Disability Payments Research Articles

THU0317 Disability in Fibromyalgia is Associated with Greater Self-Reported Symptoms and Functional Impairment

BackgroundIt is intuitive that disablement due to illness should be reflected in illness severity. When illness measurement is based on subjective report only, without objective validation, the reliability of symptom...

Pediatric Medical Complexity Algorithm: A New Method to Stratify Children by Medical Complexity

The goal of this study was to develop an algorithm based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), codes for classifying children with chronic disease (CD) according to level of medical complexity and to assess the algorithm's sensitivity and specificity. A retrospective observational study was conducted among 700 children insured by Washington State Medicaid with ≥1 Seattle Children's Hospital emergency department and/or inpatient encounter in 2010. The gold standard population included 350 children with complex chronic disease (C-CD), 100 with noncomplex chronic disease (NC-CD), and 250 without CD. An existing ICD-9-CM-based algorithm called the Chronic Disability Payment System was modified to develop a new algorithm called the Pediatric Medical Complexity Algorithm (PMCA). The sensitivity and specificity of PMCA were assessed. Using hospital discharge data, PMCA's sensitivity for correctly classifying children was 84% for C-CD, 41% for NC-CD, and 96% for those without CD. Using Medicaid claims data, PMCA's sensitivity was 89% for C-CD, 45% for NC-CD, and 80% for those without CD. Specificity was 90% to 92% in hospital discharge data and 85% to 91% in Medicaid claims data for all 3 groups. PMCA identified children with C-CD (who have accessed tertiary hospital care) with good sensitivity and good to excellent specificity when applied to hospital discharge or Medicaid claims data. PMCA may be useful for targeting resources such as care coordination to children with C-CD.

The association between employee obesity and employer costs: evidence from a panel of U.S. employers.

To estimate the employer costs associated with employee obesity. The study used cross-sectional analysis of employee health-risk assessment, disability, workers' compensation, and medical claims data from 2006 to 2008. The study took place in the United States from 2006 to 2008. A panel database with 29,699 employees drawn from a panel of employers and observed for 3 years each (N = 89,097) was used. Workdays lost owing to illness and disability; the cost of medical, short-term disability, and workers' compensation claims; and employees' adjusted body mass indices (BMI) were measured. We model the number and probability of workdays lost from illness, short-term disability, and workers' compensation events; short-term disability and workers' compensation payments; and health care spending as a function of BMI. We estimate spline regression models and fit results using a third-degree fractional polynomial. Probability of disability, workers' compensation claims, and number of days missed owing to any cause increase with BMI above 25, as do total employer costs. The probability of a short-term disability claim increases faster for employees with hypertension, hyperlipidemia, or diabetes. Normal weight employees cost on average $3830 per year in covered medical, sick day, short-term disability, and workers' compensation claims combined; morbidly obese employees cost more than twice that amount, or $8067, in 2011 dollars. Obesity is associated with large employer costs from direct health care and insurance claims and indirect costs from lost productivity owing to workdays lost because of illness and disability.

Editor's Spotlight/Take 5: How Does Accounting for Worker Productivity Affect the Measured Cost-effectiveness of Lumbar Discectomy?

Editor's Spotlight/Take 5: How Does Accounting for Worker Productivity Affect the Measured Cost-effectiveness of Lumbar Discectomy?

The impact of Medicaid peer support utilization on cost.

Peer support programs have proliferated over the past decade, building on recovery oriented programming, yet relationships between peer support services and the costs to public programs have not been well described in literature. The purpose of this study is to fill gaps in the literature related to peer support programs and cost: lack of comparison groups, small sample sizes, and the availability of research examining utilization of Medicaid mental health services. The study employed a retrospective design with treatment and comparison groups created from three administrative databases. Three ordinary least squares regression models were constructed to predict crisis stabilization cost, psychiatric hospitalization cost, and total Medicaid cost while controlling for other factors. The Chronic Illness and Disability Payment System + Rx was used to control for illness severity. Peer support was associated with $5,991 higher total Medicaid cost (p < .01). Peer support was also associated with higher crisis stabilization cost and lower psychiatric hospitalization cost, but the relationships were not statistically significant. Peer support was associated with $2,100 higher prescription drug cost (p < .01), $5,116 higher professional services cost (p < .01), and $1,225 lower facility cost (p < .01). While the implementation of Medicaid financed peer support programs may not result in savings from reductions of costly crisis stabilizations and psychiatric hospitalizations, it does support the principles of self-direction and recovery from severe mental illness. State policy makers must weigh the potential higher cost associated with peer support programs with efforts to redesign the delivery of mental health services.

Mental health selection and income support dynamics: multiple spell discrete-time survival analyses of welfare receipt

BackgroundThe higher occurrence of common psychiatric disorders among welfare recipients has been attributed to health selection, social causation and underlying vulnerability. The aims of this study were to test for...

Repair of Symptomatic Rotator Cuff Tears After Failed Nonoperative Treatment Is Cost-Effective

Repair of Symptomatic Rotator Cuff Tears After Failed Nonoperative Treatment Is Cost-Effective

The Societal and Economic Value of Rotator Cuff Repair

Although rotator cuff disease is a common musculoskeletal problem in the United States, the impact of this condition on earnings, missed workdays, and disability payments is largely unknown. This study examines the value of surgical treatment for full-thickness rotator cuff tears from a societal perspective. A Markov decision model was constructed to estimate lifetime direct and indirect costs associated with surgical and continued nonoperative treatment for symptomatic full-thickness rotator cuff tears. All patients were assumed to have been unresponsive to one six-week trial of nonoperative treatment prior to entering the model. Model assumptions were obtained from the literature and data analysis. We obtained estimates of indirect costs using national survey data and patient-reported outcomes. Four indirect costs were modeled: probability of employment, household income, missed workdays, and disability payments. Direct cost estimates were based on average Medicare reimbursements with adjustments to an all-payer population. Effectiveness was expressed in quality-adjusted life years (QALYs). The age-weighted mean total societal savings from rotator cuff repair compared with nonoperative treatment was $13,771 over a patient's lifetime. Savings ranged from $77,662 for patients who are thirty to thirty-nine years old to a net cost to society of $11,997 for those who are seventy to seventy-nine years old. In addition, surgical treatment results in an average improvement of 0.62 QALY. Societal savings were highly sensitive to age, with savings being positive at the age of sixty-one years and younger. The estimated lifetime societal savings of the approximately 250,000 rotator cuff repairs performed in the U.S. each year was $3.44 billion. Rotator cuff repair for full-thickness tears produces net societal cost savings for patients under the age of sixty-one years and greater QALYs for all patients. Rotator cuff repair is cost-effective for all populations. The results of this study should not be interpreted as suggesting that all rotator cuff tears require surgery. Rather, the results show that rotator cuff repair has an important role in minimizing the societal burden of rotator cuff disease.

The Labor Force Participation Rate: An Examination Of The Determinants Of Its Recent Precipitous Decline

The Labor Force Participation Rate (LFPR) is defined as those Americans in the labor force, i.e. above the age of sixteen, below retirement age, who are either actively employed or actively seeking employment. From 1950 until 1998 it rose from 59.2% to 67.2%. Given the near doubling of the U.S. population, its impact on our economy was enormous. However, since 1998 the LFPR has declined steadily to 63.3%. Parallel to this decline, we have seen a polarization of both wealth and income in the U.S. Many economists have examined both trends the decline of LFPR and inequality and have put forth a variety of determinants. These include technology and globalization a decline or hollowing out of the middle class, if you will. Also included are the demographics of an ageing society, and the increased racial and gender participation, but also a workforce that has become only marginally prepared by todays educational institutions. Another class of determinants is the welfare safety net at both the Federal and state levels, including extended unemployment benefits, disability payments and other subsidies. The authors examine each class of determinants, including whether their aspects are cyclical, structural or even part of an ominous trend for our economy.

Determinants of Fertility in the United States

This study provides a panel data analysis of the key determinants of statewide fertility rates in the United States for the period 1994-2011. It looks into the effects of immigration, child tax credit law, maternity leave or short-term disability payments, wages, unemployment rate, labor force participation, and urbanization on fertility. My model finds that urbanization, immigration, and child tax credits are important determinants of fertility in the US.

Veterans' attitudes toward work and disability compensation: Associations with substance abuse

IntroductionVeterans deemed disabled for conditions resulting from, or aggravated by, their service in the military are eligible for service-connected disability payments. Despite many positive effects of disability payments, one concern is that Veterans with psychiatric conditions who receive disability payments are less likely to be employed compared to those who are denied benefits. Little is known about the attitudes of substance using Veterans, for whom work is a particularly important part of recovery, toward work and disability compensation. MethodsThis study compared the responses of Veterans with (n=33) and without substance use problems (n=51) to questions about work's significance and its relationship to disability payments. T- and chi-square tests were conducted to determine if Veterans with substance use problems differed from the others on work-related attitudes and perceptions of the relation between work and Veterans' benefits. ResultsVeterans endorsed high levels of agreement with statements that working would lead to loss of benefits. Veterans with substance use agreed more strongly that they would rather turn down a job offer than lose financial benefits. ConclusionsThe greater preference for disability payments among substance-using Veterans may reflect a realistic concern that they are particularly likely to have difficulty maintaining employment. The widespread concern among Veterans that work will lead to loss of VA disability payments is striking given the ambiguity about how likely loss of benefits actually is, and should be addressed during the service-connection application process.

Financial Victimization of Adults With Severe Mental Illness

People with severe mental illness are vulnerable to having other people directly take or misappropriate their disability payments. This study investigated the prevalence of different types of financial victimization and the client characteristics associated with being financially victimized. Adults (N=122) receiving inpatient or intensive outpatient psychiatric treatment who received Social Security disability payments completed assessments about money management and victimization. A path model was used to estimate the association of victimization with participant characteristics. Seventy percent of participants experienced at least one type of financial victimization in the preceding 28 days; 35% ran out of money because of victimization. Victimization was significantly associated with being younger, having had more psychiatric hospitalizations, having more recent alcohol use, and, most robustly, having problems managing money (β=.52, p<.01). Financial victimization of disability recipients in acute care settings is common and more likely among people with recent substance use and difficulty managing their funds.

Not Better but Quite Good

Not Better but Quite Good

The Direct and Indirect Costs to Society of Treatment for End-Stage Knee Osteoarthritis

Although total knee arthroplasty for end-stage osteoarthritis is a cost-effective procedure, payers are focusing on its indications and cost because of its high and growing use. Improvements in pain and physical function from total knee arthroplasty could yield benefits in the form of increased work life and lower disability payments. The purpose of this study was to estimate the value of total knee arthroplasty from a societal perspective, including the costs and benefits to patients, employers, and payers. A Markov model was used to estimate the value of total knee arthroplasty for patients with end-stage osteoarthritis of the knee by comparing direct and indirect costs between surgical and nonsurgical treatment scenarios. Direct costs included all medical costs for surgical and nonsurgical treatment of osteoarthritis of the knee. Indirect costs were related to lost wages due to an inability to work, lower earnings, or receipt of disability payments. Direct and indirect costs and quality-of-life measures were incorporated into the Markov model to estimate the impact of total knee arthroplasty on costs over patients' lifetimes and quality-adjusted life years. The assumptions used in the model were developed with use of claims and survey data as well as clinical expert opinion and the peer-reviewed literature. Compared with nonsurgical treatment, total knee arthroplasty increased lifetime direct costs by a mean of $20,635 (net present value in 2009 U.S. dollars). These costs were offset by societal savings of $39,565 from reduced indirect costs, resulting in a lifetime societal net benefit from total knee arthroplasty of $18,930 per patient. Eighty-five percent of these savings originated from increased employment and earnings, with the remaining 15% from fewer missed workdays and lower disability payments. The estimated lifetime societal savings from the more than 600,000 total knee arthroplasties performed in the U.S. in 2009 were estimated to be approximately $12 billion. These societal savings primarily accrued to patients and employers. The study demonstrates the importance of a societal perspective when considering the costs and benefits of total knee arthroplasty and policies that will affect access to this procedure.

Social disadvantage and individual vulnerability: A longitudinal investigation of welfare receipt and mental health in Australia

To examine longitudinal associations between mental health and welfare receipt among working-age Australians. We analysed 9 years of data from 11,701 respondents (49% men) from the Household, Income and Labour Dynamics in Australia (HILDA) Survey. Mental health was assessed by the mental health subscale from the Short Form 36 questionnaire. Linear mixed models were used to examine the longitudinal associations between mental health and income support adjusting for the effects of demographic and socio-economic factors, physical health, lifestyle behaviours and financial stress. Within-person variation in welfare receipt over time was differentiated from between-person propensity to receive welfare payments. Random effect models tested the effects of income support transitions. Socio-demographic and financial variables explained the association between mental health and income support for those receiving student and parenting payments. Overall, recipients of disability, unemployment and mature age payments had poorer mental health regardless of their personal, social and financial circumstances. In addition, those receiving unemployment and disability payments had even poorer mental health at the times that they were receiving income support relative to the times when they were not. The greatest reductions in mental health were associated with transitions to disability payments and parenting payments for single parents. The poor mental health of welfare recipients may limit their opportunities to gain work and participate in community life. In part, this seems to reflect their adverse social and personal circumstances. However, there remains evidence of a direct link between welfare receipt and poor mental health that could be due to factors such as welfare stigma or other adverse life events coinciding with welfare receipt for those receiving unemployment or disability payments. Understanding these factors is critical to inform the next stage of welfare reform.

Early psychosis and employment

BackgroundEmployment may be an important factor in helping patients with early psychosis to recover rapidly and to avoid involvement in disability and welfare programs. MethodsThis study followed 351 patients with early psychoses, either primary psychoses or substance-induced psychoses, for two years to examine their patterns of competitive employment in relation to service use, psychosocial outcomes, and disability and welfare payments. ResultsWorkers differed from non-workers at baseline and over two years. At baseline, they had better educational and employment histories, were more likely to have substance-induced psychoses rather than primary psychoses, were less likely to have drug dependence, had fewer negative symptoms, and had better psychosocial adjustment. Over two years, baseline psychosocial differences persisted, and the workers used fewer medications, mental health services, and disability or welfare payments. ConclusionsEmployment predicts less service use and fewer disability claims among early psychosis patients. Thus, greater attention to supported employment early in the course of illness may reduce federal insurance costs and disability payments.

Antisocial personality disorder is associated with receipt of physical disability benefits in substance abuse treatment patients

BackgroundOpioid dependence is growing at an alarming rate in the United States, and opioid dependent patients have substantial medical, as well as psychiatric, conditions that impact their ability to work. This study evaluated the association between antisocial personality disorder (ASPD) and receipt of physical disability payments in methadone maintenance patients. MethodsUsing data from 115 drug and alcohol abusing methadone maintained patients participating in two clinical trials, baseline characteristics of individuals receiving (n=22) and those not receiving (n=93) physical disability benefits were compared, and a logistic regression evaluated unique predictors of disability status. ResultsBoth an ASPD diagnosis and severity of medical problems were significant predictors of disability receipt, ps<.05. After controlling for other variables that differed between groups, patients with ASPD were more than five times likelier to receive physical disability benefits than patients without ASPD (odds ratio=5.66; 95% confidence interval=1.58–20.28). ConclusionsThese results demonstrate a role of ASPD in the receipt of disability benefits in substance abusers and suggest the need for greater understanding of the reasons for high rates of physical disability benefits in this population.

Cardiac Rehabilitation and Cardiovascular Disability

The Social Security Administration (SSA) oversees the disability determination process and the payment of disability benefits to Americans. According to recent SSA data, approximately 900 000 persons are receiving cardiovascular disability payments and about 145 000 adult claims for cardiovascular disability are processed by the SSA annually. An objective and comprehensive examination of functional capacity is an important part of the disability assessment process. This statement reviews various protocols for disability assessment of aerobic capacity, muscle function, and the physical requirements of job tasks. Cardiac rehabilitation programs are ideal settings for conducting comprehensive disability assessments of functional capacity in persons with cardiovascular disease. In addition, exercise training provided by cardiac rehabilitation programs can increase functional capacity in most patients.

Cursing the Darkness: Reactions to Fibromyalgia

Erratum to “Cursing the Darkness: Reactions to Fibromyalgia”dx.doi.org/10.1155/2013/612849

Unique Challenges Face Psychiatrists Treating N.Y.’s Haitian Community

Back to table of contents Previous article Next article Professional NewsFull AccessUnique Challenges Face Psychiatrists Treating N.Y.’s Haitian CommunityAaron LevinAaron LevinSearch for more papers by this authorPublished Online:16 Nov 2012https://doi.org/10.1176/pn.47.22.psychnews_47_22_5-bAbstractThe 2010 Haitian earthquake left massive trauma and loss in its wake, not only in Haiti but among the Haitian community in the United States.In October, just after APA’s 2012 Institute on Psychiatric Services ended in Manhattan, psychiatrists and others who work with that community gathered across the river in Brooklyn to reflect on the quake’s mental health effects.Louis Belzie, M.D., M.P.H.In general, reactions among community members are little different from reactions of other populations affected by a major tragedy, said Louis Belzie, M.D., M.P.H., health and palliative care at Brookdale University Hospital and Medical Center. These included depression and anxiety, as well as posttraumatic stress disorder, substance abuse, major depression, and panic disorder in the longer term. Most vulnerable to these symptoms were women, children, the elderly, and people who had a preexisting physical injury or preexisting mental illness.“Those who sought help often looked for a Haitian psychiatrist but stayed home if they could not find one to help them,” said Belzie.“Psychoeducation can expedite engagement by defining the process of therapy as well as patient expectations about it,” he noted. “It is also important for non-Haitian therapists to develop confidence in working with Haitians, particularly in the beginning stages of therapy.”Working with Haitians may not be easy, even for Haitian-born psychiatrists, said Mardoche Sidor, M.D., a child and adolescent psychiatry fellow at Harvard Medical School–Cambridge Health alliance.“They may not be able to tell you everything, even when asked, so form a relationship so that you can ask the questions the next time,” he said.In Brooklyn, immediately after the Haitian quake, staff members from SUNY Downstate Medical Center used their outreach van to connect with churches and religious leaders in the immigrant Haitian community.“We went to church basements and set up blood-pressure screenings,” recalled Michael Garrett, M.D., a clinical professor of psychiatry and vice chair for clinical services in the Department of Psychiatry at SUNY Downstate Medical Center. “That allowed us to informally engage people, and we found a number with serious problems, either physical or mental.”People who needed services were referred to King’s County Hospital or to Downstate’s clinics.Garrett and others received a grant from the Brooklyn Community Foundation to expand outreach to religious and community leaders, connect with social-service agencies to solve housing and other problems, and run educational support groups in churches.Georges Casimir, M.D.Managing problems in the geriatric population of New York’s Haitian community required consideration of immigration status as well as age, said Georges Casimir, M.D., a clinical associate professor in the Geriatric Psychiatry Division at SUNY Downstate Medical Center in Brooklyn.Someone who had immigrated decades ago and worked in the United States would have a better understanding of the American health care system and likely be receiving government benefits for the aged.“But imagine an older person brought recently to the U.S. to care for their grandchildren while the parents were at work,” he said. “They might not be at ease here, go out very little, and face language barriers.”Because they had not worked outside the home, they would not be eligible for Social Security disability payments or Medicare. They might also have culturally different ideas about disability and recovery.Those individuals “are likely to present with somatic symptoms,” said Casimir. “To them, everything is physical.”The quake killed about 360,000 Haitians, including six medical-school classmates of child psychiatrist Pierre Jean-Noel, M.D., M.B.A.“Very young children, up to the age of 4, respond to the distress of their caregivers, so children’s responses depend of their caregiver’s responses,” said Jean-Noel, acting chair of psychiatry at Brookdale.From ages 4 to 6, children may see the event as their fault, he said, and they may exhibit symptoms such as fear of separation, insomnia, and regression. Between ages 6 and 12, children can understand concrete explanations of the earthquake but may still present with physical symptoms, aggression, regressive behavior, fear, anxiety, and confusion.Intervention is essential to prevent the child from seeing the world as a hostile and dangerous place, Jean-Noel said.“The Haitian Mental Health Forum was a culturally specific public-education event customized for the Haitian community of Brooklyn,” said Annelle Primm, M.D., M.P.H., director of APA’s Office of Minority and National Affairs, which cosponsored the program. “The event was designed to respond to the needs of diverse and underserved communities, disseminate information about local mental health resources, and collaborate with other organizations and institutions.” ISSUES NewArchived