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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 7th, 2019
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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.))
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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)
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RESULTSDISTRIBUTION OF THE TRAJECTORIES BY GENDER (VS. DISTRIBUTION OF EMPLOYEES UNDER SURVEILLANCE)
0
10
20
30
40
50
60
70
80
90
100
TOTAL GROUP (n=5935)MEN (n=2000) 33,7
WOMEN (n=3935) 66,3
%
0
10
20
30
40
50
60
70
80
90
100
TOTAL GROUP (n=778804)
MEN (n=341896) 43,9
WOMEN (n=436908) 56,1
%
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RESULTSDISTRIBUTION OF THE TRAJECTORIES BY AGE (VS. DISTRIBUTION OF EMPLOYEES UNDER SURVEILLANCE)
0
10
20
30
40
50
60
70
80
90
100
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(n=1163)
19,6
%
0
10
20
30
40
50
60
70
80
90
100
TOTAL GROUP (n=773724)
Age 15-24 (n=76392) 9,9
Age 25-34 (n=179009) 23,1
Age 35-44 (n=184972) 23,9
Age 45-54 (n=189745) 24,5
Age 55 and older(n=143606)
18,6
%
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RESULTSDISTRIBUTION OF THE TRAJECTORIES BY COMPANY SIZE (VS. DISTRIBUTION OF EMPLOYEES UNDER SURVEILLANCE)
0
10
20
30
40
50
60
70
80
90
100
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
%
0
10
20
30
40
50
60
70
80
90
100
TOTAL GROUP (n=706936)
A (n=302415) 42,8
B (n=182078) 25,8
C+ (n=30960) 4,4
C- (n=103769) 14,7
D (n=87714) 12,4
%
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RESULTSDISTRIBUTION OF THE TRAJECTORIES BY SECTOR OF EMPLOYMENT (VS. DISTRIBUTION OF EMPLOYEES UNDER SURVEILLANCE)
0
10
20
30
40
50
60
70
80
90
100
HealthSector
(n=1607)
Industry(n=738)
Trade(n=968)
Government
(n=385)
Services(n=943)
Construction
(n=268)
Education (n=155)
Transport(n=325)
Cateringindustry(n=165)
OtherSectors(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
%
0
10
20
30
40
50
60
70
80
90
100
Health
Sector
(n=159154)
Industry
(n=74361)
Trade(n=94292)
Government(n=83398)
Services
(n=63571)
Constructio
n(n=21989)
Education(n=171523)
Transport
(n=26638)
Catering
industry
(n=12558)
OtherSecto
rs(n=73377)
TOTAL GROUP (n=780861) 20,4 9,5 12,1 10,7 8,1 2,8 22,0 3,4 1,6 9,4
%
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RESULTSDISTRIBUTION OF THE TRAJECTORIES BY INITIATOR
0
10
20
30
40
50
60
70
80
90
100
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
%
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DISTRIBUTION OF THE TRAJECTORIES BY DURATION OF SICKNESS ABSENCE BEFORE START OF TRAJECTORY
RESULTS
0
10
20
30
40
50
60
70
80
90
100
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
%
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RESULTSDISTRIBUTION OF THE RE-INTEGRATION OUTCOME
0
10
20
30
40
50
60
70
80
90
100
Return possible inown job -
temporary withadaptations
(n=500)
Return possible inown job in the
future, not at themoment (n=273)
Definitive no returnpossible in own jobbut return possiblein other job (with
adaptations)(n=1086)
Definitive no returnpossible in own job,
no possible re-integration at thesame employer
(n=2551)
Re-integration tooearly (n=380)
TOTAL GROUP (n=4790) 10,4 5,7 22,7 53,3 7,9
%
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RESULTSRESULTS 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 (<20 employees)
0,433 0,070 1,541 0,000
Initiator employee 0,000
Initiator medical advisor
-1,540 0,100 0,214 0,000
Initiator general practitioner
-0,065 0,135 0,937 0,633
Initiator employer -0,653 0,071 0,520 0,000
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RESULTSRESULTS 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
Health Sector -0,087 0,136 0,916 0,512
Industry -0,071 0,151 0,932 0,640
Trade 0,292 0,144 1,339 0,043
Government -0,363 0,177 0,695 0,040
Services 0,041 0,148 1,042 0,783
Construction 0,273 0,194 1,314 0,159
Education -0,010 0,226 0,990 0,966
Transport -0,015 0,186 0,985 0,936
Catering industry 0,252 0,220 1,287 0,252
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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
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Head office
Interleuvenlaan 58
3001 Heverlee
Tel.: +32 16 39 04 11
Email | Website
[email protected] | www.idewe.be
[email protected] | www.ibeve.be
Godewina MylleOccupational Health Physician