Finnish Occupational Health Services Research Articles

Frequent attenders in occupational health primary care: A cross-sectional study.

This study characterizes frequent attenders in primary care provided by occupational health services (OHS) in Finland. This is a nationwide cross-sectional study using medical record data from an OHS provider in 2015. Frequent attenders were defined as persons who were within the top decile of annual visits to healthcare professionals (frequent attender 10%, FA10) at any of the OHS's 37 stations. FA10s within this study consulted the OHS primary care unit eight or more times during 2015. We used logistic regression to analyse factors associated with frequent attendance in OHS primary care. The independent variables were age, gender, employer size and industry, health professionals visited and diagnoses given during visits to the OHS. The dependent variable was belonging to the FA10 group. Altogether 31,960 patients met the inclusion criteria and were included in the study. The FA10 group included 3617 patients, who conducted 36% of visits to healthcare professionals. The findings indicate that working within the manufacturing industry, health and social services, or public administration, and being employed in medium or large companies, are associated with frequent attendance. Frequent attendance was also associated with being female, diagnoses of the musculoskeletal system, or mental and behavioral disorders. In particular, depressive episodes and anxiety were associated with FA10s. This research characterized FA10 clients at a Finnish OHS. Illnesses of the musculoskeletal system and mental and behavioral disorders were accentuated among FA10s. The stability of the FA10 group, along with their sickness absences and work disabilities, should be investigated further.

Market competition, ownership, payment systems and the performance of health care providers – a panel study among Finnish occupational health services providers

Many health care reforms rely on competition although health care differs in many respects from the assumptions of perfect competition. Finnish occupational health services provide an opportunity to study empirically competition, ownership and payment systems and the performance of providers. In these markets employers (purchasers) choose the provider and prices are market determined. The price regulation of public providers was abolished in 1995. We had data on providers from 1992, 1995, 1997, 2000 and 2004. The unbalanced panel consisted of 1145 providers and 4059 observations. Our results show that in more competitive markets providers in general offered a higher share of medical care compared to preventive services. The association between unit prices and revenues and market environment varied according to the provider type. For-profit providers had lower prices and revenues in markets with numerous providers. The public providers in more competitive regions were more sensitive to react to the abolishment of their price regulation by raising their prices. Employer governed providers had weaker association between unit prices or revenues and competition. The market share of for-profit providers was negatively associated with productivity, which was the only sign of market spillovers we found in our study.

Work-Related Primary Care in Occupational Health Physician’s Practice

Primary care is frequently integrated in Finnish occupational health services (OHS). This study examines the frequency of work-related health problems in occupational health (OH) physicians' consultations for primary care and associations between health problems and interventions carried out by OH physicians. OH physicians assessed the health problems of 651 consecutive visits in a private OHS unit. The health problem was regarded as work-related if it was caused or aggravated by work, or involved impaired work ability. Interventions carried out by OH physicians were analysed by logistic regression analysis. The main health problem was caused either partially or mainly by work or symptoms were worsened by work (27%), or symptoms impaired work ability (52%). Musculoskeletal and mental disorders were the main work-related reasons for visits. In two-thirds of the cases of mental health problems, work caused or worsened symptoms, and the majority of long sickness absences were issued due to these problems. OH physicians carried out interventions concerning work or workplace in 21% of visits. Mental disorders were associated most strongly (OR 7.23, 95% CI 3.93-13.32) with interventions. The strongest association (OR 16.09, 95% CI 9.29-27.87) with work-related visits was, when the health problem was both work-induced and impaired work ability. Work-related health problems comprise a considerable part of Finnish OH physicians' work. OH physicians play an important role in early treatment, in the prevention of disability, and in interventions aimed at workplaces based on the knowledge they get through primary care in OHS.

Efficiency of Workplace Surveys Conducted by Finnish Occupational Health Services

In Finland, workplace surveys are used to identify and assess health risks and problems caused by work and make suggestions for continuous improvement of the work environment. With the aid of the workplace survey, occupational health services can be tailored to a company. The aims of this study were to determine how occupational health professionals gather data via the workplace survey and the effect survey results have on companies. A total of 259 occupational health nurses and 108 occupational health physicians responded to the questionnaire: 84.2% were women and 15.8% were men. The mean age of the respondents was 48.8 years (range, 26 to 65 years). Usually occupational health nurses and foremen and sometimes occupational health physicians and occupational safety and health representatives initiate the workplace survey. More than 90% of the surveys were followed by action proposals, and about 50% of these were implemented. The proposals implemented most often concerned personal protective equipment and less often leadership. Survey respondents should have both the opportunity and the authority to affect resources, the work environment, work arrangements, and tools. Teamwork among occupational health and safety professionals, management, and employees is vital for cost-effectively solving today's complex problems at workplaces around the globe.

Efficiency of Workplace Surveys Conducted by Finnish Occupational Health Services

In Finland, workplace surveys are used to identify and assess health risks and problems caused by work and make suggestions for continuous improvement of the work environment. With the aid of the workplace survey, occupational health services can be tailored to a company. The aims of this study were to determine how occupational health professionals gather data via the workplace survey and the effect survey results have on companies. A total of 259 occupational health nurses and 108 occupational health physicians responded to the questionnaire: 84.2% were women and 15.8% were men. The mean age of the respondents was 48.8 years (range, 26 to 65 years). Usually occupational health nurses and foremen and sometimes occupational health physicians and occupational safety and health representatives initiate the workplace survey. More than 90% of the surveys were followed by action proposals, and about 50% of these were implemented. The proposals implemented most often concerned personal protective equipment and less often leadership. Survey respondents should have both the opportunity and the authority to affect resources, the work environment, work arrangements, and tools. Teamwork among occupational health and safety professionals, management, and employees is vital for cost-effectively solving today's complex problems at workplaces around the globe.

Public health care providers and market competition: the case of Finnish occupational health services

As reforms in publicly funded health systems rely heavily on competition, it is important to know if and how public providers react to competition. In many European countries, it is empirically difficult to study public providers in different markets, but in Finnish occupational health services, both public and private for-profit and non-profit providers co-exist. We studied possible differences in public providers' performance (price, intensity of services, service mix-curative medical services/prevention, productivity and revenues) according to the competitiveness of the market. The Finnish Institute of Occupational Health (FIOH) collected data on clients, services and personnel for 1992, 1995, 1997, 2000 and 2004 from occupational health services (OHS) providers. Employers defray the costs of OHS and apply for reimbursement from the Social Insurance Institution (SII). The SII data was merged with FIOH's questionnaire. The unbalanced panel consisted of about 230 public providers, totalling 1,164 observations. Local markets were constructed from several municipalities based on commuting practices and regional collaboration. Competitiveness of the market was measured by the number of providers and by the Herfindahl index. The effect of competition was studied by ordinary least square regression analysis and panel models. The more competitive the environment was for a public provider the higher were intensity, productivity and the share of medical care. Fixed panel models showed that these differences were not due to differences and changes in the competitiveness of the market. Instead, in more competitive markets public providers had higher unit prices and higher revenues.

Health Education and Communication in Occupational Health Services in Finland

This article discusses health education and communication in Occupational Health Services (OHS) based on a questionnaire study conducted in Finnish OHS in 2005. The study focused on educational activities carried out by OH professionals and directed at individual employees, work communities and groups, and representatives of client organisations. The questionnaire was sent to 1132 OH professionals--physicians, nurses, physiotherapists and psychologists--working in 130 OHS units, and representing different OHS providers in Finland. 635 respondents (162 physicians, 342 nurses, 96 physiotherapists, 35 psychologists) returned the questionnaire. The overall response rate was 58%. There were statistically significant differences in educational activities by different professional groups; differences were also related to the length of working experience in OHS. For all OH professionals, individual employees were the primary clients of health education and communication. Education was less often directed at work communities and representatives of client organisations. However, many issues related to health and well-being at work are not within the reach of individual employees. The impact of health education would be more evident if it also reached those organisational stakeholders with discretion in decision-making. Furthermore, OH personnel should pay attention to the social aspect of learning and work more with groups and work communities.

Promoting prevention with economic arguments – The case of Finnish occupational health services

BackgroundBoth social and ethical arguments have been used to support preventive occupational health services (OHS). During the 1990s it became more common to support political argumentation for occupational health and safety by converting the consequences of ill health at work into monetary units. In addition, OHS has been promoted as a profitable investment for companies, and this aspect has been used by OHS providers in their marketing.Our intention was to study whether preventive occupational health services positively influence a company's economic performance.MethodsWe combined the financial statements provided by Statistics Finland and employers' reimbursement applications for occupational health services (OHS) costs to the Social Insurance Institution. The data covered the years 1997, 1999 and 2001 and over 6000 companies. We applied linear regression analysis to assess whether preventive OHS had had a positive influence on the companies' economic performance after two or four years.ResultsResources invested in preventive OHS were not positively related to a company's economic performance. In fact, the total cost of preventive OHS per turnover was negatively correlated to economic performance.ConclusionEven if OHS has no effect on the economic performance of companies, it may have other effects more specific to OHS. Therefore, we recommend that the evaluation of prevention in OHS should move towards outcome measures, such as sickness absence, disability pension and productivity, when applicable, both in occupational health service research and in practice at workplaces.

Return-to-work policies in Finnish occupational health services

To describe return-to-work services for employees on sick leave offered by Finnish occupational health services (OHS). Finnish OHS are surveyed every 3 years. Respondents are asked if they offer services to facilitate return to work (RTW), and if so, to describe them. The description was qualitatively analysed using the Atlas-ti programme to find the themes that best describe the services. We also studied characteristics of OHS predicting a return-to-work policy. Of the total sample of 969 occupational health units, 95% responded to the survey. Forty-one per cent reported offering services for facilitating RTW after sick leave. The service usually consisted of occupational physician examination of employees on sick leave for approximately 6 weeks. This was followed by a joint discussion between employee, physician and supervisor, which could result in work accommodation or a work trial period. There was a substantial variation, with only 10% mentioning a joint meeting and 13% mentioning a work trial period or work accommodation. Return-to-work policies were more frequently found in the OHS that served only a few employers, provided more group activities and collaborated more with employers and research institutes. Less than half of Finnish OHS offer return-to-work services of which the contents show wide variation that is not in line with current scientific evidence. A guideline project for return-to-work practices is needed to fill the gap. More research is needed to best define monitoring and screening practices for workers on sick leave.

Challenges of OHS for changing working life

The background for the considerations of this article is changing working life and its demands to occupational health services (OHS). It can be said that the needs and the demands of the clients are more versatile than ever before. Today the OHS personnel are facing a variety of complex problems. The OHS Act 2001 defines very clearly and loyally the experts and professionals needed in OHS. Training of OHS personnel 2003 study reveals the inadequate manpower situation in Finnish OHS units. Maintenance of Work Ability Activities (MWA barometer) study 2001 reveals the unfulfilled OHS expectations the clients have and the factors perceived to affect the fluency of cooperation between the clients and OHS. The new phenomena and problems of working life demand versatile expertise. New open-minded solutions are needed to ensure human resource for OHS.

Special section

The aim of this article is to describe how an audit matrix for occupational health units was formulated, what the preliminary results tell about its applicability, and how the matrix can help to implement the principles of "good practice in occupational health services". Twelve areas eligible for auditing were selected for the matrix. According to the recently issued principles of good practice, the principles of total quality management and continuous quality improvement, each area was divided into descriptions of 4 quality levels, the lowest being given 0 points and the highest 5-6 points. The maximum total score was 72 points. Of the 30 external audits, no unit had less than 18 points. Nine units had 19-36 points, 17 units had 37-54 points, and 4 units had over 54 points. "Maintenance of work ability" received the highest mean of the given points (4.1), followed by "curative care"(4.0) and "multidisciplinarity"(3.9). The lowest means were for "planning of activities" (3.1), "customer orientation"(3.2), and "quality improvement"(3.2). The audit matrix proved to be a practical method for auditing occupational health units, revealing both the most common flaws and strengths in the quality of Finnish occupational health services. Because the matrix has been accepted well by occupational health professionals and it manages to classify the units, it is probably a useful instrument for evaluating the performance of occupational health units and promoting good practice.

The performance follow-up of Finnish occupational health services.

The aim of the study was to describe the structure, input and output figures of occupational health services (OHS) in Finland as basic data for a revised follow-up system. A cross-sectional postal survey. All OHS units in Finland (n = 1025). The response rate was 94%. The more extensive questionnaire was returned by 82% (n = 837), and an additional 12% (n = 127) returned a shorter questionnaire. The variation in structure (number and education of personnel, number of clients and size of client enterprises), input indicators (employees per full-time equivalent physician and nurse) and output indicators (worksite visits per 100 employees, health checks per 100 employees, office visits per 100 employees) were compared by the five prevailing OHS models and within the models. There were often two- to threefold differences in the median figures of the different manpower and performance indicators between the OHS models. Although the lowest and highest deciles were excluded, the differences within the models were usually even greater. We found a great variation in both input and output figures within OHS in Finland. Part of this variation can be explained by the different needs and contents of services. The data can serve as a basis for evaluation of OHS activities both at the national level and as benchmark data for the individual OHS units. However, these types of data do not allow us to assess the quality or outcome of services.