MONASH MEDICINE, NURSING & HEALTH SCIENCES 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
Acknowledgements Funding Collaborative Partnership to Improve Work Participation – Department of Social Services – Expert input Dr Bronwyn Morkham – Prof Natasha Lannin – Interviewees Twenty five experts who participated in interviews – Data providers 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” 2
Health-related work incapacity in Australia Working age Fig. Number of Years Lived with Disability (YLD) by disease and age group, 2011 (AIHW) 3
Health-related work incapacity in Australia Work Work Disability “There is a strong evidence base showing “… when a worker is unable to work or that work is generally good for physical return to work because of an injury or and mental health and wellbeing” 1 disease” 2 1. Waddel & Burton (2006) 2. Loisel & Anema (2013) 4
Health-related work incapacity in Australia 5
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 • of five priority areas for the Collaborative Partnership 1. Cross-sector system 2. Employer mobilisation 3. Employee awareness 4. GP support 5. Rehabilitation services 6
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 7
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 • 8
Plotting a map of Australian systems of income support – structure 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 9
Plotting a map of Australian systems of income support – structure 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? • 10
Plotting a map of Australian systems of income support – stock 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) 11
Plotting a map of Australian systems of income support – stock 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 12
Plotting a map of Australian systems of income support – stock 13
Plotting a map of Australian systems of income support – stock 14
Plotting a map of Australian systems of income support – flow 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 15
Plotting a map of Australian systems of income support – flow Fig 1. Social security benefit recipients circumstances before and after social security benefits 16
Plotting a map of Australian systems of income support – flow % Fig 2. Sources of income support 4 years following major traumatic injury (RESTORE Study) 17
Plotting a map of Australian systems of income support – flow 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 18
Plotting a map of Australian systems of income support – flow Themes from interviews Personal Some people will enter Policy and product circumstances can multiple systems design determine flow affect decision making and influence flow People can access There are multiple Lack of support during multiple systems gaps in coverage system transition simultaneously Most people return to work 19
Plotting a map of Australian systems of income support – flow Factors affecting system access Mechanism of Jurisdiction Employer injury / illness Nature of injury / Partner status Personal income illness Family income Age Leave entitlements 20
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 21
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) 22
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 23
Income support service delivery – who provides what? There were five categories of services in scope 24
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