1. TNO Work and Employment Wout de Boer, MD ICF and social insurance of work disability

2. Köln, 14 October 2003ICF and social insurance of work disability2 Disability for work Does this person meet the social norm of being entitled to exclusion form work? Is he sick enough? Can anything be done about his disability Has he done what can be expected from him?

3. Köln, 14 October 2003ICF and social insurance of work disability3 Projects I drain from 15 country study on criteria, daily practice, management and control (2003) Working group Council of Europe on criteria and assessment (2001) Comparison of 7 types of evaluation for work in the Netherlands (2002) EUMASS (european association of medicine in assurance and social security) working group on disability evaluation and ICF Comparison of 7 disability scales, Barema’s

4. Köln, 14 October 2003ICF and social insurance of work disability4 Viaene: human damage Disability represents a loss of value of human existence: a lowering on Y axis Due to a specific cause: disease Develops in time, X axis, in relationship to Normal expectations that are hypotheses.

5. Köln, 14 October 2003ICF and social insurance of work disability5 N Y X Time D B N C A

6. Köln, 14 October 2003ICF and social insurance of work disability6 Big question is what is Y? Second big question is what is the value of a diminution of Y?

7. Köln, 14 October 2003ICF and social insurance of work disability7 It is not the criterion itself or the concept of disability (earning or working capacity) that determines the Y-axis Rather, it is the operationalisation that is constructed in an administrative category.

8. Köln, 14 October 2003ICF and social insurance of work disability8 Operationalisation Medical: the judgment on disability is on severity of sickness Body structure and function Listings, Barema’s Functional: the judgment on disability is on restrictions of activities Activities Functional scales Rehabilitative: the judgment on disability is on possibilities and lack of effect of rehabilitation Curative aspect: if treatment is possible judgment may be delayed or for a short period In practice decision making most often contains all, motivation of decision is limited

9. Köln, 14 October 2003ICF and social insurance of work disability9 ICF? Conceptually close to practice: language Reveals hidden links with personal factors and notably environment: policy Personal factors like coping and motivation are missing, this is a pity, technically Gradation of severity is problematic, what does it mean to a social norm? Big questions (What is Y) are more concrete but not anywhere near to being solved!