82.6%), financial navigation (53.3%), and disability insurance claims (46.5%). Only few HCWs reported feeling “comfortable” or “very comfortable” assisting patients with health insurance (22.1%), finances (17.2%), or disability insurance (9.5%). The 1-week and 6-month post-intervention surveys were completed by 852 and 211 individuals, respectively, and standardized questionnaire scores demonstrated improvement in tested knowledge from baseline (26% questions correct) to 1-week (67.5%) and 6-month (35%) follow-up. Self-rated improvement in HCW competence following intervention at 1-week (surveyed using 10-point scale, mean improvement 3.14, 95% CI [3.05, 3.25]) and 6-months (corrected mean improvement 2.52 [2.29, 2.75]) were significant (p < 0.001 for both). At 6-month follow-up, 90.5% of surveyed HCWs reported changing behavior or practice based on the training, noting the education facilitated patient care through navigation of health and disability insurance and appeals; reducing financial burden, stress, and anxiety; and improving quality of life (Likert scales ranged 3.17-3.41 with 3 for Agree and 4 for Strongly Agree). Conclusions: This study showcases the necessity, success, and practicality of implementing a legal training for HCWs who note high frequency of legal concerns from their patients, but lack the comfort or expertise in appropriately navigating these.

A scoping review of early childhood support for Aboriginal and Torres Strait Islander children living with a disability in regional, rural and remote settings.

Many experts and communities have concerns about how National Disability Insurance Scheme services are provided to Aboriginal and Torres Strait children. This study was undertaken at the request of the NPY Women's Council in partnership with the researchers, to explore supports for Aboriginal and Torres Strait Islander children living with a disability in their remote areas. This scoping review aims to (a) explore the barriers and enablers to accessing disability support services for families of young Aboriginal and Torres Strait Islander children (0-8 years) living in regional, rural and remote settings, and (b) summarise best practice approaches for accessing support for young children in these settings. The search was run in three electronic databases, as well as grey literature sources. We assessed the quality of included publications using the Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange tool. A narrative synthesis was supported by thematic analysis. From an initial search (557 citations), we identified 13 eligible documents. Most documents were peer-reviewed articles of qualitative studies. Key themes identified included the following: (1) Holistic approach, (2) Understanding disability, (3) Consistent relationships, (4), Flexibility, (5) Simplify system and (6) Enhance communication. This scoping review has revealed gaps in the provision of quality, culturally responsive disability services for families of Aboriginal and Torres Strait Islander children living in regional, rural and remote areas of Australia. A family-centred, flexible approach will help address their needs. Future research is required to design and evaluate models of care for Aboriginal and Torres Strait Islander children.

Experiences of Australian adults with disabilities living with government supports in the home during the COVID-19 pandemic

Adults with disabilities who live with government supports in their homes were among those most heavily impacted by COVID-19 public health measures, though few studies have considered the lived experiences of this group. This study invited Australian adults with disabilities who lived with government supports under the National Disability Insurance Scheme during the pandemic to share their experiences. The focus was changes in life satisfaction before, during and since stay-at-home orders (i.e. ‘lockdowns’). Thirty-four Australian adults completed an online survey. Findings revealed a decline in life satisfaction and mental health during lockdowns by comparison with pre-pandemic times. Informal supporters and paid support services were important but difficult to access during this period. Communication and community awareness of the challenges associated with public health policy for people with disabilities and their supporters were key issues. Resources addressing future health crises should be co-designed with people with disabilities and their supporters.

Understanding the evolution of competing institutional logics in the marketization of care: A stage model analysis of Australia's National Disability Insurance Scheme

This study explores the marketization of healthcare through a stage model analysis, focusing on Australia's National Disability Insurance Scheme (NDIS). By employing mixed methods, including sentiment and frequency analysis as well as qualitative content analysis of policy documents and media coverage, we trace the NDIS's evolution and the interplay of competing social welfare and market logics over time. Our findings underline that the evolution and interplay between competing institutional logics follow a stage model of institutional change, detailing pre-emergence, orientation, contestation, consolidation, and normalization phases. Additionally, we observe a shift in dominant institutional logics across different stages, demonstrating the critical role of media and public sentiment in shaping discourse about the marketization of care, which intertwines with policy decision-making. Our findings emphasize the importance of adaptive engagement and communication strategies by policymakers to avoid marginalizing vulnerable groups as institutional logics evolve, especially in the latter stages of the process when a dominant logic has emerged. The study highlights the complex dynamics of institutional change and offers insights for both researchers and practitioners in the healthcare sector, shedding light on the coevolution of competing logics in the policy development and implementation process.

A collaborative approach to support people with a disability living in Australian group homes during the COVID-19 pandemic: a case study.

In this case study we describe how Sydney Local Health District (SLHD) Disability Inclusion and Advice Service (DIAS) provided support to disability group homes during the COVID-19 Delta and Omicron waves. The study provides insights into group home providers' experience of supports implemented by SLHD and other stakeholders. A mixed method approach was undertaken that included analysing data from a database and electronic medical records and a survey of disability group home managers. DIAS developed a range of processes to support prevention, outbreak preparedness and response. This included developing a Disability Shared Living COVID-19 Pathway, engaging with group home providers through a fortnightly Community of Practice, assisting with improving vaccination status and procuring personal protective equipment. During an outbreak DIAS provided a 24h, 7days per week on call support, coordinated outbreak management team meetings and collaborated with several internal and external stakeholders. SLHD infection prevention and control nurses were recruited to undertake a process of reviewing outbreak management plans and providing support during an outbreak. Most disability providers (86%) reported that they felt very prepared to manage outbreaks at the time of the survey (August 2022) compared with the pre-Delta wave, for which 36% reported feeling 'not prepared'. The proportion who rated the support from the stakeholders as very supportive/supportive was as follows: SLHD (100%), NSW Health (64%), National Disability Insurance Agency (50%) and National Disability Insurance Scheme Quality & Safeguards Commission (37%). Our case study provides insights into the support that LHDs can provide to disability homes in response to future outbreaks.

Medical Malpractice in Otolaryngology within the United States: A LexisNexis-Based Demographic Analysis.

Otolaryngologists are at a significantly greater risk of being sued than most other physicians. To date, there is a lack of studies characterizing trends in otolaryngology malpractice claims. To assess these trends and risk variables, this study examined malpractice claims against otolaryngologists. Retrospective database review. LexisNexis Jury Verdicts and Settlements. The LexisNexis legal database was used to locate jury verdicts and settlements related to medical malpractice in otolaryngology, from 2018 to 2024. The study did not include any claims covered by the Social Security Disability Insurance, Workers' Compensation, Healthcare Law, or Criminal Law and Procedure categories. Temporal trends were evaluated, and logistic regression was used to identify independent risk factors. Out of 903 items, 79 reported malpractice cases were included (mean age 44.5; 60.3% female). The most sued subspecialty was head and neck oncology (32.5%). Negligence (93.7%) was the primary cause of action. Of cases sent to the jury, 87.7% of them resulted in a verdict in favor of the defendant. The mean plaintiff verdict payout was $7,432,508.06 and the mean identified settlement amount was $1,562,500.00. Physical injury (62.0%) was the highest type of harm. Regional analysis indicated a higher percentage of cases from New York favored the defendant (21.1% vs 13.6%; P = .034). This study highlights key trends in otolaryngology malpractice claims, emphasizing the prevalence in cases of head and neck surgery, primarily attributed to negligence. By identifying trends and risk factors, otolaryngologists can get a better understanding of the dynamics surrounding malpractice.

Financial and Business Literacy Among Urology Residents: Is this a Problem and How Can We Better Prepare Residents for their Careers?

Although financial wellness is a predictor of physician burnout, we are yet to optimize financial education or wellness of Urology trainees. We assessed existing studies, compared them to those of other specialties, and discussed resources and methods to address this deficiency. Urology residents tend to be less fiscally savvy (carry significant debt, and lack retirement savings or disability insurance), and 90% of trainees and young Urologists do not feel comfortable with the business of practice, including skills like coding and billing, contract negotiation, and self-value assessment. Financial and business literacy are deficiencies of Urology training, as in other specialties. Eventually, the goal should be universal adoption of a formal curriculum that is graded in nature. In the interim, we need to propose and endorse adoption of a formal curriculum, and we should support trainees by promoting a space for easily accessible and transparent information regarding best practices in personal finance and the business of healthcare.

Access to community-based eye services in Meru, Kenya: a cross-sectional equity analysis

BackgroundOver 80% of blindness in Kenya is due to curable or preventable causes and 7.5 m Kenyans currently need eye services. Embedding sociodemographic data collection into screening programmes could help identify the groups facing systematic barriers to care. We aimed to determine the sociodemographic characteristics that were associated with access among patients diagnosed with an eye problem and referred for treatment in the Vision Impact Programme, currently operating in Meru County.MethodWe used an embedded, pragmatic, cross-sectional design. A list of sociodemographic questions was developed with input from key stakeholders. The final question set included the following domains: age, gender, religion, marital status, disability, education, occupation, income, housing, assets, and health insurance. These were integrated into an app that is used to screen, refer, and check-in (register) participants within a major eye screening programme. We gathered data from 4,240 people who screened positive and were referred to their local outreach treatment clinic. We used logistic regression to identify which groups were facing the greatest barriers to accessing care.ResultsA quarter of those screened between April – July 2023 were found to have an eye problem and were referred, however only 46% of these people were able to access care. In our fully adjusted model, at the 0.05 level there were no statistically significant differences in the odds of attendance within the domains of disability, health insurance, housing, income, or religion. Strong evidence (p < 0.001) was found of an association between access and age, gender, and occupation; with males, younger adults, and those working in sales, services and manual jobs the least likely to receive care.ConclusionsAccess to essential eye services is low and unequal in Meru, with less than a third of those aged 18–44 receiving the care they need. Future work should explore the specific barriers faced by this group.

‘We're trying to get out of here, that's what we're doing’: A Bourdieusian examination of ‘choice’ in the National Disability Insurance Scheme

‘We're trying to get out of here, that's what we're doing’: A Bourdieusian examination of ‘choice’ in the National Disability Insurance Scheme

Integrating Feminism, Transforming the National Disability Insurance Scheme (NDIS): An Analysis of the Scheme Through the NDIS Plans of People with Intellectual Disability

ABSTRACT The implications of gender inequality have been overlooked in the lives of women with intellectual disability who suffer intersectional discrimination because they are women but also because they have a disability. The individualised funding models used by the National Disability Insurance Scheme (NDIS) aims to advance human rights concerns, such as gender equality, by giving people the ability to decide how they are supported. Underpinning the strategy is that individuals have ‘choice and control’ over care under a market-based economy model as businesses create services to meet their needs. However, it is unclear to what extent the system recognises the needs of women with intellectual disability and the intersectional discrimination that they experience. The article presents research aimed at locating how the notions of choice, control and autonomy intersect with gender by examining 20 NDIS plans for men and women with intellectual disability. We use a feminist perspective to analyse how the complexities of power dynamics in the planning process, the subjugation of women in society, and epistemic knowledge creation are part of women with intellectual disabilities' experience of the NDIS. This article contributes to the feminist discourse and makes suggestions for improving the approach and policy of the NDIS.

Promoting the social in psychosocial recovery: Interviews with Australian National Disability Insurance Scheme participants

AbstractSocial connection is a central element in mental health recovery and has been found to have a significant impact on the health and well‐being of individuals. This study examines the experiences of social connectedness for people accessing NDIS support for psychosocial disability. Interviews were conducted with eight NDIS participants. The study's findings suggest that people with psychosocial disabilities experience limited social connections and small social worlds. While NDIS support relationships were seen as important facilitators in increasing social engagement, these relationships may also limit opportunities for participants to extend their social connections beyond these professional support contacts. The impacts of participants' illnesses were identified as major barriers to establishing social connections and further research is needed to identify effective interventions that reduce social isolation in this population. This study highlights the role the NDIS can play in supporting social connection and inclusion for participants. Further consideration regarding the role of NDIS support relationships and NDIS‐funded interventions in supporting the social connectedness of participants is needed.