1. The Belgian social security system: focus on return to work RI Finland 19 oktober 2015 Saskia Decuman, Occupational therapist; Disability Case Manager; Expert research and development, Department of Benefit of the National Institute for Health and Disability Insurance

2. Content Belgium: a complex country The Belgian social security system: very short A new paradigm in work (dis)ability? Which shift? Is work disability a problem? Some facts and figures! How is wage loss compensated by the NIHDI? Return to work: which initiatives? Results? Center of knowledge Disability management

3. Belgium: a complex country NGI Brussel 2001 Federal: NIHDI: Benefits due to sickness + private accidents + reintegration Regional: Employment services eg VDAB, GTB

4. Social Security in Belgium (1) Social security is a public system of social assurances. 3 systems of social security Salaried persons 79% Selfemployed persons 12% Civil servants 6% Its own reglementation Its own social protection Its own methode of financing

5. Social Security in Belgium (2) The social security contains different sectors: Salaried persons Selfemployed persons Civil servants Insurance for accidents at work XX Insurance for occupational diseases XX Unemployment X Insurance for medical care and benefits XXX Pensions XXX Family benefits XXX Annual vacation XX Bankruptcy X Not working due to a disease or private accident: more than paying benefits!

6. A new paradigm in work (dis)ability? (1) RTW is ‘rare’ and  with  period of sick leave Focus was on the allocation of benefits: paradigmashift by stakeholders is needed: eg. insurance physician: –Control but also Advise, information, guidance, … of the insured + treating team Socio-professional reintegration: pro-active –RTW –  nuance –first contact: prognosis Importance of « early » intervention

7. A new paradigm in work (dis)ability? (2) Is this paradigma shift applied?

8. Which shift? Control + PASSIVE paying benefits control + paying benefits (social security) + ACTIVE policy RETURN TO WORK Offering stakeholders the necessay tools!

12. Is work disabilty a problem? Some facts! From an « individual » perspective, work is: –in general terms: good for health and well being –‘important’: has different meanings (financial added value, identity, structure, social contact, …) From a « society » perspective: –high indirect costs –Belgian: increasing number of people on sick leave/disability From an « employer » perspective: –  costs –  productivity/competences

13. Is work disabilty a problem? Some facts! Full stop  RTW during work incapacity In Belgian a complex situation –legal framework (federal, regional, …) –many different stakeholders: employee, employer, family, general practitioner, specialist, occupational physician, insurance physician, occupational therapist, social worker, job coach, … –Communication: what is permitted by whom? Difficult economic situation

14. Is work disabilty a problem? Some figures (1) Sick leave Work disability 200920102011201220132014 E391648399075413903411845412922419940 SE 11706 11970 12309 12434 1288912872 Totaal403354411045426212424279425811432812 200920102011201220132014 E245209257935269499283541299408321573 SE 19459 20136 20315 20911 21415 22353 Totaal264668278071289814304452320823343926 30% 7%

15. Is work disabilty a problem? Some figures (2) Two periods Update: Psychische stoornissen : 98 171 in 2012; 104 291 in 2013 en 112 648 in 2014 MSA: 79 643 in 2012; 86.017 in 2013 en 94.884 in 2014

16. How is wage loss compensated by the NIHDI? Time frames –(Period of guaranteed pay)  employer –Sick leave/ short time work incapacity/ primary incapacity (< 1 year) NIHDI Social insurance physician –Work disability/ long term work incapacity (  1 year) NIHDI (Physician of) NIHDI on advise of social insurance physician Statute: salaried (+ unemployed) versus self-employed Evaluation loss of earning capacity (economic labour capacity)

17. How is wage loss compensated by the NIHDI? SALARIED PERSONS Sick leave (0-12 months) –Degree (%) of work incapacity: > 66% –Evaluation with regard to reference profession? < 6 months > 6 months –Level of income substitution: 60%

18. How is wage loss compensated by the NIHDI? SALARIED PERSONS Work disability (> 12 months work incapacity) –Degree (%) of work incapacity: > 66% –Level of income substitution: Beneficiary with dependents: 65% Single persons: 50% Cohabitants: 40%

19. How is wage loss compensated by the NIHDI? SELFEMPLOYED PERSONS Primary incapacity: < 12 months: evaluation in function of the last work as self-employed person Work disability: > 12 months: evaluation in function of the whole labour market Degree (%) of work incapacity: 100% Level of income substitution: after one month: lump- sum amount which varies according to their family situation and according to whether or not they have stopped their company

20. Return to work: which initiatives? Results? Work resumption with permission Retraining

21. Work resumption with permission Progressive RTW with permission Declaration but not allowance before RTW:  time lost Also in period of garanteed salary What can be allowed? –< or  or = 50% of the former working time –Progressive until working FT –FT but with productivity loss –Work adapted to functioning –… Pros for employee, employee and society Attention: vacation

22. Work resumption with permission Permissions between 2009-2013 20092010201120122013 100§2 2185023905267722825730833 23 155 128 118 121 119 23bis 1608 1687 1742 1581 1754 20bis 590 892 1180 1360 1548  41%

23. Retraining Retraining – re-orientation Renewal of competences – new competences Unfit for their own professional catagory (reference profession) Reintegration on the labor market in a adapted professional category Conventions with regional employment services (see also presentation afternoon)

24. CENTER OF KNOWLEDGE

25. Center of knowledge (1) Center of knowledge –Vision and mission Knowledge about work incapacity: collection + making available Supporting the policy (Inter)national networking –Organisation and management Daily coordinations: department of benefits NIHDI Guidance comittee: NIHDI, academic world, Mutual Benefits Societies, employees, employers

26. 26 Center of knowledge (2) networks with (inter)national experts among others concerning disability management (current practices, education, …). stimulates and coordinates research in the field of work incapacity studies possibilities to implement the ICF (biopsychosocial view on functioning)

27. DISABILITY MANAGEMENT

28. Implementation of the DM-methodology (1) Definition and description of DM The process in the workplace designed to facilitate the employment of persons with a disability through a coordinated effort and taking into account individual needs, work environment, enterprise needs and legal responsabilities (International Labour Organisations, 2002).

29. Implementation of the DM-methodology (2) Definition and description of DM … a proactive process that minimized the impact of an impairment (resulting from an injury, illness or disease) on the individual’s capacity to participate competitively in the work environment (Shrey 1995)

30. Implementation of the DM-methodology (3) Definition and description of DM The ultimate goals of worksite based disability management are to control workers compensation and disability costs and to promote the sustained employment of workers with injuries and disabilities. Disability management strategies and interventions are focused on three objectives (1)Reducing the number and magnitude of injuries and illnesses (2)Minimizing the impact of disabilities on work performed and (3)Decreasing lost time associated with injuries, illnesses and resulting disabilities (Shrey 1999)

31. Implementation of the DM-methodology (4) ACTIVITIES FOCUSED ON: Individual workers: development and implementation of RTW-plans The organization: analysis of trends, cost benefit analysis, policies and procedures Society: establishment of policies that protect workers

32. Implementation of the DM-methodology (5) KEY CONCEPTS Early contact (2 levels) –Informing person responsible for DM –Contact with the worker (or family); formal and informal Early intervention –the longer away from work, the less likely to return –personal consequences –loss of the competences –RTW as soon as possible, if needed gradual (task + time)

33. Implementation of the DM-methodology (6) An interdisciplinary approach –ICF: beyond a medical approach  range of experts –Rehabilitation: holistic Labor-management collaboration –E.g. committee with labor + management representatives –Follow-up of development + operation of DM –Coordination with other programs –Involve all stakeholders –Education/information

34. Implementation of the DM-methodology (7) Interventions directed at both the worker + the workplace –Jobmatching: requirements + capacities –Avoid faillure: as risk of not at all RTW –Goals are not always aligned Case management –Central point of contact –Liaison –(C)RTWC: detects barriers + determines how (+who) to resolve

35. Implementation of the DM-methodology (8) Injury prevention (health and safety) Health promotion  Key for activating social security RTW Health promotionHealth and safety

36. Implementation of the DM-methodology (9) Why have a DM-program? Benefits DMCosts no DM Wage of individuals  Cost of recruitment/replacement Workplace moraleLoss of skills, experience and knowledge Ensure that legislative requirements are met Loss of productivity Costs for society  Turnover Meaning of workWorkplace conflict  Costs for e.g. rehabilitation Work oad pressure

37. DM: OK! BUT do we have the necessary competences? We need some education! Offering the NIDMAR curriculum (adapted) followed by a certification process

38. The future is bright? Awareness Communication – coordination Studies  policy recommendations Reintegration plan

39. Questions? saskia.decuman@riziv.fgov.be