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Minerva Medicolegale 2020 December;140(4):76-82

DOI: 10.23736/S0026-4849.21.01799-5


lingua: Inglese

Indemnisable illness of fixed-time agricultural workers: a preliminary experimental study

Alessio SULLO 1, Vincenzo MARTIGNETTI 2, Leopoldo FERRANTE 1

1 INPS Medical Examiner’s Center in Avellino, Avellino, Italy; 2 INPS Medical Legal Center of Benevento, Benevento, Italy

The social health insurance managed by INPS provides workers with compulsory insurance with an economic indemnity in the event of illness resulting in temporary and absolute incapacity for specific work (Article 6 of Law 138/43, Article 2110 of the Civil Code, Article 38 of the Constitution 1st paragraph, Art. 2 Law 33/80). For the first 3 days of illness, there is a deductible, referred to as a deficiency, the economic coverage of which is borne by the employer, according to the specific contractual provisions. The right to sickness allowance, therefore, runs from the 4th day, does not include Sundays and holidays and ceases upon expiry of the prognosis. To obtain the insurance benefit, the worker is obliged to transmit one or more medical certificates containing the diagnosis and clinical prognosis to INPS. The current disease certification analysis model is based on a statistical multivariate analysis technique (data mining), which makes it possible to report the most ‘at-risk’ certificates in terms of the prognosis adequacy, based on a probability indicator. The risk not only refers to cases of so-called suitability (i.e. of workers able to resume work due to termination of the indemnifiable illness) but also for cases of non-existence of illness or reduction of the forensic prognosis following a more favorable clinical course than expected. Data mining allows one to examine all active certificates at the time of analysis and, therefore, not just those recently received. With the help of the SAVIO system (system for the assignment of optimized visits), the combinations between available doctors and proposed visits are optimized, in full automation and maximum timeliness. To carry out the work, a further 286 visits were added to the ordinary budget of home check-ups available ex officio in the period 20/04/2017 - 10/05/2017. Medical checkups were carried out, as usual for office visits, only on non-holiday days. The study design envisaged an increase in the number of visits assigned to agricultural OTDs, compared to the standard required by data mining, equal to 286 additional visits in the reference period. The statistical analysis did not show significant differences between the percentages of eligible and confirmed in 2017 compared to 2016. The results of this study, although highlighting some methodological and analytical limitations, also present encouraging data that justify the launch of a more structured experimentation in the coming years. During the next trials, periodic checks should be provided to evaluate the study’s progress and, upon reaching its limit, stop it in the event of clear uneconomicity. The final assessment should be carried out in the first month of the following year and should include the use of an outcome indicator (output/outcome) that allows to evaluate the overall impact of the proposed operating model on the economic value of production.

KEY WORDS: Forensic medicine; Social security; Data mining

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