SLIDE 1 The Cross Sector Project: Mapping Australian Systems of Income Support for People with Health-Related Work Incapacity
Prof Alex Collie, Dr Ross Iles, and Mr Michael Di Donato Insurance Work and Health Group Monash University
MONASH MEDICINE, NURSING & HEALTH SCIENCES
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Acknowledgements
– Collaborative Partnership to Improve Work Participation – Department of Social Services
– Dr Bronwyn Morkham – Prof Natasha Lannin
– Twenty five experts who participated in interviews
– Organisations that provided data and / or data dictionaries
“The views expressed in this presentation are those of the authors and do not necessarily represent those of the project funders or members of the Collaborative Partnership to Improve Work Participation”
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Health-related work incapacity in Australia
- Fig. Number of Years Lived with Disability (YLD) by disease and age group, 2011 (AIHW)
Working age
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Health-related work incapacity in Australia
Work Disability “… when a worker is unable to work or return to work because of an injury or disease” 2 Work “There is a strong evidence base showing that work is generally good for physical and mental health and wellbeing” 1
1. Waddel & Burton (2006) 2. Loisel & Anema (2013)
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Health-related work incapacity in Australia
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The Cross Sector Project
- The Collaborative Partnership to Improve Work
Participation aims to:
- Improve work participation
- Reduce costs of claims, premiums, and
disability support
- Improve employee health and wellbeing
- Reduce workplace absenteeism
- Improve work productivity
- The Cross Sector Project was addressed the first
- f five priority areas for the Collaborative
Partnership 1. Cross-sector system 2. Employer mobilisation 3. Employee awareness 4. GP support 5. Rehabilitation services
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The Cross Sector Project
“to develop a high-level system map of the current Australian service delivery model for supporting people with a work related injury or disability in their return to work, while concurrently mapping system related data and data gaps. More specifically, the project seeks to:
- Identify the systems and their associated services
- Identify data sources to determine numbers of people within different systems, their movement between
systems, and their access to services
- Identify data sources that can be used to indicate what helps people get into and stay at work; what
pushes them out of work and out of systems; and what supports and services are available when they are out of work
- Consider and document how the services in different sectors and systems interact, or have potential to
interact
- Identify critical points at which people move between systems and the triggers for their movement, and
- Provide direction and guidance for where the best opportunities lie for improvements in getting people
back to work in order for them to enjoy the health benefits derived from being in employment
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The Cross Sector Project
- Data collection
- Semi-structured interviews
- Document collation (academic and grey literature)
- Data collation
- Synthesis
- System descriptions, service summaries, and data summaries
- Stock of income support recipients in each system
- Review eligibility criteria for each system
- Mapping
- Collate system level information to produce conceptual visual map of the “system of
systems” and supporting data
- Describe opportunities to improve work and health across systems
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- 10 systems were in scope of the Cross Sector project:
1. Employer Provided Entitlements 2. Workers’ Compensation – Short Tail 3. Workers’ Compensation – Long Tail 4. Motor Vehicle Accident Compensation – Statutory Benefits 5. Motor Vehicle Accident Compensation - Lump Sum Schemes 6. Life Insurance – Income Protection 7. Life Insurance – Total and Permanent Disability (TPD) 8. Social Security – Disability Support Pension, Newstart, Sickness, and Youth Allowances 9. DVA Compensation and Pensions
- 10. Superannuation withdrawals
Plotting a map of Australian systems of income support – structure
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- We developed a number of features that defined the basic structure of these systems:
- Coverage – are they national or jurisdictional?
- Mechanism or disability based?
- Source of funding – taxation, employer premiums, or employee contributions?
- Services funded – wage replacement? Healthcare?
- Case management – via public and private sector insurers?
- Incapacity duration – days, weeks, years?
- Common health conditions – musculoskeletal conditions, mental health, terminal?
- Governance – Nationally regulated?
Plotting a map of Australian systems of income support – structure
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- Determined in-scope people – “… a partial or complete incapacity to work”
- We used a bottom-up approach to estimate stock based on available documentation
- Number of recipients was calculated from number of people receiving income support
from the system AND proportion of those people who were working when they acquired a health condition that affected their work capacity
- No one single source for this data, so we performed an extensive evidence and
document search (data also vary in completeness and quality)
Plotting a map of Australian systems of income support – stock
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- Then, we combined the data from each of the 10 systems to calculate the total
number of recipients
- Where assumptions about stock were required, we consulted with system experts to
verify our approach
- We also calculated the total cost of each system in the 2015 / 16 financial year
- Finally, we determined the range in weekly amount of income provided in each
system for a person working full time with national average weekly earnings prior to the onset of the health condition leading to work incapacity
Plotting a map of Australian systems of income support – stock
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13 Plotting a map of Australian systems of income support – stock
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14 Plotting a map of Australian systems of income support – stock
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- There is minimal evidence about the flow between systems
- The totality of research to-date in the Australian context include
- Data from SunSuper and AIA
- Data from the Department of Social Services
- Early data from the RESTORE study
Plotting a map of Australian systems of income support – flow
SLIDE 16 16 Plotting a map of Australian systems of income support – flow
Fig 1. Social security benefit recipients circumstances before and after social security benefits
SLIDE 17 17 Plotting a map of Australian systems of income support – flow
Fig 2. Sources of income support 4 years following major traumatic injury (RESTORE Study) %
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- So, we conducted interviews with 25 experts and analysed the results for themes
regarding flow
- We also examined system eligibility and benefit rules to determine factors that
predict or influence pathway through systems
Plotting a map of Australian systems of income support – flow
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19 Plotting a map of Australian systems of income support – flow
Some people will enter multiple systems Policy and product design determine flow Personal circumstances can affect decision making and influence flow There are multiple gaps in coverage People can access multiple systems simultaneously Lack of support during system transition Most people return to work
Themes from interviews
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20 Plotting a map of Australian systems of income support – flow
Jurisdiction Mechanism of injury / illness Employer Nature of injury / illness Partner status Personal income Family income Age Leave entitlements
Factors affecting system access
SLIDE 21 21 Plotting a map of Australian systems of income support – flow
- Bubble size represents stock
- These are positioned on a scale from
working to temporary, and permanent incapacity
- The colour scale represents likelihood of
return to work
- The semi-circles in each bubble represent
the average duration of benefit receipt in each system
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22 Plotting a map of Australian systems of income support – flow
From To 1 Employer Provided Entitlements Workers’ Compensation 2 Employer Provided Entitlements Life Insurance (TPD and Income Protection) 3 Employer Provided Entitlements Social Security (Newstart Allowance) 4 Workers Compensation Life Insurance (TPD and Income Protection) 5 Workers Compensation Social Security (Newstart Allowance) 6 Life Insurance Social Security (Newstart Allowance) 7 Social Security (Newstart Allowance) Social Security (Disability Support Pension)
SLIDE 23 23 Plotting a map of Australian systems of income support – flow
- A middle-aged worker in SA develops chronic
disabling back pain attributed to their employment
- Takes sick leave
- Then takes SA workers’ comp
- Benefits cease at 2 years
- Applies for DSP and TPD
- Has to apply for Newstart in the interim
- TPD payment made
- Cannot access DSP later due to lump sum
TPD payment This is a hypothetical ‘worst case’ scenario, and should not be considered representative of the population
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- There were five categories of services in scope
Income support service delivery – who provides what?
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- 6 systems fund return to work services
- 5 systems fund healthcare and treatment
- 6 systems fund job finding / employment services
Income support service delivery – who provides what?
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- 4 systems fund provision of functional supports
- All systems have some sort of case management service
Income support service delivery – who provides what?
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- All systems have some form of structured dataset
- But, the data landscape is highly fragmented and “siloed”
- There is some centralization – e.g., the NDS
- There is also some adopted standards – e.g., TOOCS and ANZSCO
- However, there are substantial gaps in data capture, standardization, and reporting
Data sources in income support systems – centralization, standardization, and gaps
SLIDE 28 28 Upstream and downstream opportunities for the future
Fig 4. Opportunities for improvements in income support systems
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29 Upstream and downstream opportunities for the future
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Michael Di Donato Insurance Work and Health Group School of Public Health and Preventive Medicine Monash University michael.didonato@monash.edu +61 03 9905 6417 553 St Kilda Road, Melbourne
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- AIHW 2016. Australian Burden of Disease Study: Impact and causes of illness and death in Australia
- 2011. Australian Burden of Disease Study series no.3. BOD 4. Canberra: AIHW
- Anema, J. R., Loisel, P. Handbook of work disability prevention and management. New York, NY:
Springer 2013
- Collie, A., Iles, R., Di Donato, M. F. The Cross Sector Project: Mapping Australian Systems of Income
Support for People with Health Related Work Incapacity. Insurance Work and Health Group, Faculty of Medicine Nursing and Health Sciences, Monash University (2017)
- Waddell G, Burton K. Is work good for your health and well-being? United Kingdom: UK Government
Department for Work and Pensions, 2006
References and further information
