[Utilization of health care system by patients with chronic pain who apply for disability pensions. A registry study].
BACKGROUND
Patients with chronic pain may be awarded a disability pension if their working capacity is reduced as a result of an illness. Patients with chronic pain very often consult several specialists in order to obtain proof of their illness. The aim of this study was to investigate how an application for disability pension affected the utilization of health care services by patients with chronic pain.


METHODS
Patients with chronic pain who applied for a disability pension in 1989 and 1990 were entered. The study period was divided into three: the year preceding the submission of the application for a disability pension, the time from submission of the application to the making of the decision, and the year following the decision of the health authorities. The patients were divided into four subgroups according to whether the disability pension was awarded or rejected, and whether the patients accepted or appealed the decision. The total costs of care in the primary sector were calculated on the number of and charges for visits to GPs and the total costs of hospital care were calculated on the number of bed days, visits to outpatients clinics, operations, and investigations.


RESULTS
Patients with chronic pain had a significantly lower health care utilisation after the case has been closed. Those who did not get a disability pension and those who were not satisfied with the level of the disability pension, continued their utilisation of health care after the decision. The mean health care used by patients who appealed the level of the disability pension was three times higher than that used by patients who accepted the level of the disability pension.


CONCLUSIONS
The study indicates that lack of or insufficient economic compensation from the social system in patients with chronic pain may contribute to inexpedient behaviour leading to increased costs to the health care sector.
H:S Rigshospitalet, Tvaerfagligt Smertecenter, DSI Institut for Sundhedsvaesen, København.
J
J
Højsted
A
A
Alban
K
K
Hagild
J
J
Eriksen
D002908:Chronic Disease; D017281:Cost of Illness; D003718:Denmark; D004185:Disability Evaluation; D006301:Health Services Needs and Demand / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D018868:Insurance, Disability / Q000191:economics; D010146:Pain / Q000175:diagnosis / Q000191:economics* / Q000534:rehabilitation; D010415:Pensions; D012042:Registries; D018582:Sick Leave / Q000191:economics