The role of social criteria in the prognosis

and evolution of the diseases and their
use in insurance medicine
Dr. Ioana Soare, m.d., ph.d.
Romanian National House of Pensions CNPAS
Romanian Association of Insurance Medical
Experts CMEA

environmental contact.we focus now on evidence based medicine and on the quality of life of the patient. .In the last 30 years a new statistical. globalizing approach in medicine has reached importance . covering all common aspects including health. financial aspects and human rights.

statistically speaking. occupation. The most usually considered non-medical factors implied in health. age. alcohol abuse/smoking/lifestyle. this factors are not yet considered. not merely the absence of disease or functional limitations. are: sex. If the private insurers have long ago considered those as risk factors.The quality of life component that refers strictly to health involves physical. in disability assessment medicine/social medicine/insurance medicine for state insurance companies. .    WHO: health is a state of complete physical. mental. and social well-being. and acted accordingly. emotional and social wellbeing .

studies. working as shop assistant. nurse aide or charlady among women. Neither the private nor the state insurers take in consideration this risk factors. low education. Manual work was identified as a predictor for disability pensioning with osteoarthritis among the people employed in Norway. A very large study in Norway found out that risk factors for becoming a disability pensioner with a musculoskeletal diagnosis are female sex. access to medical care .particularly coxarthrosis/ hip arthritis a main health problem     Scandinavian authors determined the most important social factors implied in the prognosis and evolution of coxarthrosis: marital status. 1971-1990 From further studies considering the quality of life (QOL). low income.Osteoarthritis. and heavy occupations among men . low level of education. . low socio-economic status. among the elements worsening the evolution and prognosis of any disease or disability are: being single. not being married. including the social factors together with the health/medical factors. old age. rural/ living in the countryside. It would be high time to modernise underwriting/ risk assessment/disability assessment and the criteria for those mentioned before.

Disabilit y and Health (ICF). with its limitations. defect.International Classification of Functioning.  Participation to the social life may have some restrictions. loss or other significant deviation from certain generally accepted population standards. social and civic life ICF was designed to make international research on consequences of disease comparable. . The ICF lists 9 broad domains of functioning which can be affected:  Learning and applying knowledge  General tasks and demands  Communication  Mobility  Self-care  Domestic life  Interpersonal interactions and relationships  Major life areas  Community.  Activity is defined as the execution of a task or action. WHO Impairment in bodily structure or function is defined as involving an anomaly. which may fluctuate over time.

then people with a non-normative functional status would not be disabled in the sense that they would be able to fully participate in society. . and policy environments. cultural. The social model of disability holds a very different view. If the environment is designed for the full range of human functioning and incorporates appropriate accommodations and supports.see British cosmologist Stephen Hawking. which can facilitate the evaluation of disability.   It favorises a bio-psychosocial approach. believing that disability arises from the interaction of an individual’s functional status with the physical.

a term roughly equivalent to access to basic necessities—things such as food. survivor benefits and unemployment insurance. unemployment and others     social insurance. disability. primarily a social insurance program providing social protection. shelter. More rarely. money. old age. or protection against socially recognized conditions. aspects of social work and even industrial relations. education. and medical care. These services typically include provision for retirement pensions. income maintenance—mainly the distribution of cash in the event of interruption of employment. . the term is also used to refer to basic security. including retirement. disability and unemployment services provided by administrations responsible for social security. where people receive benefits or services in recognition of contributions to an insurance scheme. In different countries this may include medical care. including poverty.Social security represents state assistance. clothing. disability insurance.

The state of living on less than $2 a day. . Poverty can also represent a lack of opportunity and empowerment. emotionally and socially. The state of having little or no money and few or no material possessions.World Bank Report 2009-2010    Poverty:a certain level of material deprivation below which an individual suffers physically. There are a number of methods of determining this level of deprivation. according to the World Bank. and bad quality of life in general.

Large and widening health inequalities within Member States show that not all have benefited equally from the economic progress that delivers better health. Ageing can bring with it new patterns of morbidity including multi-morbidity (multiple chronic diseases. disability .  The cost and quality of housing is key to living standards and well-beingincreasing number of homeless people.

etc. age. and could reach 10. The rate is more than double for young workers (20. care responsibilities. migrant background.7%) and migrants (19.3% in 2010.1%). . often facing multiple barriers to entry (including low skills. disability and other discriminatory factors. The last decade has also seen the persistence of groups of people who remain outside or on the margins of the labor market.).  Unemployment in the EU is now at 9.1%.

Gipsies Largest Migrant Group In Europe .

Kalo. .  Tribal populations from North India and today Pakistan have left for Europe in the last 1000 years. Gipsy. They were mostly slaves and were bought and sold till 1850.called Sindi.

undertaken by the Ministry of Interior. . In the '80s. banning the practice of nomadisme and itinerant trades.In Romania     500 000 to 2 million are considered now living here Between 1950 . Romanian government approved a national strategy to address the problem of Gypsies. On 25 April 2000. a 10-year program which aimed at raising social and economic integration in the society.1970. the national program "Integration of the Gypsies". continued forced sedentarisation measures. covered only their evidence.

Gipsy populations add more social factors towards chronicisation of diseases and disability:  Low education  Poverty  Homelessness  Lack of papers/ no identity – they cannot receive health care  Traditional occupations  Unemployment .

This cross-sectional study provides population-level. separated/divorced. ≥ high school graduate). education (< high school graduate vs. and disability duration (years limited as a continuous variable). race/ethnicity (white non-Hispanic. unemployed. other nonHispanic groups. never married).In USA    A large American study on 11. retired. gender. and all Hispanics). current employment status (employed. unable to work). student/ homemaker.905 adults with disability. African American non-Hispanic. examined the relationship between disability onset and health status. . marital status (married. They included a set of potential confounding variables: age (as a continuous variable). widowed. generalizable evidence of increased fair or poor health in people with later onset disability compared to those with disability onset prior to the age of 21 years.

leading to higher reported general health. as well as the duration of the disability. . less than high school education. Individuals who acquire a disability later in life may be more likely to rate their global health status in relation to their perceived health prior to the disability and have greater difficulty adjusting to the disability. early disability onset and longer duration of disability may allow greater adjustment to the disability both in terms of psychosocial identity development and adoption of coping strategies. In contrast. and not currently being employed.   Age at onset of a disability. African American race/ethnicity. can also impact health status. divorced/separated marital status. employed. The early onset group was younger on average and more likely to be male. and more educated compared to the later onset groups. The following variables also showed a significant relationship with fair/poor health: age.

In private insurance companies. with a low level of education. not discriminating persons over 50 years old. these factors are not officially considered. social and vocational point of view. But we work with them and we apply them. low income. single females living in the countryside. most of these factors are considered already for a long time ago. .State/ Private Insurance     Social factors may be more important in determining the unemployment and disability retirement than the medical factors. We realize that we must make more sustained efforts to rehabilitate them from a medical. In the state insurance companies.

Conclusions The modern tendencies are towards medico-social guidelines in insurance medicine. and  (2) prevention of the social and environmental conditions that stop people with those types of limitations from being able to participate in social and economic activities. through leaflets at the family doctors. . We must impose EDUCATION – one mandatory week insurance medicine for every student in medicine and also for patients. Prevention of disabilities:  (1) prevention of medical conditions that lead to body function or structure limitations. reinforcing partnerships and reaching out to new actors. The European Year 2010 for combating poverty and social exclusion helped by raising awareness.

Music unites all! .