Showing papers on "Disability insurance published in 1993"

A Measure of Malpractice: Medical Injury, Malpractice Litigation, and Patient Compensation

Abstract: "A Measure of Malpractice" tells the story and presents the results of the Harvard Medical Practice Study, the largest and most comprehensive investigation ever undertaken of the performance of the medical malpractice system The Harvard study was commissioned by the government of New York in 1968, in the midst of a malpractice crisis that had driven insurance premiums for surgeons and obstetricians in New York City to nearly $200,000 a year The Harvard-based team of doctors, lawyers, economists, and statisticians set out to investigate what was actually happening to patients in hospitals and to doctors in courtrooms, launching a far more informed debate about the future of medical liability in the 1990s Careful analysis of the medical records of a representative sample of 30,000 patients hospitalized in 1984 showed that approximately 1 in 25 patients suffered a disabling medical injury, one-quarter of these as a result of the negligence of a doctor or other provider After assembling all the malpractice claims filed in New York State since 1975, the authors found that just one in eight patients who had been victims of negligence actually filed a malpractice claim, and more than two-thirds of these claims were filed by the wrong patients The study team then interviewed injured patients in the sample to discover the actual financial loss they had experienced: the key finding was that for roughly the same dollar amount now being spent on a tort system that compensates only a handful of victims, it would be possible to fund comprehensive disability insurance for all patients significantly disabled by a medical accident The authors, who came to the project from very different perspectives about the present malpractice system, are now in agreement about the value of a new model of medical liability Rather than merely tinker with the current system - which fixes primary legal responsibility on individual doctors who can be proved medically negligent - legislatures should encourage health care organizations to take responsibility for the financial losses experienced by all patients injured in their care

Privatization of Social Security: Lessons from Chile

Abstract: In Chile, all covered workers must place 10% of monthly earnings in a savings account with a highly regulated intermediary that manages a single fund and provides survivors and disability insurance Workers pay a commission charge, in addition to the mandatory 10%, to finance this insurance and to cover the costs and profits of the intermediaries On becoming eligible to receive benefits, a worker can choose between a sequence of phased withdrawals and a real annuity In addition, there is a sizable guaranteed minimum pension Unlike the purchased annuities, the minimum pension is not indexed, but adjusted by the government from time to time The Chilean reform gets high marks for defending the system from political risk and for its effects on capital accumulation and on the functioning of the capital market The Chilean reform gets low marks for the provision of insurance and for administrative cost Perhaps the most surprising aspect of the Chilean reform is the high cost of running a privatized social security system, higher than the 'inefficient' system that it replaced Valdes-Prieto has estimated that the average administrative charge per effective affiliate while active is US $8910 per year (for 1991) which is 294% of average taxable earnings This is close to 30% of the 10% mandatory savings rate The cost per person is not far from costs observed in other privately-managed pension systems, such as defined- benefit private pensions in the US However, it compares unfavorably with administrative costs in well-run unified government managed systems The issue here is the administrative efficiency of reliance

The Relationship between Health and Labor Market Status

Abstract: Few relationships seem more self-evident than the impact of poor health on labor market behavior. Chronic health conditions that diminish basic physical and mental capabilities are typically expected to disrupt normal work functioning, not only by preventing the performance of some job-related tasks altogether, but also by raising the difficulty or cost of discharging these role responsibilities beyond levels that a reasonable person would judge tolerable. As a result, individuals with impaired health are expected to reduce the amount of time spent in the labor force, the date or age of their complete withdrawal from the job market, and/or the kind of work performed. Because the onset of chronic health problems is not uncommon at any age, and incidence rises steeply with age, health-related work adjustments are likely to be required of most persons at some stage of the life course. In fact, an extensive set of institutional arrangements for retirement and disability insurance benefits has developed over time to cushion the expected losses in market income brought about by these health-induced changes in work effort. Yet, the impact of poor health on labor market status (and the corresponding magnitude of the economic toll exacted by various health problems) is at present neither fully understood nor measured with any precision. Uncertainty about the relation­ ship arises from the difficulty of gauging the extent to which the severity of physical and mental conditions varies across the population in poor health and the degree to which institutional arrangements, such as disability program

Insurance and genetic testing: where are we now?

Abstract: Basic research will spur development of genetic tests that are capable of presymptomatic prediction of disease, disability, and premature death in presently asymptomatic individuals. Concerns have been expressed about potential harms related to the use of genetic test results, especially loss of confidentiality, eugenics, and discrimination. Existing laws and administrative policies may not be sufficient to assure that genetic information is used fairly. To provide factual information and conceptual principles upon which sound social policy can be based, the Human Genome Initiative established an Ethical, Legal, and Social Issues Program. Among the first areas to be identified as a priority for study was insurance. This paper provides a review of life, health, and disability insurance systems, including basic principles, risk classification, and market and regulatory issues, and examines the potential impact of genetic information on the insurance industry.

The Economic Implications of Disability Insurance in Canada

Abstract: The article empirically estimates the effects of disability pensions provided under the Canada / Quebec Pension Plans on the labor-force participation rates of males aged 45-64 years. Two data sets are used. One consists of pooled cross section / annual time-series data by province for the years 1975-83. The other consists of observations as of 1985 on 651 males in the specified age group. Naive estimation results from both sets of data suggest a large negative effect of pension income. In the case of the micro data, this effect becomes small and statistically nonsignificant when more sophisticated estimation methods are used.

The Economic Implications of Public Disability Insurance in the United States

Abstract: A review of previous analyses of labor supply effects of Social Security Disability Insurance (DI) concludes that estimates of labor supply effects and net social costs are upward biased because they ignore interactions between DI and other insurances. A model of optimal insurance, postinjury accommodations, and labor supply shows that reduction in labor supply and increase in consumption when disabled do not necessarily imply moral hazard. Optimal postinjury accommodations vary inversely with firm size. The Americans with Disabilities Act will reduce wages and labor supply of healthy workers, particularly in small firms. Effects on labor supply of the disabled are ambiguous.

Privatization of Social Security: Lessons from Chile

Abstract: In Chile, all covered workers must place 10% of monthly earnings in a savings account with a highly regulated intermediary that manages a single fund and provides survivors and disability insurance Workers pay a commission charge, in addition to the mandatory 10%, to finance this insurance and to cover the costs and profits of the intermediaries On becoming eligible to receive benefits, a worker can choose between a sequence of phased withdrawals and a real annuity In addition, there is a sizable guaranteed minimum pension Unlike the purchased annuities, the minimum pension is not indexed, but adjusted by the government from time to time The Chilean reform gets high marks for defending the system from political risk and for its effects on capital accumulation and on the functioning of the capital market The Chilean reform gets low marks for the provision of insurance and for administrative cost Perhaps the most surprising aspect of the Chilean reform is the high cost of running a privatized social security system, higher than the 'inefficient' system that it replaced Valdes-Prieto has estimated that the average administrative charge per effective affiliate while active is US $8910 per year (for 1991) which is 294% of average taxable earnings This is close to 30% of the 10% mandatory savings rate The cost per person is not far from costs observed in other privately-managed pension systems, such as defined- benefit private pensions in the US However, it compares unfavorably with administrative costs in well-run unified government managed systems The issue here is the administrative efficiency of reliance

Social Security and Individual Equity: Evolving Standards of Equity and Adequacy

Abstract: Principles of Social Insurance Social Security: Scope, Distributional Impact, and Long-Term Financing An Earnings-Based Standard of Individual Equity Extending Social Adequacy Disability Insurance and Individual Equity Individual and Social Fairness of the Medicare Program Social Security and Individual Equity: A Summing Up

Obtaining Social Welfare Benefits for Persons With Serious Mental Illness

Abstract: The types of social welfare benefits available for mentally ill patients, including Social Security, Social Security Disability insurance, Supplemental Security income, Aid to Families With Dependent Children, Medicare, and Medicaid, are briefly described, and their eligibility criteria are summarized, Special requirements that may apply to immigrants are briefly noted. Case vignettes illustrate how mental health professionals can help patients obtain benefits to improve the quality of their living conditions.

Comments on Danzon, Maki, Murray, and Allen

Abstract: The two studies on disability by Patricia Danzon and Dennis Maki nicely complement each other. Danzon provides a very fine theoretical analysis of the effects of disability insurance, while Maki's is a good empirical study of the Canadian experience. Why are governments so extensively involved in disability programs? Two very different explanations are (1) that governments offset failures in the private insurance market or (2) that government disability programs redistribute resources to some groups at the expense of others. Some analysts claim that private insurance markets do not work well because of the difficulties in handling self-selection and moral hazard. Empirical studies in both the United States and Canada typically find that public disability programs significantly reduce labor force participation rates. For example, Maki finds that about a third of the reduction in participation rates of Canadian males aged 45-64 in recent years is due to disability programs. Sizable effects are also found with U.S. data, although Danzon shows the large unexplained differences in estimates from different studies. She states, "It is often implicitly assumed that all reduction in labor supply associated with disability insurance is moral hazard and entails an excess burden" (p. S188). Her theoretical analysis helps evaluate this implicit assumption. For she shows that an optimal first-best disability program might well reduce labor supply relative to a world with no insurance, even when there is full information about disabilities. Indeed, she shows more than this, that under certain conditions with first-best insurance, the insuree is better off by suffering a disability than not. Insurees then have a strong incentive to fake disabilities. It is not yet possible to evaluate how much of the reduction in labor supply in either Canada or the United States is due to redistributive aspects

Early Retirement of Older Male Workers Under the Dutch Social Security Disability Insurance Programme

Abstract: In the Netherlands, and elsewhere, labour force participation among older workers has been steadily declining during the 1970s and 1980s. Extrapolation of this trend combined with the demographic trend of the greying of the baby-boom generation would predict alarming labour shortages in the future. Fortunately, things are likely to turn out less dramatic than they seem at the moment. Preferences for (early) retirement are likely to be reduced by the market mechanism inducing wages to rise and improving the career prospects for older workers in general. On top of that, adjustments of private and public pension schemes (and also of related schemes such as public disability programmes) may be introduced to restrict pension eligibility and decrease post-retirement income. The market mechanism reinforced by policy measures may, therefore, reverse the downward trend in labour force participation of older workers.

Constricted Employment Opportunities Encountered by People with Severe Disabilities

Abstract: People with disabilities are estimated to make up 17% of the working population in the United States. Frey (1985, cited by Bordieri & Comminel, 1987) reported that the unemployment rate in the U. S. for workers with disabling conditions was 72.6%, and noted that the poverty rate was 26% for workers with disabling conditions, while only 10% for workers without disability. Among the factors that contribute to the high unemployment rate are: (a) Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) that are believed to either reduce or eliminate the motivation to work, especially when benefit dollars exceed potential earnings; (b) severity of disability; (c) level of education; (d) mobility; (e) geographical location; (f) age; (g) sex; and (h) number of dependents (Poole, 1987). Since passage of the 1973 Rehabilitation Act, the business community has become more active in its attempt to facilitate employment by providing training and actual work experience to persons with disabilities. Such individual firms as 3M and Dow Chemical have become involved in the rehabilitation of their own employees with disabilities, either by establishing an internal rehabilitation system, or developing a relationship with outside rehabilitation sources (Berkley Planning Associate, 1980, cited by Young, Rosati, & Vandergoot, 1986). Labor unions have also recognized the benefits of retraining injured workers and have initiated programs for that purpose (Mallil & Moretti, 1982). In addition various agencies of the federal government have developed rehabilitation initiatives, designed to promote employment of people with disabilities. These efforts to rehabilitate and retrain people and to purposefully find a place for them in the workplace have allowed many to overcome obstacles to obtaining gainful employment. However, employment among those with severe disabilities is not easily overcome, and is now recognized as a serious social problem. Of the estimated 14% of adults with severe disabilities employed in the nation's labor force, only 2% are employed in a full-time capacity (Social Security Administration, 1982, cited by Poole, 1987). Individuals with severe disabilities typically receive more public benefits and are less apt to be rehabilitated or to enter competitive employment than other persons with disabilities (Berkowitz, 1980; Walls, 1982). As a result, various government organizations have recruitment initiatives designed to provide more accessible employment opportunities for people with disabilities. Under a special recruitment category of targeted disabilities, the federal government lists individuals who are deaf, blind, missing extremities, or mentally retarded, or who suffer from partial paralysis, complete paralysis, convulsive disorders, mental illness or distortion of a limb/spine as having severe disabilities. Although the government has increased efforts to ensure that workers with disabilities are recruited and properly placed in federal positions, the more severely challenged continue to experience greater difficulties securing federal positions. This recruitment problem mirrors the overall problem faced by the individuals with severe disabilities seeking employment for positions outside federal service. Recruitment of Individuals with Disability at a Federal Installation from 1984 to 1989 The purpose of this research study was (a) to determine the success rate of efforts by a Department of the Army (DA) installation in meeting the DA's stated goal of 4% workers with disabilities accessions against total accessions from outside the government and (b) to evaluate and compare the success rate of the installation in meeting the DA's goal of recruitment at 1.5% for individuals with severe disabilities. The population considered in this study included all individuals hired from outside (non-federal-government) sources for the recruitment years 1985 through 1989. …

Variations cantonales dans l'utilisation des Centres d'observation médicale de l'assurance-invalidité en Suisse

Abstract: The Medical Observation Centres of the state Disability Insurance (COMAI) are specialized agencies serving the cantonal commissions of the Disability Insurance in Switzerland. Using data collected for each case examined by the COMAI, utilisation rates and rankings were established for each canton. Utilisation rates varied by a factor of 40 from one canton to the next. This observed variation is independent of the number of new cases presenting to the Disability Insurance and of the number of disability pensions granted. Rankings were also independent of denominators used to define utilisation rates. These results suggest possible non-uniform application of state directives concerning the use of the COMAI, and unequal access to these specialized agencies. The reasons for these variations are the object of a study now underway.

Cooperative Employee Compensation

Abstract: This study looks at how education, cooperative function, and geography influence patterns in compensating cooperative employees. Generally, cooperative respondents in the West reported employees had the highest median salaries. Job responsibility, decisionmaking, and performance were the three most important factors for setting salaries according to respondents in a survey conducted for this study. Bonuses were given across job categories. Bonuses were tied to a variety of factors but most reported were financial performance, sales, and performance. Health, life, and disability insurance were the most commonly paid benefits across all geographic areas, all sizes (sales) of cooperatives, and all cooperative function.

Human Immunodeficiency Virus Exposure Among Medical Students

Abstract: We must point out that the ad hoc AIDS Committee at Cornell University Medical College was formed 6 months before Dr Jones' publication in JAMA. Safety issues with respect to human immunodeficiency virus exposure had been raised by many different medical school faculty, including Dr Roberts who was instrumental in setting up the committee. The committee made many recommendations regarding student conduct on the floors and in the operating rooms. One serious concern was related to the availability of disability insurance. Since students technically are not employees, insurance to cover their "disability" is not applicable. In this context, Dr Vergilio responded to a specific question about disability insurance with the comment that "an ad hoc AIDS Committee... is currently examining this problem in the hope offormulating a policy...." Indeed, a standing Committee on AIDS (one of 14 of the dean's committees) was recommended by the ad hoc committee and established

Insurance andGenetic Testing: WhereAreWe Now?

Abstract: Summary Basic research will spurdevelopment ofgenetic teststhat arecapable ofpresymptomatic prediction ofdisease, disability, andprematuredeath inpresently asymptomatic individuals. Concerns havebeenexpressed about potential harms related tothe useofgenetic testresults, especially loss ofconfidentiality, eugenics, and discrimination. Existing laws andadministrative policies may notbesufficient toassurethat genetic information isused fairly. Toprovide factual information andconceptual principles upon which sound social policy canbe based, theHumanGenomeInitiative established an Ethical, Legal, andSocial Issues Program. Amongthefirst areastobeidentified asapriority forstudy was insurance. This paperprovides areview oflife, health, and disability insurance systems, including basic principles, risk classification, andmarket andregulatory issues, and examines thepotential impact ofgenetic information on theinsurance industry.