The role of the insurance physician in return to work. An international survey Corina Oancea, Soren Brage, Freddy Falez, Wout de Boer 21 st EUMASS Congress Ljubljana 2016

21 st EUMASS Congress Research, education and practice in insurance medicine and social security Faculty Disclosure Nothing to disclose

Background Return to work (RTW) is the main theme of the present congress Return to work of people with health conditions is an issue of major interest in many European countries Return to work serves the health and wellbeing of workers and social security schemes Return to work activities include many different procedures, involving different types of professionals One group of professionals involved is represented by the doctors who work for social security or private insurance (insurance physicians: IPhs) The insurance physicians’ role is typically to assess work capacity but some are also active in promoting return to work

Return to work Returning to work by a worker on his/her own initiative A physician (IPh/GP) sending a patient back to his/her work A case manager organizing a gradual uptake of work A group of professionals from health care, the company and insurance, trying to establish a cooperation that favours the return to work of the injured/ill worker

Objective To operationalize the concept of promoting RTW, in the context of great diversity of the socio-economic and legal environments across Europe To explore the IPhs involvement in RTW

Operationalisation of RTW Professionals Institutions Procedures People with health conditions RTW Collaboration

Methods We drafted and piloted a questionnaire, based on this operationalization We carried out a survey: 34 experts from 15 EUMASS countries responded We collected and analysed the data with SPSS software, using parametric and non-parametric tests

EUMASS countries participants at the study Belgium Croatia, Czech Republic Finland, France Germany Ireland Netherlands, Norway Poland Romania Slovenia, Sweden, Switzerland UK Missing countries: Iceland, Italy, Portugal, Serbia, Slovakia

Respondents Mean of service duration: ± SD 9.53 years

IPhs’ tasks RTW- small task vs. assessments

The role of the IPh in medical rehabilitation High percentage for recommendation Small percentages for coordination, referral

The role of the IPh in vocational rehabilitation High percentage for recommendation Small percentages for monitoring, coordination

Work-oriented medical rehabilitation centres

Possibility of vocational rehabilitation

The collaboration of IPh with the rehabilitation centres

Providers of vocational rehabilitation Highly scattered results, it is not a clear responsibility of a certain provider

Customized (individualized) rehabilitation programs

Is compliance with RTW program expected?

Possible consequences if not following the rehabilitation program

Responsibility for assigning clients to a customized rehabilitation program Highly scattered results, it is not a clear task of a certain stakeholder

IPh collaboration with the persons involved in RTW IPh collaborates mainly with the social insurance officer

Rehabilitation measures suggested by IPh in practice

Guidelines for IPh to promote RTW Yes/No = 17/17 from 34 answers No: BE, CZ, FR, RO, SE, GB Yes: HR, DE, IE, NL, PL Not clear: CH, FI, NO, SI

The main strengths of IPh’s existing approach to promote RTW

The main weaknesses of IPh’s existing approach to promote RTW

Recommendation of VR Assignement of clients to a customized RP – GP Customized RP more frequent Collaboration with the GP more developed Rehabilitation measures more recommended: medical, psychological treatment and (re) training Main strength - Know how Higher percentages for initiating, referral to vocational rehabilitation (NS) Assignement of clients to a customized RP – IPh Main strength - Role in vocational rehabilitation RTW approach

Discussion Similarities among countries seem higher than differences The results outline certain characteristics but they must be interpreted with caution The sample study is small We did not go into details about practices

Positive aspects for including IPhs in RTW The infrastructure for promoting RTW seems to be present in all countries we have respondents from: Work-oriented medical rehabilitation centres Possibility of vocational rehabilitation In many countries RPs are customized In some countries (mainly in E countries) IPhs have the responsibility for assignment of clients to a customized RP Recovery and RTW are important outcomes; financial consequences may follow the lack of compliance with the RP There is a developed cooperation of IPhs with other professionals, mainly with the SIO; in W countries the GPs are more involved IPh is an essential player, having the knowledge and sometimes an active role in VR

Challenges for including IPhs in RTW IPhs spend a small % of their time in RTW IPhs do not have an active role, only recommending MR or VR The collaboration of IPhs is mainly with the SIO and rather weak with other persons or institutions involved in RTW The providers of VR and the responsibility in this area seem often to be diffuse Guidelines for RTW seem to be few Not a main task of IPh, weak cooperation, lack of resources are listed as weaknesses of the systems

Conclusions A main theme for the present EUMASS congress is RTW and its’ target is represented by the IPhs However, presently, IPhs have a small task in RTW According to our respondents, VR and RTW should be more tasks for IPhs If IPhs are fit for this process, should be further established

Take message home: Work is to be done! IPhs More involvement Active role Better collaboration Guidelines Systems Define clear responsibilities (actors, institutions) Higher resources

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