2 YEARS LEGISLATION ON RETURN TO WORK IN BELGIUM: EXPERIENCES OF A LARGE OCCUPATIONAL HEALTH SERVICE Godewina Mylle European Conference for Socio Professional Rehabilitation Brussels, March 7 th , 2019 1
BACKGROUND • 28/11/2016: new legislation on return to work (RTW) • Regulation of access to occupational health physicians during sickness absence to support RTW o On initiative of employee himself (at any moment during absence) o Referral by employer (after 4 months of absence) o Referral by general practitioner (at any moment during absence) o Referral by medical advisor (at any moment during absence – use of Quickscan after 2 months of absence (see poster session: Quickscan to assess Risk of Long-Term Sickness absence: predictive validity by Goorts K.) ) 2
OBJECTIVES AND METHODS OF THE STUDY • What? Assessment of the conditions for which RTW carried out by the regulations of the new legislation was more successful • How? By analyzing the trajectories carried out by IDEWE o one of the largest Occupational Health Services in Belgium o +/- 800 000 employees under occupational health surveillance o 5 935 trajectories from 1/1/2017 until 17/12/2018 o Descriptive analyses: distribution of trajectories by gender, age, company size, initiator, sector of employment and duration of sickness absence o Regression: to study the relation between the outcome ‘re - integration’ and the various covariates (see above) 3
RESULTS DISTRIBUTION OF THE TRAJECTORIES BY GENDER (VS. DISTRIBUTION OF EMPLOYEES UNDER SURVEILLANCE) 100 % 90 80 % 100 70 60 90 50 40 80 30 20 70 10 0 60 TOTAL GROUP (n=778804) MEN (n=341896) 43,9 WOMEN (n=436908) 56,1 50 40 30 20 10 0 TOTAL GROUP (n=5935) MEN (n=2000) 33,7 WOMEN (n=3935) 66,3 4
RESULTS DISTRIBUTION OF THE TRAJECTORIES BY AGE (VS. DISTRIBUTION OF EMPLOYEES UNDER SURVEILLANCE) % 100 100 % 90 80 90 70 60 80 50 40 70 30 60 20 10 50 0 TOTAL GROUP (n=773724) Age 15-24 (n=76392) 9,9 Age 25-34 (n=179009) 40 23,1 Age 35-44 (n=184972) 23,9 Age 45-54 (n=189745) 24,5 30 Age 55 and older 18,6 (n=143606) 20 10 0 TOTAL GROUP (n=5935) Age 15-24 (n=162) 2,7 Age 25-34 (n=1105) 18,6 Age 35-44 (n=1612) 27,1 Age 45-54 (n=1899) 32,0 Age 55 and older 19,6 (n=1163) 5
RESULTS DISTRIBUTION OF THE TRAJECTORIES BY COMPANY SIZE (VS. DISTRIBUTION OF EMPLOYEES UNDER SURVEILLANCE) % 100 100 90 % 80 90 70 60 80 50 70 40 30 60 20 10 50 0 TOTAL GROUP (n=706936) A (n=302415) 42,8 40 B (n=182078) 25,8 C+ (n=30960) 4,4 C- (n=103769) 14,7 30 D (n=87714) 12,4 20 10 0 TOTAL GROUP (n=5759) A (n=1949) 33,8 B (n=1355) 23,5 C+ (n=243) 4,2 C- (n=1141) 19,8 D (n=1071) 18,6 6
RESULTS DISTRIBUTION OF THE TRAJECTORIES BY SECTOR OF EMPLOYMENT (VS. DISTRIBUTION OF EMPLOYEES UNDER SURVEILLANCE) 100 % % 100 90 90 80 70 80 60 70 50 40 60 30 50 20 10 40 0 Healt Indust Trade Gover Servic Const Educ Trans Cateri Other h ry (n=94 nment es ructio ation port ng Secto 30 Secto (n=74 292) (n=83 (n=63 n (n=17 (n=26 indust rs r 361) 398) 571) (n=21 1523) 638) ry (n=73 (n=15 989) (n=12 377) 9154) 558) 20 TOTAL GROUP (n=780861) 20,4 9,5 12,1 10,7 8,1 2,8 22,0 3,4 1,6 9,4 10 0 Health Industry Trade Governm Services Construct Educatio Transport Catering Other Sector (n=738) (n=968) ent (n=943) ion n (n=155) (n=325) industry Sectors (n=1607) (n=385) (n=268) (n=165) (n=388) TOTAL GROUP (n=5942) 27,0 12,4 16,3 6,5 15,9 4,5 2,6 5,5 2,8 6,5 7
RESULTS DISTRIBUTION OF THE TRAJECTORIES BY INITIATOR % 100 90 80 70 60 50 40 30 20 10 0 TOTAL GROUP (n=5935) Employee (n=2210) 37,2 General Practitioner (n=341) 5,7 Medical advisor (n=898) 15,1 Employer (n=2486) 41,9 8
RESULTS DISTRIBUTION OF THE TRAJECTORIES BY DURATION OF SICKNESS ABSENCE BEFORE START OF TRAJECTORY 100 % 90 80 70 60 50 40 30 20 10 0 TOTAL GROUP (n=3528) <= 1 month (n=184) 5,2 2 to 3 months (n=260) 7,4 4 to 6 months (n=602) 17,1 7 to 12 months (n=919) 26,0 > 1 year (n=1563) 44,3 9
RESULTS DISTRIBUTION OF THE RE-INTEGRATION OUTCOME 100 % 90 80 70 60 50 40 30 20 10 0 Return possible in Return possible in Definitive no return Definitive no return Re-integration too own job - own job in the possible in own job possible in own job, early (n=380) temporary with future, not at the but return possible no possible re- adaptations moment (n=273) in other job (with integration at the (n=500) adaptations) same employer (n=1086) (n=2551) TOTAL GROUP (n=4790) 10,4 5,7 22,7 53,3 7,9 10
RESULTS RESULTS OF THE REGRESSION ANALYSIS: PROBABILITY ON NO POSSIBLE RE-EMPLOYMENT MODELED AS OUTCOME VARIABLES B ESTIMATE STANDARD ERROR OR P VALUE Female employee 0,219 0,074 1,245 0,003 Older employee 0,007 0,003 1,007 0,015 Small Enterprises 0,433 0,070 1,541 0,000 (<20 employees) Initiator employee 0,000 Initiator medical -1,540 0,100 0,214 0,000 advisor Initiator general -0,065 0,135 0,937 0,633 practitioner Initiator employer -0,653 0,071 0,520 0,000 11
RESULTS RESULTS OF THE REGRESSION ANALYSIS: PROBABILITY ON NO POSSIBLE RE-EMPLOYMENT MODELED AS OUTCOME VARIABLES B ESTIMATE STANDARD ERROR OR P VALUE Other Sectors 0,001 -0,087 0,136 0,916 0,512 Health Sector -0,071 0,151 0,932 0,640 Industry 0,292 0,144 1,339 0,043 Trade -0,363 0,177 0,695 0,040 Government 0,041 0,148 1,042 0,783 Services 0,273 0,194 1,314 0,159 Construction -0,010 0,226 0,990 0,966 Education -0,015 0,186 0,985 0,936 Transport 0,252 0,220 1,287 0,252 Catering industry 12
CONCLUSION • Re-integration was suggested by the Occupational Health Physician of IDEWE for 33,1% of the initiated trajectories • RTW is most challenging for older women, working in small enterprises, in the trade sector, when initiated by the employee him/herself • Earlier guidance to re-employment into a more suitable job is indispensable to avoid long-term absence • Cooperation with medical advisors and general practitioners towards RTW is highly recommended 13
Head office Email | Website Godewina Mylle info@idewe.be | www.idewe.be Interleuvenlaan 58 Occupational Health Physician 3001 Heverlee info@ibeve.be | www.ibeve.be godewina.mylle@idewe.be Tel.: +32 16 39 04 11 14
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