title: Between health care and social security--psychiatric patients and the disability pension system in Norway and Russia.
abstract: BACKGROUND
  The official statistics of persons with mental disorders who are granted disability pension (DP) in Russia and Norway indicate large differences between the countries.
  
  
  METHODS
  This qualitative explorative hypothesis-generating study is based on text analysis of the laws, regulations and guidelines, and qualitative interviews of informants representing all the organisational elements of the DP systems in both countries.
  
  
  RESULTS
  The DP application process is initiated much later in Norway than in Russia, where a 3 year occupational rehabilitation and adequate treatment is mandatory before DP is granted. In Russia, two instances are responsible for preparing of the medical certification for DP, a patients medical doctor (PD) and a clinical expert commission (CEC) while there is one in Norway (PD). In Russia, the Bureau of Medical-Social Expertise is responsible for evaluation and granting of DP. In Norway, the local social insurance offices (SIO) are responsible for the DP application. Decisions are taken collectively in Russia, while the Norwegian PD and SIO officer often take decisions alone. In Russia, the medical criterion is the decisive one, while rehabilitation and treatment criteria are given priority in Norway. The size of the DP in Norway is enough to cover of subsistences expenditure, while the Russian DP is less than the level required for minimum subsistence.
  
  
  CONCLUSIONS
  There were noteworthy differences in the time frame, organisation model and process leading to a DP in the two countries. These differences may explain why so few patients with less severe mental disorders receive a DP in Russia. This fact, in combination with the size of the DP, may hamper reforms of the mental health care system in Russia.
authors: Nordland Hospital, Psychiatric department, N-8092, Bodø, Norway. grigory.rezvy@nlsh.no
authors: Grigory
authors: G
authors: Rezvyy
authors: Walter
authors: W
authors: Schönfelder
authors: Terje
authors: T
authors: Øiesvold
authors: Reidun
authors: R
authors: Olstad
authors: Georges
authors: G
authors: Midré
mesh_terms: D000328:Adult; D003431:Cross-Cultural Comparison; D004185:Disability Evaluation; D017408:Guidelines as Topic; D006291:Health Policy; D006801:Humans; D018868:Insurance, Disability / Q000331:legislation & jurisprudence; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000191:economics* / Q000628:therapy; D009664:Norway; D010415:Pensions; D036301:Qualitative Research; D012426:Russia; D018582:Sick Leave / Q000191:economics / Q000331:legislation & jurisprudence; D012945:Social Values
references: J Intellect Disabil Res. 2006 Aug;50(Pt 8):555-60
references: 16867062
references: Soc Psychiatry Psychiatr Epidemiol. 2007 Feb;42(2):131-9
references: 17160593
references: Scand J Prim Health Care. 1998 Dec;16(4):199-203
references: 9932311
references: Tidsskr Nor Laegeforen. 1999 Jun 10;119(15):2192-6
references: 10402914
references: Scand J Prim Health Care. 2004 Dec;22(4):228-32
references: 15765638
references: Acta Psychiatr Scand Suppl. 2001;(410):56-62
references: 11863052
references: Tidsskr Nor Laegeforen. 2002 Jun 10;122(15):1486-91
references: 12190052
references: Health Hum Rights. 1999;4(1):82-113
references: 10438556
references: Health Policy. 2006 Dec;79(2-3):144-52
references: 16472887
references: BMJ. 2004 Jan 10;328(7431):88
references: 14691065
references: BMC Health Serv Res. 2005 Nov 09;5:70
references: 16281967
references: Acta Psychiatr Scand Suppl. 2006;(429):41-5
references: 16445481
references: Med Sci Monit. 2002 Dec;8(12):RA275-81
references: 12503047
references: Tidsskr Nor Laegeforen. 1995 Mar 20;115(8):962-5
references: 7709389
references: Fam Pract. 2000 Apr;17(2):139-44
references: 10758076
references: Int J Epidemiol. 2002 Dec;31(6):1183-91
references: 12540720