1. Disability evaluation Czech System of Assessment MUDr. JUDr. Helena Štaňková MUDr. Dušan Gajdoštík Department for Assessment Service Ministry of Labour and Social Affairs Czech Republic This presentation does not contain any potential conflict of interest

2. Target to introduce the Czech system of invalidity assessment (long term work incapacity) show some results of assessment show the most frequent causes of invalidity in Czech rep. This presentation does not contain any potential conflict of interest 1

3. Legislation Pension insurance Act No. 155/1995 Coll. came into effect from 1. 1. 1996 Significant amendment from 1. 1. 2010 Decree No 359/2009 Coll., on assessment of invalidity Methodology of the Czech Social Security Administration and Ministry of Labour and Social Affairs 2

4. Competence in assessment of invalidity Medical Assessors of DSSA –> decision is issued by CSSA Medical Assessors of CSSA –> decision is issued by CSSA Assessment by Commission of MoLSA (legal proceedings) DSSA – District Social Security Administration CSSA – Czech Social Security Administration MoLSA – Ministry of Labour and Social Affairs 3

5. It is the ability of an insured person to perform an employment, that corresponds to his/her physical, sensory and mental abilities, with regard to his/her education, experience, knowledge and previous income activities Work capacity in pension insurance 4

6. It is a decrease of capacity to perform gainful activity due to the limitation of physical, sensory and mental abilities in comparison to the situation that was before the occurrence of long-term unfovarable health condition Decrease of work capacity 5

7. There are three degrees of invalidity depending on reduction of work capacity If the work capacity decreased: -at least 35% but not more than 49% = first degree of invalidity -at least 50% but not more than 69% = second degree of invalidity -at least 70% = third degree of invalidity Degrees of invalidity 6

8. The percentile degree of the reduction of work capacity and the prerequisites for invalidity assessment and the rules for work capacity assessment for the purposes of invalidity are stated in the regulation No 359/2009 Coll. Percentile degree of the work capacity reduction 7

9. It is the basic precondition for invalidity status It is bad health state that reduces physical, sensory or mental capabilities that are important for ability to work This health state lasts more than 1 year or we can assume that it will take longer than 1 year according to the knowledge of medical science Long term unfavorable medical state 8

10. Annex of the Decree No 359/2009 Coll. the Annex presents the percentage of the work capacity reduction the Annex has 15 Chapters due to various types of disability (Infection, Oncology, Psychiatric disorders, Heart diseases and cardiovascular system etc.) each Chapter contains health states with items which present percentage of work capacity decrease -these items correspond with a functional level of disability Assessment criteria 9

11. Annex of the Decree No 359/2009 Coll. it does not depend on the specific diagnose, but on the functional impact of the health status on work ability it is not possible to add percentage of more items (more causes) in the case of more health disorders is determined the most important cause of long-term unfavorable health state upper percentage limit can be increased by up to 10% lower percentage limit can be reduced by up to 10% Assessment criteria 1010

12. E.g.: Dorsopatie, spondylopatie (Chapter XIII, Section E) item 1a - minimal functional impairment (without root irritation) = 5 % item 1b - slight functional impairment (occasional root irritation) = 10 - 20% item 1c - moderate functional impairment (frequent root irritation, significant neurological findings) = 30 - 40 % item 1d - severe functional disability (permanent root irritation symptoms, severe paralysis, muscular atrophy, impaired sphincter) = 50 - 70 % Assessment criteria - example Annex of the Decree No 359/2009 Coll. 11

14. Invalidity evaluation is based on: medical reports (GP + specialists) physical investigation of the client (only if it is necessary) Invalidity evaluation 12

15. First invalidity evaluation 2010 – 2015 Results of assessment in % 13

16. Surveillance of first invalidity evaluation 1992-2015 Results of assessment in %

17. Repeated invalidity evaluation 2010 – 2015 Changes in % 15

18. Surveillance of repeated invalidity evaluation 1993 – 2015 Changes in % 1616

19. Results of appeal administrative procedures 2010 - 2015 In appeal proceedings the changes of results of assessment are presented in 18 – 19 % 17

20. The most frequent invalidity causes, ICD-10 Due to chapter of ICD-10 1. - XIII. Diseases of the musculoskeletal system and connective tissue – 24 % 2. - V. Mental and behavioral disorders – 18 % 3. - II. Neoplasms – 10 % 4. - IX. Diseases of the cardiovasc. system – 9% 5. - VI. Diseases of the nervous system – 6 % 18

21. The most frequent invalidity causes, ICD-10 19

22. The most frequent invalidity causes, Dg. The most frequent diagnosis 1.M 51 + M 54 - Lumbar and other intervertebral discs´ disorders + Dorsalgia - 14 % 2.M 16 + M 17 - Osteoarthritis of hip + knee - 4,5 % 3.F 20 - Schizophrenia - 3,5 % 4.J 44 + J 45 - Other chronic obstructive pulmonary disease + Asthma - 3,5 % 5.I 25 - Chronic ischemic heart disease - 3 % 20

23. The most frequent diagnosis 21

24. The most frequent invalidity causes at the age to 18 years 1.Mental and behavioral disorders – 50 % 2.Diseases of the nervous system – 25 % 3.Diseases of the ear and mastoid process – 6 % 4.Congenital malformations, deformations and chromosomal abnormalities – 5 % 5.Diseases of the eye and adnexa – 3 % 22

25. The most frequent invalidity causes at the age to 18 years

26. Conclusions 1. The most frequent invalidity causes are different at the age to 18 and after then, because of influence of congenital malformations and perinatal diseases 2. The influence of the changing legislation in invalidity assessment is evident 3. Invalidity evaluation according to the assessment of working capacity decrease is effective, objective and from 2010 seems to be stabilized 24

27. Thank you for your attention Ministerstvo práce a sociálních věcí, odbor posudkové služby, Na Poříčním právu 1, 128 01 Praha 2 tel: +420 950 194 538, e-mail: helena.stankova@mpsv.cz, www.mpsv.cz, www.noviny-mpsv.cz