Disability evaluation : a place for the international classification of functioning disability and health?

Individuals
who
are
sick
and
unable
to
work
may
receive
wage
replacement
benefits
from
social
insurance.
To
receive
wage
replacement
or
support
for
return
to
work,
the
work-­‐disabled
person
has
to
undergo
a
disability
evaluation
for
social
insurance.
Medical
reports
of
disability
evaluation
are
criticised
for
lack
of
standardisation
and
transparency
in
European
countries.
The
international
classification
of
Functioning,
Disability
and
Health
(ICF)
was
developed
by
the
World
Health
Organisation
to
express
the
situation
of
people
with
disability
evaluation.
However,
it
is
unclear
whether
the
ICF
framework
and/or
the
ICF
classification
can
reproduce
the
content
of
medical
reports
because
it
was
not
developed
for
disability
evaluation.
The
objectives
of
this
thesis
are:
(1)
to
study
if
the
content
in
medical
reports
of
disability
evaluation
is
similar
across
European
countries;
(2)
to
investigate
if
and
how
the
ICF
framework
and
classification
can
depict
the
content
of
medical
reports;
and
finally
(3),
to
study
what
extent
the
ICF
framework
and
classification
can
depict
in
practice
the
content
in
medical
reports.
This
thesis
consists
of
four
different
studies:
1)
a
survey
on
the
content
of
summary
and
conclusion
of
medical
reports
in
15
different
European
countries,
2)
a
conceptual
study
assessing
the
ICF
framework
and
classification
in
medical
reports,
3)
an
empirical
study
linking
72
Swiss
medical
reports
to
categories
of
the
ICF
classification
and
investigating
if
existing
ICF
core
sets
for
specific
health
condition
might
be
used
for
medical
reports,
and
4)
a
content
validation
of
the
EUMASS
Core
Set
in
6
European
countries.
Different
European
countries
have
different
ways
to
organize
disability
evaluation,
but
medical
reports
in
social
security
contain
similar
key
features
among
European
countries:
(1)
health
condition,
(2)
work
capacity,
(3)
socio-­‐medical
history,
(4)
feasibility
of
interventions,
(5)
prognosis
of
disability,
(6)
causality,
(7)
consistency
of
the
situation
of
the
claimant,
and
(8)
legal
disability.
The
ICF
classification
is
not
implemented
in
disability
evaluation
in
social
insurance
but
attempts
are
underway.
The
ICF
was
not
developed
for
disability
evaluation
but
we
can
use
some
elements
of
it.
The
ICF
framework
allows
medical
experts
to
describe
the
claimant
in
a
bio-­‐psycho-­‐social
manner
and
thereby
fits
the
current
thinking
about
disability.
The
ICF
classification
covers
work
capacity
to
some
extent:
What
a
person
is
able
and
unable
to
do
can
be
depicted
in
general
terms
(such
as
carry,
sit,
walk)
but
current
ICF
categories
run
short
of
typical
descriptions
of
work
capacity
(such
as
overhead
working,
change
positions).
The
7
other
key
features
of
medical
reports
in
social
security
are
more
cumbersome
to
cover
or
cannot
be
covered
at
all
by
the
ICF
classification
as
they
require
specifications
of
categories
or
new
aspects
to
be
included
in
the
ICF,
such
as
describing
relations
of
time
and
cause
and
effect.
The
ICF
classification
with
its
1424
categories
is
not
practicable
for
daily
routine.
Therefore
researchers
started
to
develop
core
sets:
purpose
specific
abstracts
of
the
ICF.
The
study
on
the
validation
of
the
EUMASS
core
set
shows
that
such
a
core
set
might
be
a
good
for
making
medical
reports
more
transparent.
I
conclude
that
it
is
possible
that
ICF
categories
about
work
capacity
help
promote
standardized
presentation
and
enhance
transparency
in
disability
evaluation
in
social
insurance.
More
research
is
necessary
to
clarify
the
optimal
way
of
development
of
one
or
more
core
sets.
Given
that
the
labour
markets
and
the
health
conditions
between
European
countries
might
not
be
completely
different,
medical
examiners
could
join
efforts
in
developing
a
core
set
that
is
applicable
in
all
European
countries.
Such
a
core
set
would
also
facilitate
exchange
of
information
among
European
countries
and
allow
for
comparison
and
collaboration.
The
application
of
such
an
international
core
set
may
still
be
different
between
countries
as
legal
disability
processes
of
disability
evaluation
are
different
among
European
countries.