Sickness Benefit
August 12th, 2008 at 3:12 pm by David FarrarMacDoctor has an interesting post on sickness benefits. He observes:
It is my experience when I do GP locums, that sickness beneficiaries fall into the same categories. There are genuinely ill people, many of whom will eventually gravitate to invalid benefits. There are genuinely sore people who have long-term recovery problems from old injuries. But about a quarter of beneficiaries are undoubtably “swinging the lead”. They are the lower back pains that flounce into your office and flop into a chair without a single grimace. They are the asthmatics who apparently can go to gym or karate, but wheeze whenever they are near work. They are the depressives who laugh and joke with you as you fill in their form.
The 25% estimate would equate to around 10,000 people.
Now people might ask why doctors give out certificates. MacDoctor explains in full, but the summary is:
The real reason that all GPs blithely sign sickness benefit forms, even though we know they may not be genuine, is that we don’t know that they are not genuine, we only suspect. For most of the suspicious cases, you would need a number of investigations, or a specialist opinion to confirm your suspicion. Your patient will either refuse to go, or make appointments with the specialist and then simply not attend. And there is no way you can force them.
His solution:
The only way this can stop is if you compel sickness beneficiaries to have an annual (or six monthly) medical with an independent doctor, preferably a specialist. This is not only good politics, it is actually good medicine, as specialist review of long-term illness is good clinical practice. Frankly, I don’t see this as being unpopular with sickness beneficiaries, apart from the ones milking the system. The majority of them would love to get better and go back to work, if they could.
National’s policy is that after 12 months on teh sickness benefit you see a designated independent doctor.
Related posts:
- How to gain a bigger benefit
- A decade on the sickness benefit
- Welfare reform is coming
- Invalids Benefit
August 12th, 2008 at 3:41 pm
Going back a few years to when I was the Police Court Orderly at a Major Centre District Court, the number of “Sickness Beneficiaries” that were arrested and charged with Burglary,Fighting, Assualt etc was unbelievable really.
Vote:August 12th, 2008 at 3:42 pm
That’s a frighteningly blinkered understanding of depression from someone who claims to be a GP. Mind you, one of the most eye-opening jobs I had was as a medical representative, “detailing” (aka trying to convince them to prescribe our drugs) GPs around the bottom half of the North Island. Most were highly intelligent and genuinely committed to patient care but I was surprised by the number who seemed to have a fixation on one particular disease and thought all their colleagues were over-diagnosing and over-prescribing.
Since I was flogging asthma medications it was that disease I debated most often. I still wonder what happened to patients of the narrow-minded quack in Wanganui who insisted that the only people who suffered it were women and children and that that was because it was all due to “their being too emotional”. His prescription was “a good strong cup of tea”.
Those suffering from depression can still laugh and joke with others. In fact they develop a great deal of skill in “appearing normal” so as to avoid the ostracision that comes with being known to have a mental illness. And for many, their GP is the one person they feel they can talk to without fear of judgement, so they’re paradoxically likely to be superficially happy to be there.
A GP who understood depression would know that in fact it’s someone who walked in with their features drooping and listed off the symptoms of depression as per DSMIV who is probably the malingerer.
And he might recall that asthma is triggered by various challenges to the immune system, so that while whatever’s in the air at the gym and the dojo might not cause an attack, something in the air at work (chemicals, dust etc) might.
Which is not to say there aren’t lead swingers. Just that that’s a superficial diagnosis of the type.
Vote:August 12th, 2008 at 3:46 pm
It goes like this – gimmie a sickness benefit or I will punch ya lights out.
Vote:August 12th, 2008 at 4:03 pm
Rex, I think you have to read the extract in context to see that MacDoc is not suggesting that every laughing, joking depressive is a malingerer. I would be surprised if MacDoc couldn’t tell the anxious chuckle and forced humour of a depressive (not bi-polar) from the carefree bonhomie and thigh-slapping joking of a malingerer.
Moving on (before we get immersed in a debate about the symptoms of depression), I was surprised at MacDoc’s estimate of 25%. The tories get an awful lot of political milage out of the malingerers it seems to me.
Vote:August 12th, 2008 at 4:04 pm
Tim
You really have no idea do you….
It goes like this…
WINZ Case officer: Hey John, how are things with you, any luck finding a job?
Dole Bludger: Nah, been a bit busy lately aye.
WINZ: Thats no good, how long have you been on the dole now?
DB: Two years.
WINZ: Shit!, is it that long
DB: Yeah man.
WINZ: (thinking about last memo from Dyson demanding a reduction in unemployment numbers) Tell me John, are you feeling a bit low?
DB: Nah man, I feel like shit cos I got on the piss last night.
WINZ: Thats good enough for me, rip down to our Doctor, you are obviously suffering from stress.
DB: Nah man, I told you I am crook with the piss.
WINZ: John, I am giving you a pay rise.
DB: You mean I get more dole money?
WINZ: If you go on the sickness benefit you do.
DB: Chur man!, I am about as stressed as a dude can get, where did you say this Doctor is?
WINZ: Just around the corner, I will ring him and tell him that you are on your way.
DB: And you fella’s are going to pay for the consultation aye?
WINZ: of course John
Vote:August 12th, 2008 at 4:06 pm
Jafa
So you think its perfectly acceptable for 25% (I suspect it is a lot more than that) of the people on the sickness or invalids benefit to be stealing from the tax payer do you?
Vote:August 12th, 2008 at 4:17 pm
McDoc is fairly accurate.
My doctor friends talk about the scenario when someone comes in for an appointment asking for their sickness benefit form to be signed.
They are not coming for a diagnosis or a second opinion. Simply to have their certificates signed.
If the doctor does not sign the form then the patient will go elsewhere to another doctor and the funding subsidy goes with them.
If the form says anxiety or depression then someone has put this diagnosis ( actually just a convenient label) on the form.
It is so much easier to sign the form with minimal questioning when you are 25 minutes late and can get the person out the door in 2 minutes thus catching up time.
Doctors who refuse to sign certificates willy nilly and only do so for genuine cases actually get few if any patients presenting for sickness form filling.
There is a perverse economic incentive to accept the form and just sign it.
This then produces a document certifying an ilness but actually technically a probable fraud.
Some doctors sign dozens of these each week.
Doctors would love to have a system whereby there was independant review of long standing cases.
Where the hell do you think National policy on this came from?
Vote:it comes from doctors feedback to National , doctors who are fed up with the current system
August 12th, 2008 at 4:40 pm
Fisiani
That just shows us what a silly policy it is. Clearly there are more sickness beneficiaries than there are doctors. If you wanted to buy the votes of either of these groups why oh why would you pick the smaller group.
National just don’t understand the concept of saying “bugger the country and the tax payers – it’s about power for us!”.
Vote:August 12th, 2008 at 5:09 pm
Interestingly, MacDoctor also says:
The other significant thing that MacDoctor recommends is to “compel sickness beneficiaries to have an annual (or six monthly) medical with an independent doctor, preferably a specialist. This is not only good politics, it is actually good medicine, as specialist review of long-term illness is good clinical practice.”
Note that National’s policy does not suggest the review is by a specialist, which MacDoctor recommends. It will be by a GP (because that is all they will be able to afford from the $1.2m costing. The danger is that Work and Income will favour “tame” GPs, who will tend to assess beneficiaries as fit for work when there is some doubt in order to be confident of ongoing referrals.
I would support this policy if the independent assessments were done by specialists who had a greater understanding of the medical condition of the beneficiary, and who, because of their seniority (and therefore income) were less likely to be corrupted by the prospect of easy bucks from Work and Income referrals. And because, as MacDoctor says, a specialist review of long-term illness is good clinical practice. National’s policy, however, will not achieve these objectives. It is purely fiscally motivated – to get sickness benefit numbers down.
Vote:August 12th, 2008 at 5:09 pm
“Doctors would love to have a system whereby there was independant review of long standing cases.”
Yes, honest and responsible doctors would. Many good doctors refuse to become complicit in little conspiracies that produce false sickness benefit forms or sickness certificates required by employers.
But there is still a worrying number of GPs out there who think only of their own incomes – they sign the form, pocket the money, and justify their dishonest actions to themselves by blaming something remote like a “perverse economic incentive to accept the form and just sign it”. Ultimately we all bear the cost.
Vote:August 12th, 2008 at 5:17 pm
He’s right that it should take a proper investigation, not just his opinion, to “out” a sickness benefit abuser, though, because there’s a big difference between walking into the doc’s office for 15 minutes, and doing 8 straight hours of something a day.
Vote:And you’d want to make certain someone really was unworthy, before you cut off their income…
August 12th, 2008 at 5:19 pm
I had a large number of doctor clients when I was operating my business in NZ before emigrating and sometimes this issue would come up in conversation. One aspect of sickness beneficiaries seeking compliant GPs not mentioned by McDoc and Fiasini are the standover tactics and threats of violence made by some patients when a GP declines to sign. Some come with partners who are equally threatening and violent thus ramping up the pressure. Bogus beneficiaries seek out young and female GPs they consider to be weaker. If one GP in a practice is seen as a softer touch, these types of beneficiaries gravitate towards the weaker GPs. People just respond to the incentives (or lack of disincentives) in the system. This policy’s introduction is so simple and basic it defies belief that Labour has resisted it for so long.
I remember reading the Court section of the paper and seeing the numbers of sickness beneficiaries who were well enough to burgle, rape, murder and commit violent assaults. This policy will flush them out leaving the benefit to be paid to those in genuine need.
Vote:August 12th, 2008 at 5:36 pm
Years ago, there was this sickness beneficiary who got so mad with someone that he got out of his wheelchair to hit him.
I also heard of a school leaver who went to a GP to get a sickness beneficiary certificate and the GP refused to issue her one. The father phoned the GP threatening all sorts of tings if he did not give her one.
It turned out that the older child was on a sickness benefit while attending university, and the younger child was planning to do the same. I think sickness beneficiaries get teritiary fees paid to facilitate rehabilitation (I am not sure). Saves all the bother of paying back a studen loan.
Vote:August 12th, 2008 at 5:50 pm
peterwn said: I think sickness beneficiaries get teritiary fees paid to facilitate rehabilitation (I am not sure). Saves all the bother of paying back a studen loan.
Not true. Invalid’s Beneficiaries can get assistance – the Training Incentive Allowance – to cover course fees etc. Sickness beneficiaries cannot.
Anyway, we should get rid of the ridiculous student loan scheme, cap tertiary fees, and pay universal student allowances. We’ve now got over $10billion in student debt racked up. This is a significant financial risk for Government if the economy heads south and heaps of graduates decide to go overseas and never come back.
Vote:August 12th, 2008 at 5:55 pm
As toad points out, having sickness beneficiaries reviewed by “WINZ GPs” raises the spectre of WINZ contracting only those GPs it knows will give it the answers it wants to hear (i.e. that most beneficiaries are fit for work). In effect they’ll use the threat of withdrawal of a lucrative income stream in the same way that some beneficiaries will doctor shop till they find one whose desire for dollars outweighs their clinical judgement.
It then becomes a messy argument of “my doctor knows more than your doctor”. This happens in states of Australia which don’t have no fault accident compensation systems. The bludgers know which doctors will sign them unfit for work and the insurance companies know which doctors would say a quadraplegic could always sort washers with their head pointer.
The people who lose out worst of all are those with hard-to-diagnose problems, mental illness (in the case of accidents, mainly depression and PTSD) chief amongst them.
The only way around it is to have an agency that is independent of government, and which employs specialists, and which is funded a set amount per year regardless of how many referrals they deem fit for work or not. Fairness, however, costs money and doesnt always give you the answers you want to hear.
So Labour will continue to favour the malingerers, National will continue to vow to make life miserable even for the truly deserving (who have to keep re-proving their deservedness, which can be removed on the whim of a GP) and knees will continue to jerk this way and that.
Vote:August 12th, 2008 at 6:04 pm
Well said Rex! The Solutions are Green, and what you’ve posted could almost be taken straight out of Green Party policy. When you joining up mate? You can do it here.
Vote:August 12th, 2008 at 6:25 pm
Booo Rex . Spare a though for the truely deserving taxpayer. We’re deserving of good value ‘hand up’ social spending, and the genuinely needy are deserving of more help, not less on account of the fraud that exists today.
Vote:August 12th, 2008 at 6:36 pm
If the solution to the problem is Green then god help us.
Vote:August 12th, 2008 at 6:38 pm
Rex
“So Labour will continue to favour the malingerers, National will continue to vow to make life miserable even for the truly deserving (who have to keep re-proving their deservedness, which can be removed on the whim of a GP) and knees will continue to jerk this way and that.”
Jesus mate, you are beginning to sound a bit like Winston, there is no evidence that the Nat’s are going to make life miserable for the (few) genuine or truly deserving, certainly not as long as John Key is in charge.
Vote:August 12th, 2008 at 6:51 pm
Rex is on the money with this;
“So Labour will continue to favour the malingerers, National will continue to vow to make life miserable even for the truly deserving (who have to keep re-proving their deservedness, which can be removed on the whim of a GP) and knees will continue to jerk this way and that.”
The issue is being tackled at an ideological political level (knee jerk) and it should be an issue that has multi party support. We are talking about people who genuinely need the benefits and people who milk the system. We cannot attempt to draw a line between the two groups unless we use a transparent process that is not bias toward a certain outcome, a process that is a qualified assessment involving more information and testing than can be conducted in a few 10 minute GP visits.
It’s hard to imagine people defending welfare cheats, but they do. It’s astounding how far the ethics of this country have fallen under the hand-out mentality of rampant and expanding welfareism.
Vote:August 12th, 2008 at 6:59 pm
Lots of great discussion going on here! I should point out that I don’t suggest WINZ-employed GP reviews quite deliberately. Although I think most of my colleagues would be relatively impartial, the incentives to over-refuse benefits would always be there. I much prefer allowing the GP to choose an appropriate specialist in private practice, with WINZ footing a negotiated standard fee. This has the benefit of being the most impartial and the most useful to the patient. Overall, this is likely to help some of the genuinely sick to get better as well.
And, Rex, yes I do know that depressives can fake bonhomie quite well. However, I do like to keep the medical aspect of my blog as simple as possible.
Vote:August 12th, 2008 at 7:09 pm
There is good reading in the book ‘The Millionaire Next Door – The Surprising Secrets of American’s Wealthy’ (Thomas J. Stanley, Ph.D & William D. Danko, Ph.D.) with regard to economic out patients. The concept of economic out patients is very well presented in welfare states. It’s a more complex analysis of the concept ‘Give a man a fish and feed him for a day – teach a man to fish and he can feed himself forever’.
It’s undeniable that we have lifestyle welfare people in our economy, it’s bewildering that Labour can be against National’s idea to reduce the drain on tax payers resources. Clearly the votes from welfare cheats are more important to Labour than being accountable for tax payers money.
Vote:August 12th, 2008 at 7:20 pm
Privatise all welfare….practice tough love and seperate the pollies from the incentive to keep people dependant for political gain.Taxpayers become charitable givers,the really needy are looked after while the scum are out on their arses ….a big win I think and moral too….the State can’t provide welfare without violating some peoples rights…a no no and the complete opposite of why Governments are created in the first place.
Vote:August 12th, 2008 at 7:36 pm
toad: Sorry but I’m presently of the opinion that, to misquote big bruv, if the solution is any political party then god help us. The fact that I can see positives in many of the things Act advocates as I can in many of the things the Greens advocate but the chances of them ever working towards a viable compromise is virtually nil because they are political parties just gives me the shits basically. Mind you, they’re both (along with the Maori Party) parties of principle which is more than can be said for anyone else.
But all too often principle becomes confused with rigid ideology (just look at the karma hammering I’m taking here, for instance LOL). Ideology dictates that the 75% (on MacDoctor’s figures) of decent, honest, deserving sickness beneficiaries must be treated like worthless malingerers in order to weed out the 25% who are worthless malingerers.
MacDoctor: Fair enough, my apologies for implying you were amongst those who couldn’t tell the difference. They are out there, though. I’m not sure about NZ but there’s a lot of work going on in Australia (e.g. Beyond Blue) to convince the doubters that depression isn’t just the way most people feel every Monday morning and it’s in fact a genuine, debilitating illness. As I have a personal interest in the topic I guess I just worry that those who see is as “just another excuse for malingering” can point to a quote from a doctor to support their prejudices, even if that wasn’t your intention.
Vote:August 12th, 2008 at 7:53 pm
Apology accepted, Rex. Any doctor who doesn’t think depression is a nasty, debilitating illness is one in serious need of some medical re-education.
Ideology dictates that the 75% (on MacDoctor’s figures) of decent, honest sickness beneficiaries must be treated like worthless malingerers in order to weed out the 25% who are worthless malingerers.
I can’t see how an unbiased specialist review can be construed as treating someone as a “worthless malingerer”. If you are actually ill, I would have thought this would be a positive experience.
Vote:August 12th, 2008 at 8:02 pm
Agreed, MacDoctor. It works reasonably well with ACC – although there are still disputes among specialist about whether conditions such as chronic pain syndrome and multiple chemical sensitivity are injuries or illnesses.
I also think that if a beneficiary/ACC claimant wants to challenge the medical evidence, then they should be funded for a consultation with a specialist of their own choice – just to ensure there are checks and balances in the system. I’d rather see the State pay for an extra assessment that may, in may cases, be unnecessary, than see people who are not fit for work be forced to try to work, to their detriment and possibly that of their employer or workmates.
Vote:August 12th, 2008 at 8:28 pm
Besides all these tedious broken old favourite records that everybody loves to play – over and over and crack, crackle, over and…
Why not pay [all] beneficiaries xtra for going to job interviews? That way they may feel secure to try and get jobs they actually want to keep and it will be easier to check the performances or lack there of.
Vote:August 12th, 2008 at 8:37 pm
I think there is some good content here (have two of the most destructive commentors gone away perhaps?).
What some on the left miss is that the population as a whole are supportive of the welfare state so long as they can see that those on welfare are deserving. 25% of malingerers may be a smallish proportion of the total, but it poisons the overall support for the welfare state, and results in less sympathy for programs that are designed to genuinely help people in need, and for a level of payment that is anything more than a very basic living allowance. If we are to make the life of those genuinely in need easier, we need to first ensure that those who are undeserving are not able to take advantage of that system.
This policy should be one that the Greens support for exactly that reason.
Vote:August 12th, 2008 at 8:40 pm
PaulL – Appreciate your comments. Always well considered, well balanced. Thanks!
Vote:August 12th, 2008 at 9:19 pm
PaulL said: have two of the most destructive commentors gone away perhaps?
3 actually – Philu, Redbaiter, and Nome. Just get rid of Murray and we could have a highly intelligent week of discussion here.
Vote:August 12th, 2008 at 9:25 pm
Rex
Haven’t read through the rest yet, but want to add to your comments before I get too far down.
Depression is a bitch. I’ve suffered from it to the extent that I decided the only way to deal with it was to come home from a high-paying job on the other side of the world to a pittance in New Zealand, to try to lessen the stress and get my head together. And when I was finally diagnosed with depression, even though I had known for several months, everyone I knew was astonished. How could I be depressed? I was, after all, always so bubbly, so cheerful. And all the time, I was feeling like utter shit.
You are right. Laughing, smiling, joking, gives no clue to whether a person is depressed or not. Depressives don’t all walk around looking glum and gloomy. Very possibly those who are walking around looking glum and gloomy are healthier, because they’re not expending enormous amounts of energy trying to fight the reality of their existence at that point in time.
People who have never been depressed, or never really known a depressed person, actually have no clue. It’s shit. And you spend most of your energy trying to hide the fact so that other people don’t think you’re a loser.
Vote:August 12th, 2008 at 10:28 pm
It really is quite amazing the ability for the ‘dole-bluddger’ topic to empassion even the rarest of weekend-warrior-type politician. I have friends who sat glazy-eyed through bitter-battles both for and against the ‘reasonable-force repeal bill’, who come close to smacking anyone with even the closest wiff of compassion or compromise (‘fake’ invalids) now that this topic has reared it’s purulent-smelling head.
For me, I identified closely with Russell Brown’s comments- “These policies meet a moral belief more than they meet a demonstrated need.” and “And in a sense, they’re right: in general, if people can find sustainable work, they are better in that.”.
MacDoctor, other health-professionals here (and probably any manager-types) will relate to the concepts of efficacy-of-intervention and cost effectiveness. It might be hard to justify the extents (monetarily or otherwise) which would be needed to successful flush out ‘fakers’ on the basis of cost-effectiveness alone; another of Russell’s comments, “Like the now-abandoned work-for-the-dole, the policy doesn’t come cheap or free.”
I’m a medical practitioner also and I’ve got a slightly different perspective- with the level of resourcing (time in particular) I have available to me, the benefits of challenging ‘symptomatic-bludgers’ simply are not there. I would much rather focus my limited time, energy and attention span on improving the immediate health problemsof my patients, not on challenging them.
Vote:August 12th, 2008 at 10:45 pm
PaulL
“If we are to make the life of those genuinely in need easier, we need to first ensure that those who are undeserving are not able to take advantage of that system.”
Actually, PaulL, I think you’ve got it arse about face there. In order to ensure that the life of those genuinely in need is made easier, I believe you have to accept that there will be some advantage taken of the system. That doesn’t mean you have to condone it, and it doesn’t mean that there shouldn’t be checks and balances, but there will always be intelligent shits who are able to rort the system. The only way to ensure the system is unrortable is to make sure that any doubt of worthiness (read innocence) is always removed. Therefore, the starting point of judgement always has to be: you are unworthy (guilty), prove to me that is not the case.
You might like to consider it in relation to this widely held belief: it is better that many guilty people go unconvincted, than one innocent person is found guilty.
There is a balancing act – at which point between “many” and “one” are you prepared to draw your line in the sand? Because wherever you draw it, an injustice will be done. Do you prefer that that injustice punishes the worthy or lets the unworthy off?
Vote:August 13th, 2008 at 12:30 am
Political Busker: Now there’s the sort of practical, common sense, ideology-free thinking I’m talking about! Brilliant. Simple. Workable. Obvious. And therefore unlikely to ever make it to any party’s manifes… sorry, bullet points.
Penelope: Well said. Anyone who believes someone truly suffering from depression (as opposed to faking it to facilitate a spot of malingering) needs to read your description of what’s it like. And you’re right,I believe, in your assertion that we have to accept some low life ratbags taking advantage of the system if we’re to ensure no one who’s truly in need misses out. It’s the social policy equivalent of the “better 10 guilty men go free than one innocent man is wrongly imprisoned”, in which I also believe. Of course we shouldn’t stop trying to improve the system so that less guilty men go free and fewer bludgers can take advantage of the system, but we’ll never achieve perfection unless we’re prepared to let the deserving / innocent suffer.
dandy: Welcome to Kiwiblog
I too thought Russell had it spot on.
Vote:August 13th, 2008 at 1:21 am
There should be no issue with all recipients having to attend a specialist assessment center at Waiorou
Cough and drop, Cold showers, Assault Course, and then some Bromide to calm them down!
Only fair when you think how much money is harvested!
Vote:August 13th, 2008 at 3:07 am
Time to get the sick notes back to work.
Vote:August 13th, 2008 at 10:13 am
Personally I think depression has just become the new buzz word for unhappy. In many cases the persons are unhappy because they have chosen a life style that could not possibly make them happy.
Vote:August 13th, 2008 at 10:28 am
PaulL
Couldn’t agree with you more.
The average Kiwi is quite happy to help anyone that genuinely needs it, because they know that they could one day be in the same situation and would hope others would help them.
The dragon appears when they know there are thousands who rip the system, on both unemployed and sickness benefits.
To an average Joe such as myself, it defies belief that we have a medical professional (Dandy) admitting on this site, that it is easier for him (or her) to just authorise the medical forms, than to actually validate the claims.
Surely the cleaning out of the bludgers involved is a doomed exercise unless we can change this perception.
Vote: