Occupational Rehabilitation for Workers with Non-Occupational
Health Conditions: A European perspective
Donal McAnaney PhD
International Forum on Disability Management
Monday October 15, 2018
Session 1C: International Perspectives - 1:30 pm to 2:45 pm
Vancouver Marriott Downtown Hotel
1
Background
• About 80% of people with disabilities experience its onset during their working lives (Statistics Canada, 2012).
• The vast majority of these experience disability as a result of non-occupational health conditions (Dupre & Karjalainen, 2003).
• The number of people of working age entering the disability benefits system in most developed economies is increasing and likely to become unsustainable (Organisation for Economic Cooperation and Development, 2003; 2009).
• Disability benefit recipients have less than a 2 per cent chance of exiting the system to employment in any year. This results in dependency and poverty for individuals, unsustainable social protection costs and increasing numbers of disability benefit recipients (Organisation for Economic Cooperation and Development, 2003, 2009).
2
Background
• Sickness and disability spending excluding early retirement accounts for about 10 per cent of total social expenditure (Organisation for Economic Cooperation and Development, 2008).
• Early intervention in return to work for workers with health conditions can reduce disability, protect quality of life and results in productivity gains for employers (Franche, Cullen, et al., 2005).
• Comprehensive multimodal (integrated) workplace health programs offer the most effective mechanism to reduce dependency and disability arising of from ill-health (Goldgruber & Ahrens, 2010).
• By ensuring that disabled workers are diverted from the disability benefits system back into the active labour market, DM has the potential to reduce disability costs to society, protect the rights of workers with disabilities and ensure the sustainability of the social protection system.
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Parallel Systems of Provision
• Health Condition • Occupational Health Conditions
• Non-occupational Health Conditions
• Funders • Statutory Insurance including Workers’ Compensation
• Private Insurance including Long-term Disability
• Social Protection/Public Employment Services
4
Defining Terms
5
Vocational
Rehabilitation (VR)
Occupational
Rehabilitation (OR) Disability Management (DM)
Intended Beneficiaries Intended Beneficiaries Intended Beneficiaries
Unemployed People with Disabilities
Society
Ill or Injured Workers
Employers Workers Society
Intended Outcomes Intended Outcomes Intended Outcomes
Labour Market Inclusion
Reduced Dependency
Reduced Poverty
Return to Original Job with or without Accommodations
Redeployment
Labour Market Inclusion Reduced Dependency Reduced Poverty Reduced Prevalence of
Disability Healthy and Productive
Workforce Reduced Disability Costs Increased Profitability
Defining Terms Vocational Rehabilitation
(VR)
Occupational Rehabilitation
(OR)
Disability Management
(DM)
Unique Components Unique
to VR
Components of OR Shared
with VR and DM Components Unique to DM
Assessment & Career Exploration
Independent Living/Personal Assistance
Further Education & Training
Job Matching Job Seeking Skills Job Trials Job Placement Support Supported Employment Social Development Adult & Basic Education
Functional Capacities Evaluation
Allied Health Interventions Condition Management Case Management and
Service Coordination Counselling & Guidance Building Functional
Capacity Disability Awareness
Training On-the-Job Support Job Demands Analysis Assistive Technology and
Accommodations Ergonomics
Accident Prevention and Safety
Health Promotions Employee and Family
Assistance Early Contact Early Intervention Transitional Work
Options
6
Research Question
What mechanisms are in place to ensure access to Occupational Rehabilitation for workers, who acquire or develop a non-occupational health condition in
selected European Member States?
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System Overview (Chamberlain et Al, 2009)
8
If f
acto
rs p
reven
t w
ork
resu
mp
tio
n
Work Resumption
↙(-) Social welfare/social
security law ↗(+)
↙(-) Application of the laws ↗(+)
If f
acto
rs f
acilit
ate
wo
rk r
esu
mp
tio
n
↙(-)
Rehabilitation
effectiveness/
resources
↗(+)
↙(-) Co-operation in
rehabilitation ↗(+)
↙(-) Economic factors,
labour market ↗(+)
↙(-) Medical factors ↗(+)
↙(-) Personal factors ↗(+)
Out of
Working Life
Methodology
• Expert Reports – European Platform for Rehabilitation
• Structured Questionnaire based on 4 detailed country case studies (McAnaney & Wynne, 2017)
• Expert Validation of Country Profiles
• 10 European Member States • Denmark • Finland • France • Germany • Lithuania • The Netherlands • Norway • Portugal • Slovenia
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Themes Explored
• Legal & Policy Context
• Structure & Content
• Referral and information sources
• System of Delivery
• Financing & Resources
• Organisational & Individual Incentives & Support
• Approaches to Quality & Accreditation of Services
• Conclusions and Lessons Learned
10
System Actors and Responsibilities
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Executive Agencies DK FI FR DE LT NL NO PT SI ES
Disability, Employment or
Vocational Service
● ● ●
Public Employment
Service
● ● ●
●
Vocational Education and
Training
●
Pensions ● ●
Workers Compensation ● ● ● ● ● ●
Private Insurance ● ●
Work and Income
Social Insurance or
Welfare ●
● ●
●
Municipalities ●
National Organisation for
the Blind
●
Health ● ●
Funding • Most jurisdictions operated workers’ compensation systems on a ‘no
fault’ basis apart from the Netherlands and Denmark where occupational injuries were covered through employer private insurance
• Occupational rehabilitation services for non-occupational health conditions were most often available through systems run by social protection or employment agencies
• Spain was unique in its approach as it is lottery based.
• Four jurisdictions financed the system through some form of national social insurance (Germany, France, Lithuania and The Netherlands)
• Three out of general taxation (Denmark, Norway and Portugal).
• Statutory health insurance also funded services in Germany, France and the Netherlands and in Germany the Pension Funds were also involved.
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Eligibility for Occupational Rehabilitation Services • Eligibility criteria jurisdictions varied substantially.
• Any person experiencing the permanent consequences of a disability was considered eligible if he or she had a reduced potential to secure, retain or advance in employment.
• A risk of long-term benefits dependency. • France had a wide eligibility framework that covered anyone
with a documented disability whether employed or unemployed if they were considered on the basis of a needs assessment to be able to benefit from vocational rehabilitation.
• This was also considered to be a criterion in Norway. • Denmark, anyone within the catchment area of a service not
receiving another employment service was eligible.
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Common Components of Occupational Rehabilitation • Assessment & Evaluation
• Advice & Guidance
• Vocational Education & Training
• Health & Wellbeing Support
• On the Job Support
• Adaptations & Technologies
• Service Coordination
• Alternative Employment Options
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Key Findings
• All jurisdictions provided incentives and support to individuals and employers to make it easier to gain employment or return to work.
• Job retention services for employees at risk of job loss were only identified in Finland
• Seven countries operated case management services (DK, FI, DE, LT, NL, PT, SI)
• The alternative delivery mechanism was a multi-disciplinary team approach (FR, NO,ES)
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Additional Findings
• Apart from Finland, no formal reference pathways from medical to occupational rehabilitation were identified
• Employer or workplace focused services were not specified formally in any country
• Only Finland operated formal early intervention guidelines (30-60-90 Model)
• Jobs retained were not specified as an impact indicator
• Certification requirements for professionals varied significantly
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Areas for Improvement
• Strengthening the policy basis for Occupational Rehabilitation
• Widening access to OR services
• Creating a continuum of services
• Engaging all actors in creating more responsive services
• Working more closely with employers
• Implementing efficient quality improvement processes
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Implementation of ISSA Guidelines for RTW: Non-Occupational Health Conditions
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Guideline Level of Development
6.
Comprehensive and integrated
approach with an emphasis on
prevention
Significant development
required
7. Beginning at the workplace
8. Combining medical treatment and
vocational rehabilitation
10. Early identification and intervention
12. Beginning during acute medical
treatment
14. Case management Available in 7 Countries
15. Individual plan. Well developed