Sickness Benefits Research Articles

The role of mental health-related healthcare use in employment and benefits use after unemployment

Abstract Background Mental health problems are common among unemployed job-seekers and they further hinder successful re-employment. Previous studies investigating the role of mental health problems on labour market participation after unemployment have largely focused on a single outcome. However, many have subsequent unemployment or receive different types of benefits. To understand these complex pathways a more comprehensive approach is needed. In this study, we examine how mental health-related healthcare use among the unemployed affects their employment and benefit use trajectories. Methods We use a 90% population sample of individuals who were residing in Finland at the end of 2010, who were 25-59 years old and unemployed between 2014-2016 (n = 596,323). We use multistate trajectory models to analyse their employment and benefits use development three years after the onset of unemployment. We will further use multinominal regression analysis to investigate how mental health-based healthcare use is associated with these trajectories and how this association varies between different sociodemographic groups. Results Around half of the unemployed job-seekers received some type of benefit after the onset of unemployment. Almost 25 % received sickness allowance (especially women), a little less social assistance (especially young and low educated), or unemployment benefits (especially men), and around 10 % received disability pension (especially among those with healthcare visits due to mental disorders). Next, we will conduct a trajectory analysis to get a more comprehensive picture of the employment and benefits trajectories. Conclusions Unemployment is followed by complex employment and benefits trajectories which further differ by sociodemographic groups and mental health-related healthcare use. Knowledge on the factors influencing these trajectories will help direct employment-promoting interventions towards different groups of unemployed. Key messages • Many unemployed job-seekers receive some type of social or sickness benefit after unemployment. • The employment and benefits trajectories after unemployment differ between those who had mental health-related healthcare use and those who did not, and further by sociodemographic factors.

Polycystic ovary syndrome and labor market attachment in Swedish women

Abstract Background Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of fertile age and is associated with several burdensome comorbidities. We use Swedish longitudinal register data to identify and compare clusters of employment trajectories among working age women, in order to investigate how PCOS affects labor market attachment. Data and Methods A cohort of 157,356 women born in 1975-1977 were followed annually between the ages of 30 and 39. Labor market states were constructed by combining detailed data on various types of earned income. PCOS was identified through national inpatient and outpatient registers. Sociodemographic covariates (civil status, region of origin, highest attained education, number of children) were measured at the age of 29 years. Sequence analysis was used to identify clusters of typical labor market trajectories. Multinomial logistic regression was employed to assess the associations between being diagnosed with PCOS and belonging to the identified clusters. Results Women with PCOS spent less time in employment and were more dependent on sickness benefits during the follow-up time than those without PCOS. Five clusters of trajectories were identified: stable employment, education into employment, labor market exclusion, continuous unstable position, long-term sickness. Compared to being in stable employment cluster, women diagnosed with PCOS were 97% more likely to experience long-term sickness (RRR (relative risk ratio): 1.97 [CI: 1.90-2.05]), and had 11% higher risk of belonging to education into employment (RRR: 1.11 [CI: 1.07-1.15]) and a 4% higher risk (RRR: 1.04 [CI: 1.00-1.09]) of experiencing labor market exclusion. The magnitude of the association increased for education into employment and labor market exclusion after adjusting for covariates. Conclusions PCOS can lead to disadvantaged labor market outcomes and better strategies are needed in order to prevent economic exclusion among women diagnosed with the condition. Key messages • PCOS leads to disadvantaged labor market outcomes. • Women with PCOS may experience economic exclusion.

Sociodemographic, work- and health-factors predict rejection of vocational rehabilitation in Finland

Abstract Background Vocational rehabilitation (VR) decreases the number of premature retirements. Pension insurance companies operate private sector employees’ VR in Finland. In 2022, some 15,500 individuals received rehabilitation in this earnings-related pension system. However, the rejection rate was 46%. Similar systems exist throughout OECD. VR facilitates finding suitable work despite an illness. A person is eligible if a threat of disability exists within the next few years and non-medical requirements are met. Currently VR is underused. Thus, it is important to understand which sociodemographic, work- and health-related factors predict a VR rejection. Methods We had full application data from a Finnish insurer for 2015-20. Our data cover roughly 40% of the 2.7M person Finnish working population. We excluded applicants with preceding VR and only included under 58-year-old applicants rejected due to ‘no risk for disability’. Our data comprised age, region of residence, salary, doctor’s assessment grades, diagnosis, industry, and data on preceding sickness, unemployment and rehabilitation benefits. For analysis, we used logistic regression. Results After adjustment, younger age and mental disorders showed largest effects on rejection. Features associated with a less severe medical condition as well as decreased employment were significantly connected to rejection. Industry and place of residence showed no effect. Of note, stable employment and higher pay predict entry possibly due to more possible rehabilitation options and better health in general. Interestingly, people with multiple diagnoses are more likely to be rejected. Conclusions The work-ability of aging European populations could benefit from vocational rehabilitation that better suits mental disorders and younger people. Key messages • Vocational rehabilitation (VR) is an underused method to maintain work ability. • Our study identified groups that could benefit from tailored solutions in VR that decrease barriers to entry.

Collaboration between general practice and sickness benefits office - A Scoping Review

Abstract Background Effective collaboration among stakeholders is essential in supporting return to work (RTW) processes for individuals on sick leave. Yet sickness benefits office and general practice experience a lack of collaboration. This is echoed by individuals on sick leave. This scoping review aim to map existing literature on collaboration between sickness benefits office and general practice in RTW processes to identify both collaboration activities and underlying conditions influencing the collaboration. Methods A systematic search of peer reviewed literature was conducted across five databases in March 2023. Screening and data extraction were conducted by two independent researchers. Extracted data was mapped and activities and underlying conditions were analyzed following descriptive thematic analysis. Tentative results were discussed with a reference group. Results Among the 7471 papers screened, 21 met the inclusion criteria. Certificates was the most common collaboration activity. Of underlying conditions far more barriers compared to facilitators were identified. Barriers encompassed conflicting opinions, opposing roles, communicating via certificates, and time. Facilitators included personal communication and knowledge. Conclusions The number of included papers reflects a limited emphasis on this domain within research endeavors. The prevalence of barriers outweighing facilitators underscores the challenges inherent in this collaboration. General practice is depicted as advocating for their patients while the sickness benefits office pushes for return to work. Scarcity of time induces several challenges, impacting e.g., availability for personal communication and delays. Key messages • Stereotyping and opposing roles, poor communication and time constraints are major barriers that need to be addressed to enhance future collaboration. • Meetings and mutual knowledge about working conditions including legislations and procedures benefit the collaboration.

RETURNING TO THE PUBLICATION OF DOCTOR OF JURIDICAL SCIENCES, PROFESSOR M.A. SARSEMBAYEV «THE NEED TO IMPROVE STANDARDS OF ILO CONVENTIONS AND THE KAZAKHSTAN LABOR LAW»

This article analyzes the article by Professor M.A. Sarsembayev on the topic «The need to improve standards of ILO conventions and the Kazakhstan labor law», which was published in the Bulletin of the Institute of Legislation and Legal Information of the Republic of Kazakhstan No. 2 (47) in 2017. In the article Professor M.A. Sarsembayev focuses on the International Labor Organization (ILO) conventions, including the e Convention on Equal treatment and equal opportunities for men and women workers: workers with family responsibilities, adopted in Geneva on the 67-th session of the ILO General Conference on 23 June 1981, the Convention on the Protection of Wages, adopted in Geneva on 32-th session of the General conference of the ILO 1 July 1949, and the ILO Convention on the Minimum Wage Fixing Machinery by 16 June 1928, which are ratified by the Republic of Kazakhstan, with the aim of improving the norms of national labor legislation. The author also identifies shortcomings in these conventions and provides recommendations (translations, new formulations, additional articles, and terms) for their improvement, emphasizing that Kazakhstan, as a party to these conventions, can make proposals for their enhancement through the ILO’s Bureau of Labor Administration. The article also addresses the issue of accession to conventions such as the Convention on Minimum Standards of Social Security (No. 102), the Convention on the Right to Organize and Collective Bargaining in Agriculture (No. 11), the Convention on Compensation for Workmen in Agriculture (No. 12), and the Convention on Medical Care and Sickness Benefits for Workmen in Agriculture (No. 25), considering their significance for the national legal system of Kazakhstan.

Health and socioeconomic well-being of women with endometriosis and provoked vestibulodynia: Longitudinal insights from Swedish registry data.

Endometriosis and provoked vestibulodynia (PVD) are prevalent pain conditions among women of reproductive age, significantly impacting their quality of life and psychological well-being. However, comprehensive evidence regarding the lifelong health and socioeconomic outcomes for these individuals remains scarce. Additionally, many prior studies rely on limited and sometimes unrepresentative samples. This study aims to inform on the long-term consequences of these disorders by examining health, fertility, and employment outcomes in a cohort of women diagnosed with endometriosis and/or PVD, tracing their experiences from childhood to their 40s. Leveraging nationwide administrative data from Sweden and employing a matched case-control design, we investigate both similarities and differences between women with these diagnoses and those without. Our findings indicate that women diagnosed with endometriosis and/or PVD demonstrate elevated healthcare utilization patterns, commencing in their early teenage years and progressively increasing over time. Notably, disparities in labor market outcomes emerge in their 20s, showcasing lower labor earnings and a rise in sickness benefit receipt. Moreover, our results show a higher likelihood among these women to experience mental health disorders and concurrent chronic pain diseases, as well as infertility. While the association between endometriosis and infertility is well-documented, this study offers novel insights into a potential similar link between PVD and infertility. Our study informs healthcare professionals and policymakers about the considerable burden of compromised health, adverse psychosocial well-being, and reduced productivity in the labor market faced by young women with these common pain conditions. These findings underscore the urgency of addressing the multifaceted challenges encountered by individuals diagnosed with endometriosis and PVD across their lifespan.

Treatment switching and associated economic outcomes in patients with plaque psoriasis treated with biologics: A retrospective analysis of German claims data 2016−2021

AbstractBackgroundBiologics are therapeutic options for the management of moderate−severe plaque psoriasis. Some patients need to switch biologic treatment to achieve satisfactory outcomes, which might have a considerable economic impact.ObjectivesWe assessed the characteristics and switch rates of patients with plaque psoriasis initiating biologic treatment and compared healthcare resource utilization (HCRU) and associated costs for switching and non‐switching.MethodsThis study was a retrospective claims‐based analysis comprising a 182‐day baseline period to identify patient characteristics and a 365‐day follow‐up to assess switch rates, HCRU and associated costs. Data covering claims activity from 2016 to 2021 in a representative sample of four million individuals with statutory insurance in Germany was used.ResultsWe identified 2565 patients with psoriasis initiating biologic treatment with anti‐IL‐17 (n = 1037), anti‐IL‐23 (n = 704), anti‐TNF‐α (n = 583) and anti‐IL‐12/23 (n = 241) agents. A total of 9.2% of patients switched therapy to another biologic during follow‐up, ranging from 4.9% (secukinumab) to 16.5% (etanercept). The probability of treatment switching was significantly lower in patients treated with risankizumab (p < 0.05) than in patients treated with other biologics except guselkumab (p = 0.14). HCRU and associated costs during the follow‐up were generally higher with a therapy switch (all‐cause: 32,263 ± 15,381€) than without (25,041 ± 12,090€). This applied to direct costs (outpatient services, hospitalization, drug treatment) and indirect costs (sickness benefits). Drug treatment accounted for the largest share of costs.ConclusionsTreatment switching is frequent in patients with moderate−severe plaque psoriasis initiating biologic therapy and is associated with increased HCRU and associated costs. As the probability that a switch occurs within 365 days after treatment initiation widely differs between biologic agents, further research is warranted to determine the underlying reasons for switching to help establish clinically and economically sound therapy sequences.

The causal effect of mental health on labor market outcomes: The case of stress-related mental disorders following a human-made disaster

As disasters increase due to climate change, population density, epidemics, and technology, information is needed about postdisaster consequences for people's mental health and how stress-related mental disorders affect multiple spheres of life, including labor-market attachment. We tested the causal hypothesis that individuals who developed stress-related mental disorders as a consequence of their disaster exposure experienced subsequent weak labor-market attachment and poor work-related outcomes. We leveraged a natural experiment in an instrumental variables model, studying a 2004 fireworks factory explosion disaster that precipitated the onset of stress-related disorders (posttraumatic stress disorder, anxiety, and depression) among individuals in the local community (N = 86,726). We measured labor-market outcomes using longitudinal population-level administrative data: sick leave, unemployment benefits, early retirement pension, and income from wages from 2007 to 2010. We found that individuals who developed a stress-related disorder after the disaster were likely to go on sickness benefit, both in the short- and long-term, were likely to use unemployment benefits and to lose wage income in the long term. Stress-related disorders did not increase the likelihood of early retirement. The natural experiment design minimized the possibility that omitted confounders biased these effects of mental health on work outcomes. Addressing the mental health and employment needs of survivors after a traumatic experience may improve their labor-market outcomes and their nations' economic outputs.

Joint associations of leisure time physical activity and screen sitting time with long-term sickness absence due to mental and musculoskeletal diseases: a registry linked follow-up study

ObjectivesTo examine joint associations of leisure-time physical activity (LTPA) and screen sitting time with subsequent sickness absence among the adult population. Study designRegistry linked follow-up study. MethodsA representative sample of Finnish adults (n = 10,300) were asked to fill out a questionnaire for the FinHealth 2017 survey. Self-reported LTPA was classified into three groups: inactive, moderately active, and active, and screen sitting time into two groups: 3 h or less and over three hours a day, yielding a six-category variable for the joint analyses. Questionnaire data were linked to the Finnish Social Insurance Institution's register data on sickness benefits (over 9 days), including diagnoses (follow-up 2.9 years). The analytical samples were restricted to working age (18–64 years), which included 5098 participants. Associations were examined using logistic regression analysis adjusting for covariates with SPSS 29. ResultsThe inactive and high sitting time had a higher risk for sickness absence due to mental disorders (OR 2.07, 95% CI 1.03–4.18) compared with the physically active, low-sitting time group. Additionally, the inactive and low sitting time (OR 1.69 95% CI 1.12–2.55) and the moderately active and high-sitting time groups (OR 2.06 95% CI 1.15–3.67) had a higher risk. No significant associations were found for all-cause and musculoskeletal diseases sickness absence. ConclusionEmployers and policymakers could support reducing sitting in front of a screen and increase LTPA outside working hours to prevent mental health problems and related sickness absences.

Does higher education make women sicker? A study of the gender gap in sickness absence within educational groups.

This study describes changes in the withdrawal of sickness benefits among men and women in Sweden over a period of three decades (1994-2018), based on administrative data. During this period there was a gender gap in the takeout of sickness benefits to women's disadvantages in all age groups as well as educational groups. The gap was particularly large between men and women with secondary education in the ages 30 to 39. The general gender gap in sickness absence is larger today compared to 1994. The development, after 2010, was mainly driven by a larger increase in sick leave among women with secondary education, both in relation to men with secondary education and in relation to women with both lower and higher levels of education. For women with secondary education, sick leave does not seem to vary according to age. Thus, in this educational group, women of child-rearing age are not more prone to take sick leave than other age groups.

A STUDY ON THE RELATIONSHIP BETWEEN LABOUR WELFARE SCHEMES AND ITS IMPACT ON JOB SATISFACTION AMONG WORKERS IN TITAN WATCH COMPANY, HOSUR – A CASE STUDY

In an industrial economy, the workers are subject to periodic unemployment due to cyclical fluctuations in business, sickness, industrial accidents and old age. In India it has the obligation from the Government side to help the labourers and provide them security and adopt labour welfare measures in the form of various schemes such as Workmen’s Compensation Act, Employees’ State Insurance Act, Finances and Contributions, Sickness benefit, Medical benefit, Maternity benefit, Disablement benefit, Dependents’ benefit, Employees’ Provident Fund and Bonus schemes, Gratuity Scheme and Employees’ Pension Scheme. All these welfare schemes have followed and adopted in industries for the welfare of labourers both men and women. So, the present study is done to understand the various labour welfare facilities such as statutory and non-statutory welfare facilities provided by the company to labourers / workers namely TITAN watch company, Hosur, and its impact on job satisfaction. This study shows the positive relation between welfare facilities such as medical facilities, crèche, canteen facilities, recreation, toilet facilities, rest room facilities, reading room, loan facilities for their children’s education, marriage, housing loan, insurance coverage etc. and job satisfaction. Job satisfaction is very important to know the level of contribution to workers towards his / her work and how welfare facilities affect. Labour welfare schemes are provided to strengthen man power in both physically and mentally. Thus, these facilities are more effective in improving the performance and building the morale of every worker working in industries, in order to increase the productivity of labourers.

Path Reinforcer or Policy Accelerator? COVID-19 and Scandinavian Social Protection Reform Trajectories

A pandemic may change the use of social protection systems. In this article, we compare Scandinavian reform trajectories of unemployment benefits and sickness benefits following the COVID-19 pandemic. From an institutional theory perspective, we have analyzed official documents on regulations proposed in government bills, public inquiries, reports, and secondary literature published between March 2020 and December 2023, as well as interview data from key actors representing the state, the social partners, and related stakeholder organizations. The findings show that Denmark and Norway implemented mostly provisional reforms and thus ended in path reinforcement. In Sweden, on the contrary, numerous provisional reforms during the pandemic turned out to become permanent in the post-pandemic period. As the pandemic legitimized permanent changes that in some cases had been debated for a long time in Sweden, it thus came to act as a path-clearing policy accelerator.

Prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal disorders (PREVSAM): short term effects of a randomised controlled trial in primary care

Purpose To evaluate short-term effects of the PREVention of Sickness Absence for Musculoskeletal disorders (PREVSAM) model on sickness absence and patient-reported health outcomes. Methods Patients with musculoskeletal disorders were randomised to rehabilitation according to PREVSAM or treatment as usual (TAU) in primary care. Sickness absence and patient-reported health outcomes were evaluated after three months in 254 participants. Results The proportion of participants remaining in full- or part-time work were 86% in PREVSAM vs 78% in TAU (p = 0.097). The PREVSAM group had approximately four fewer sickness benefit days during three months from baseline (p range 0.078–0.126). No statistically significant difference was found in self-reported sickness absence days (PREVSAM 12.4 vs TAU 14.5; p = 0.634), nor were statistically significant differences between groups found in patient-reported health outcomes. Both groups showed significant improvements from baseline to three months, except for self-efficacy, and only the PREVSAM group showed significantly reduced depression symptoms. Conclusions The findings suggest that for sickness absence, the PREVSAM model may have an advantage over TAU, although the difference did not reach statistical significance at the p < 0.05 level, and similar positive effects on patient-reported health outcomes were found in both groups. Long-term effects must be evaluated before firm conclusions can be drawn.

Sick leave and disability pension following delivery in women with systemic lupus erythematosus

Objective To investigate sickness benefits following delivery in mothers with systemic lupus erythematosus (SLE) and mothers without SLE. Method SLE and non-SLE mothers, matched by age and month of delivery, with a singleton liveborn (2004–2008), were identified from the Swedish Lupus Linkage cohort. Work loss (sum of sick leave and disability pension) was studied from 1 year prenatally to 3 years postpartum. Adjusted logistic regression models of covariates associated with > 30 days of work loss in the first and second years postpartum were estimated in SLE mothers. Results Among 130 SLE mothers and 440 non-SLE mothers, SLE mothers were more likely to have work loss from the prenatal year (42% vs 16%) to 3 years postpartum (49% vs 15%). In SLE mothers, work loss was on average 61 ± 112 days (mean ± sd) in the prenatal year and 38 ± 83 days in the first year postpartum, which increased to 71 ± 114 days in the third year postpartum. Having > 30 days of sick leave in the year of delivery [odds ratio (OR) 4.4, 95% confidence interval (CI) 1.5–12.9] and ≤ 12 years of education (OR 2.6, 95% CI 1.1–6.0) were associated with work loss in the first year postpartum. No covariates were associated with work loss in the second year postpartum. Conclusion SLE mothers more often had work loss in the prenatal year to 3 years postpartum compared to non-SLE mothers. Lower education and sick leave in the year of delivery were associated with a higher odds of work loss in the first year postpartum in SLE.

Incidence of sick leave and disability pension in adults with musculoskeletal pain and co-occurring long-term conditions: data from the Norwegian HUNT study and national registries

BackgroundMusculoskeletal pain is one of the leading causes of work productivity loss. Long-term conditions (LTCs) commonly occur alongside musculoskeletal pain. However, the incidence of sick leave and disability pension according to LTC status in people with musculoskeletal pain has not been previously described.MethodsWorking-age participants (20–65 years) with persistent musculoskeletal pain who participated in the HUNT3 Study (1995–97) were included. Twenty-five LTCs were classified into 8 LTC groups according to the International Classification of Diseases version 11. Data on sickness and disability benefits were obtained from the National Insurance Database and linked to the HUNT3 data using participants’ personal identification number. Age-adjusted incidence rates (IRs) (per 10,000 person-years) and hazard ratios (HRs) of sick leave during 5-year follow-up and disability pension during ~ 25-year follow-up were estimated with 95% confidence intervals (CIs) and presented according to LTC status.ResultsOverall, 11,080 participants with musculoskeletal pain were included. Of those, 32% reported one LTC and 45% reported ≥ 2 LTCs. During the follow up period, 1,312 participants (12%) received disability pension due to musculoskeletal conditions. The IR of sick leave and disability pension due to musculoskeletal conditions increased with number of LTCs. Specifically, the IR of sick leave was 720 (95% CI 672 to 768) in participants without any LTCs and 968 (95% CI 927 to 1,009) if they had ≥ 2 LTCs. The IRs of disability pension were 87 (95% CI 75 to 98) and 167 (95% CI 154 to 179) among those with no LTCs and ≥ 2 LTCs, respectively. The incidence of sick leave and disability pension due to musculoskeletal conditions was largely similar across LTCs, although the incidence of disability pension was somewhat higher among people with sleep disorders (IR: 223, 95% CI 194 to 252).ConclusionsAmong people with persistent musculoskeletal pain, the incidence of prematurely leaving the work force due to musculoskeletal conditions was twice as high for those with multiple LTCs compared to those without any LTCs. This was largely irrespective of the type of LTC, indicating that the number of LTCs are an important feature when evaluating work participation among people with musculoskeletal pain.

Financial burden of medicines in five Northern European countries: A decommodification perspective

Affordable access to healthcare including medicines is a key social policy goal in Europe. However, it has rarely been addressed in comparative social policy research. Although the concept of decommodification has already been used in the context of healthcare and sickness benefits, we argue that the scope of such studies should be expanded to medicines to understand how welfare states protect their citizens from market forces in case of illness. We examine and compare the relationship between income, other characteristics, and subjective financial burden of medicines (FBM) across five countries with universal health systems pursuing egalitarian aims (Denmark, Finland, the Netherlands, Norway and Sweden). Analyses using 2017 EU-SILC microdata and linear probability models showed large differences in the level of FBM across countries, with the highest income quintile in Finland reporting FBM more frequently than the lowest income quintile in Denmark. Finland differed from the rest by increasing probability of FBM with age. In other countries, middle-aged adults tended to be the most affected, and older adults were well-protected. The association between income and FBM was strongest in the Netherlands; however, the higher probability of FBM was skewed towards the lower quintiles in all countries. FBM and financial burden of medical care were strongly associated although FBM tended to be more common. Unmet needs for medical examination were rare and lacked sensitivity in capturing manifestations of market risk. Decommodification literature has focused healthcare services as proxy of access; nevertheless, our study shows that further functions, and broader outcomes should be examined to capture market risk. Our evidence further highlights that important differences can be found even in countries with relatively similar health policy aims. The cost of medicines should be considered in comparative studies of health and welfare states.

Effectiveness, cost-effectiveness and return on investment of individual placement and support compared with traditional vocational rehabilitation for individuals with severe mental illness in the Netherlands: a nationwide implementation study

ObjectivesTo assess the effectiveness, cost-effectiveness and return on investment of individual placement and support (IPS) implemented through a reimbursement strategy on a nationwide scale compared with traditional vocational rehabilitation (TVR)...

Effectiveness of the Coordinated Return to Work model after orthopaedic surgery for lumbar discectomy and hip and knee arthroplasty: a register-based study

ObjectivesThis study examined the effectiveness of an individualised Coordinated Return to Work (CRtW) model on the length of the return to work (RTW) period compared with a standard prescription of...

Estimating Public Economic Gains from Early Breast Cancer and Curative Treatment: A Case Study in Human Epidermal Growth Factor Receptor (HER-2) Positive Targeted Therapies.

Cancer diagnosis influences the choices that patients make regarding current and future labor market activity. These choices have implications for governments based on resulting changes in taxes paid and benefits received. In this analysis we explore how human growth receptor 2 (HER2)-positive residual invasive breast cancer and different treatments influence government accounts excluding health costs. HER2-positive early breast cancer (eBC) health states from a published disease model were used to establish likelihood of working and wage impact at different stages of disease. The indirect productivity losses for an average woman aged 49years were translated into fiscal consequences to government by applying an established government perspective-modeling framework. The fiscal projections (discounted) include gross tax revenue by disease stage, government transfer costs related to time off work and early retirement ,and net fiscal balance (e.g., gross taxes-transfers) in three countries Canada, Portugal, and Brazil. The net fiscal balance in Canada for a healthy woman was C$109,551 compared with a HER2-positive eBC woman treated with trastuzumab emtansine (C$69,767) or trastuzumab (C$62,971). A similar pattern was observed in the three countries but reflecting the overall tax burden in each country, labor force activity, and available public benefits. Age at diagnosis was an important determinant of the likely net fiscal balance, as this influences the remaining working years. Women diagnosed with HER2-positive eBC were estimated to pay less lifetime gross taxes and receive more in sickness benefits compared with healthy women. Treatments that improve outcomes are likely to offer fiscal gains for government from improved work force participation.

Social Insurance Literacy Among the Sick-listed-A Study of Clients' Comprehension and Self-Rated System Comprehensibility of the Sickness Insurance System.

Sickness insurance systems and their processes have been studied in terms of transparency, comprehensibility and fairness, highlighting the importance of just procedures that make sense to clients. Related research demonstrates differences between groups of clients, pointing towards a social gradient. The concept of social insurance literacy and the Social Insurance Literacy Questionnaire (SILQ) was recently developed and serves as a measure for client's ability to obtain, understand and act on information in a sickness insurance system, relating to the comprehensibility of the information that the system provides. The purpose of this study was to investigate social insurance literacy among clients on sick leave and its associations with perceived justice, being granted sickness benefits and background factors. This was a questionnaire study with clients on sick leave in Sweden. In the selection process 3993 clients were invited, of which 1173 recently had their sickness benefits withdrawn. Those who answered the SILQ (n = 1152) also answered a perceived justice measure and accepted sharing register data from the Swedish Social Insurance Agency. Data were analyzed through regression analysis. The findings demonstrate that clients' perceptions of system comprehensibility and the status of their sick leave case was significantly associated with perceived justice, and being granted sickness benefits, while their individual abilities to obtain, understand, and act on information had lesser influence. The system's ability to provide understandable information seems more important than clients' abilities to comprehend it. From a client perspective, a just system seems to be related to their experiences of the sick leave process (i,e., whether they had an ongoing or closed case) rather than their skills to obtain the correct information.