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Positive therapeutic effects on the work force participation derived from international clinical trials may not be directly transferable to the community based care in Germany. Therefore recent changes of data regarding sick leave (SL), work disability pension (WDP) and employment from the social insurance and from the national database of the German collaborative arthritis centers were analyzed covering a time period of at least 10 years. Health insurance data showed a steeper decline in the average duration of SL caused by rheumatoid arthritis (RA), ankylosing spondylitis (AS) and systemic lupus erythematosus (SLE) compared with all other diseases. In RA patients from the collaborative arthritis centers the mean duration of SL was much more reduced than the average duration of SL for members of the compulsory health insurance. The proportion of gainfully employed RA patients in collaborative arthritis centers has particularly increased in women. According to data from the pension insurance fund less incident cases of WDP due to RA, AS, and SLE have been observed than WDP caused by all other diseases. Thus different nationwide data show positive changes of the work force participation of individuals suffering from inflammatory rheumatic diseases in Germany.

Background: In recent years the total number of people drawing a pension - especially for psychiatric reasons - from Switzerland's Federal Disability Insurance ("IV") has been steadily climbing. As we have revealed in earlier studies of persons applying for a disability pension for psychiatric reasons only 64 % had received psychiatric treatment and only 20 % adequate drug treatment ., Hypothesis: In this study we examined whether, treatment recommendations given by medical experts were followed and if so, how successfully., Methods: In 40 patients who had got a psychiatric expertise in 2004 at the Psychiatric Outpatient Department, University of Basel, on behalf of the Swiss Disability Insurance, a 1-year follow-up was done and the results were compared., Results: At reassessment significantly more patients (58 %) were in psychiatric-psychotherapeutic treatment than at first assessment (32 %). The recommended drug treatments were fully complied with in only 43 % of the cases; the recommended psychotherapy in only 9 % of the cases; and recommended in-patient treatment at a psychiatric hospital in only 14 % of the cases. During the time between evaluations, the seriousness of the condition had altered in a number of cases: in 33 % the condition had noticeably improved (e. g. from severe to mild depression) or was no longer present, and in 9 % the condition had worsened (e. g. from mild to severe depression). No significant relationship was found between compliance (full, partial or no implementation of recommended treatments) and change in illness severity. Partnership has been identified as the factor with the strongest influence on illness severity: in subjects who were married or living with a partner illness course was much better than in subjects without a stable partnership.

The key objective of insurance medicine is the scientific based assessment of long term prognosis of a single person with respect to mortality, morbidity and disability. This is always determined in comparison to the standard population or an ideal standardised population. The evaluation of morbidity, mortality and disability is always linked to certain insurance products such as life insurance, disability cover, health insurance or derivates of these products. Additionally, insurance medicine creates the claims evaluation guidelines which are in accordance with established classifications and guidelines of other medical associations. Due to different and various reasons, insurance medicine in Germany has shown substantial deficits in the past years and decades, mostly in the areas of methodology, scientific basis, guidelines and quality control. In order to meet future challenges specific to this industry such as demographic change, longevity and new insurance covers, the discipline of German insurance medicine requires some reorganisation.