Fischer, Katrin
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Use of a structured functional evaluation process for independent medical evaluations of claimants presenting with disabling mental illness: rationale and design for a multi-center reliability study
Attitudes towards evaluation of psychiatric disability claims: a survey of Swiss stakeholders
QUESTIONS: In Switzerland, evaluation of work capacity in individuals with mental disorders has come under criticism. We surveyed stakeholders about their concerns and expectations of the current claim process. METHODS: We conducted a nationwide online survey among five stakeholder groups. We asked 37 questions addressing the claim process and the evaluation of work capacity, the maximum acceptable disagreement in judgments on work capacity, and its documentation. RESULTS: Response rate among 704 stakeholders (95 plaintiff lawyers, 285 treating psychiatrists, 129 expert psychiatrists evaluating work capacity, 64 social judges, 131 insurers) varied between 71% and 29%. Of the lawyers, 92% were dissatisfied with the current claim process, as were psychiatrists (73%) and experts (64%), whereas the majority of judges (72%) and insurers (81%) were satisfied. Stakeholders agreed in their concerns, such as the lack of a transparent relationship between the experts’ findings and their conclusions regarding work capacity, medical evaluations inappropriately addressing legal issues, and the experts’ delay in finalising the report. Findings mirror the characteristics that stakeholders consider important for an optimal work capacity evaluation. For a scenario where two experts evaluate the same claimant, stakeholders considered an inter-rater difference of 10%‒20% in work capacity at maximum acceptable. CONCLUSIONS: Plaintiff lawyers, treating psychiatrists and experts perceive major problems in work capacity evaluation of psychiatric claims whereas judges and insurers see the process more positively. Efforts to improve the process should include clarifying the basis on which judgments are made, restricting judgments to areas of expertise, and ensuring prompt submission of evaluations.
Perceived fairness of claimants undergoing a work disability evaluation: Development and validation of the Basel Fairness Questionnaire
What are the concerns of claimants who underwent a disability assessment? – A case study
Little is known on how claimants experience disability assessments. While a variety of patient satisfaction instruments reflect the quality of medical care, no such tool exists for the assessment of work disability. In disability assessment, fairness is a central component of the claimants’ satisfaction with the assessment. We therefore developed a questionnaire that measures to what degree claimants experience the disability assessment as fair. Beyond the 26 items related to fairness, we asked the claimants to comment on additional aspects that affect their satisfaction or dissatisfaction with the assessment. Ninety-four of 305 participants provided feedback, 38 (40.4%) of which were satisfied, 52 (55.3%) were dissatisfied with the assessment, and 4 (4.3%) both or neither. Approving comments addressed in particular the empathy of the expert (13/94, 13.8%), while critical comments complained about poor time management (13/94, 13.8%) and interviewing skills of the experts (12.8%, 12/94). While all expressed satisfaction on varying degrees on the global 7- point scale, claimants expressing approval in their comments versus those with critical feedback were more satisfied (6.3 vs. 4.8) and perceived a higher level of fairness with the assessment (6.5 vs. 4.8, p<0.01, each).
Forgotten by evidence - insurance medicine. Translating evidence into better health services
Basel Patient Questionnaire: How fair do patients really perceive the process of their disability evaluation?
What concerns claimants who underwent a disability assessment? – A case study
Little is known on how claimants experience disability assessments. While a variety of patient satisfaction instruments reflect the quality of medical care, no such tool exists for the assessment of work disability. In disability assessment, fairness is a central component of the claimants’ satisfaction with the assessment. We therefore developed a questionnaire that measures to what degree claimants experience the disability assessment as fair. Beyond the 26 items related to fairness, we asked the claimants to comment on additional aspects that affect their satisfaction or dissatisfaction with the assessment. Ninety-four of 305 participants provided feedback, 38 (40.4%) of which were satisfied, 52 (55.3%) were dissatisfied with the assessment, and 4 (4.3%) both or neither. Approving comments addressed in particular the empathy of the expert (13/94, 13.8%), while critical comments complained about poor time management (13/94, 13.8%) and interviewing skills of the experts (12.8%, 12/94). While all expressed satisfaction on varying degrees on the global 7- point scale, claimants expressing approval in their comments versus those with critical feedback were more satisfied (6.3 vs. 4.8) and perceived a higher level of fairness with the assessment (6.5 vs. 4.8, p<0.01, each).