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.

3

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?

7

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

9

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

11

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.

12

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.

13

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

14

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)

15

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

16

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

17

Implementation of ISSA Guidelines for RTW: Non-Occupational Health Conditions

18

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