Insurance physicians should ask their clients more extensive questions about what their illness means to them in daily life. That way, they will gain more insight into their abilities and limitations. This is the conclusion of Jerry Spanjer’s PhD research. He has developed a new interview protocol for insurance physicians. This protocol is already on offer as part of the insurance physician training given by benefits agency UWV. On 17 March 2010 Spanjer will be awarded his PhD by the University of Groningen.
Employees who cannot work due to illness or disability may apply for WIA benefits (Work and Income (Ability to Work) Act benefits) after two years. The insurance physician plays a prominent role in determining whether or not benefits are granted and to what degree, i.e. the percentage. The physician bases his or her conclusion on a medical diagnosis and an interview with the client. Spanjer developed a new interview protocol, the Belastbaarheidsgericht Beoordelingsgesprek (Disability Assessment Structured Interview) to allow for a consistent assessment of incapacitated workers.
Spanjer discovered that physicians hardly ever differ in their medical diagnosis of clients. However, assessing what the diagnosis means for the patient in everyday life is much more difficult. In order to achieve a more consistent assessment, insurance physicians don’t need more information, but instead must interpret this information in a more systematic manner, according to Spanjer. Training can help prepare them for this.
The Disability Assessment Structured Interview (DASI) is an interview that follows a consistent structure, in which certain subjects are always approached in the same manner. By deliberately asking for examples and activities, the physician will gain a clearer understanding of the client’s abilities. Spanjer researched the reliability and validity of his interview protocol by showing video recordings and reports of DASI interviews to insurance physicians. Additionally, roughly sixty WIA applicants were assessed by two different physicians, whose conclusions were compared. Half of the sixteen physicians partaking in this stage used the DASI protocol to assess the patients, while the other half did not. All physicians concluded that the DASI interview gives a realistic impression of the client and that it is an acceptable method for use in practice. Seven of the eight physicians who worked with the DASI interview found it to be a better method than their own assessment interviews. The physicians did often still differ in their assessments of the number of hours per day that a patient could work. Therefore, Spanjer recommends that a client is assessed by more than one insurance physician. The clients themselves were positive about the assessment interviews, giving them an average score of 7.7.
Jerry Spanjer (Groningen, 1958) studied medicine at the University of Groningen. He has been an insurance physician with UWV since 1989. His employer financed his research, which was conducted at the Department of Social Medicine at the University Medical Center Groningen (UMCG) and the research school SHARE. Having been awarded his PhD, Spanjer will begin work as an academic researcher at the Kenniscentrum Verzekeringsgeneeskunde (Knowledge Centre for Insurance Medicine), run by the UMCG and UWV. His thesis is entitled ‘The Disability Assessment Structured Interview. Its reliability and validity in work disability assessment’.
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