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 Private insurers and government programs in many countries worldwide
use medical experts to evaluate workers who claim that illness or
injury limits their ability to work. The experts decide whether the
employee’s health problems merit disability benefits designed to
replace lost wages.
For the current study, researchers examined data in 23 studies
conducted between 1992 and 2016 in 12 countries in Europe, North
America, the Middle East and Northeast Africa.
In 63 percent of studies, medical experts reached only low to
moderate agreement on workers’ capacity to do their jobs,
researchers report in The BMJ.
“This problem seems to be universal,” said senior study author Dr.
Regina Kunz, a researcher at the University of Basel in Switzerland.
“What we found is the challenge to decide on the threshold when a
health problem is ‘severe enough’ to qualify for disability
benefits,” Kunz added by email. “No gold standard exists as of today
to determine this threshold.”
For the current analysis, Kunz and colleagues examined data from 16
studies conducted in an insurance setting and seven done in research
settings.
Studies done in the insurance setting were conducted with medical
experts assessing claimants who were actual workers seeking
disability benefits or actors portraying hypothetical cases.
Workers were seeking benefits for mental health problems in 38
percent of cases, physical injuries or illnesses in 25 percent of
instances and a combination of both mental and physical issues in 38
percent of cases.
Only seven of the insurance studies, or 44 percent, were
generalizable to real life evaluations, the study found. Another
three insurance studies, or 19 percent, were rated as “probably
generalizable.”
Researchers saw an “excellent” level of reliability in results for
just two insurance studies.
By contrast, five of the studies done in research settings, or 71
percent, had “excellent” reliability in results, the current
analysis found.
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Conclusions were particularly unreliable when medical experts
assessed workers for subjective complaints or chronic health
problems, or when they didn’t use a standardized set of measurements
or questions to determine if people needed disability benefits.
Taken together, the authors conclude, these results suggest that
there might be greater need for strategies to improve agreement when
patients present with subjective complaints and better understanding
of factors that contribute to variability in evaluations of capacity
to work.
One limitation of the current study is that the researchers looked
at previous studies with wide variation in design, outcome
measurements and size, the authors note. This made it difficult to
draw statistically meaningful conclusions from the current analysis,
they point out.
Mental health problems in particular can stymie evaluators, and are
often exacerbated because people don’t get adequate mental health
care or vocational services, said Dr. Robert Drake, a health policy
researcher at The Dartmouth Institute in Hanover, New Hampshire, who
wasn’t involved in the study.
“Many people are disabled temporarily and need help but get trapped
in the disability system,” Drake said by email. “Continuing reviews
do not help. We need to have more sensible rules, and patients need
better mental health and vocational services.”
SOURCE: http://bit.ly/2kuezhN The BMJ, online January 25, 2017.
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