Abstract:

Objective Based on the theoretical framework of International Classification of Functioning, Disability and Health (ICF), this paper compared the classification and grading methods of disability standards in four areas in China, focusing on definition, classification, grading, coding systems and assessment tools.
Methods Four disability standards including Disability Assessment and Code for Life Insurance (insurance standard), Classification of Disability Degrees for Human Body Injury (judicial standard), Grading of Disability for Work-Related Injuries and Occupational Diseases (work-related injury standard), and Classification and Grading of Disabilities for Persons with Disabilities (disability eligibility standard) were systematically analyzed. Each standard was reviewed to identify core elements of disability definitions, classification, and grading methods. Content analysis was used to extract and compare the definitions, classification, grading, coding systems, and assessment tools. The strengths, weaknesses, and practical limitations of each standard were analyzed using the ICF framework.
Results There were different in disability definitions, classification and grading, coding systems, and assessment tools across the standards. In terms of definitions, the insurance standard emphasized ICF's body structure and function impairments; the judicial standard defined disability as limitations in life and work capacity due to bodily injury, covering ICF's body structure and function, activity and participation; the work-related injury standard focused on loss of labor capacity due to work-related injuries, involving body structure and function, activity and participation; the disability eligibility standard refered to the ICF model, defining disability as impairments in body function and structure, and activity limitations and participation restriction. Regarding classification and grading, the insurance standard divided disabilities into eight categories based on body structure and function, with ten grades of disability severity; the judicial standard first graded disabilities into ten levels and then classified as injury site; the work-related injury standard divided disabilities into five categories based on clinical disciplines, grading from one to ten; the disability eligibility standard divided disabilities into seven categories, each with four grades. For coding systems and assessment tools, the insurance standard used ICF coding system, while the disability standard for persons with disabilities used a numerical coding system other from ICF, and the other standards did not use coding systems. Assessment tools varied significantly. The use of World Health Organization Disability Assessment Schedule (WHODAS 2.0) was proposed but not applying it in grading.
Conclusion This study has systematically compared and analyzed four typical disability-related standards in China using the ICF framework. Personal Insurance Disability Assessment and Coding, Grading of Disability Caused by Bodily Injury, and Classification and Grading of Disabilities for Persons with Disabilities are all promulgated after 2011, and adopt ICF concepts and methods to define and classify disabilities, considering body function and structure, activity and participation, and environmental factors. However, due to different purposes, their grading methods and levels vary: except for Classification and Grading of Disabilities for Persons with Disabilities, which uses a four-level grading system, the other standards use a ten-level system, primarily based on body function and structure. In disability assessment, the recommended methods differ by category, showing significant variability. Due to differing classification and grading methods, disability data from various standards are lack in comparability. The international trend advocates for a unified disability standard framework based on ICF and ICD-11 to enhance the comparability and exchangeability of disability data.

Key words: International Classification of Functioning, Disability and Health, disability, Disability Assessment and Code for Life Insurance, Classification of Disability Degrees for Human Body Injury, Standard for Identify Work Ability-Grading of Disability for Work-Related Injuries and Occupational Diseases, Classification and Grading Criteria of Disability