Quality of work incapacity assessment in the Swiss disability insurance system

Quality of medical assessment of work incapa-city has been poorly investigated, despite the enormous costs engendered by transient incapa-city of work and permanent disability. This study examined some indices of quality from a stratified, random sample (n = 120) of assessments per-formed by expert assessors of the Swiss disability insurance. The distribution of work incapacity (WI) percentages over a 100 % scale showed a clustering around key values significantly asso-ciated with financial disability benefits. The precision of WI, expressed as the level of quantitative exactness, was found to be high in 74 % (95 % CI: 66-82%) of current WI assess-ments, and in 62 % (95 % CI: 53-71%) of maximal WI assessments. Disagreement was observed in 17 % of cases when comparing two ways of expressing WI by the same physician (95 % CI: 10-23%). This exploratory study is limited by the general lack of objective criteria and standards. Further theoretical and empirical developments are needed to determine standar-dized criteria and clear guidelines for medical assessments of WI, as well as for evaluating thei