Sickness Insurance Research Articles

How People with Multimorbidity and Psychosocial Difficulties Experience Support by Rehabilitation Coordinators During Sickness Absence.

PurposePeople with multimorbidity face a range of barriers in healthcare, and there is little knowledge about their challenges with regard to return-to-work (RTW). Rehabilitation coordinators, a new function in Swedish healthcare, support people in the RTW process. The present study had two aims: to explore what problems and barriers people with multimorbidity experience during their rehabilitation and RTW process and to explore in which domains the coordinators’ support is perceived to be of importance.MethodsInterviews were conducted with 12 persons with multimorbidity who had contact with a rehabilitation coordinator during their sickness absence. Thematic analysis was guided by the case-management ecological model; this analysis was revised and adapted to the Swedish context.ResultsThe participants experienced problems in all domains of the model, namely: “the healthcare system”, “the labor market and the workplace system”, “the sickness insurance system”, and “the personal system”. Rehabilitation programs that did not accommodate combinations of diseases, social complexities and needs were felt to lead to worse symptoms, thus hindering rather than promoting RTW. An overall finding regarding support by coordinators is that interventions, regardless of domain, were felt to be valuable for people with multimorbidity. The coordinator was perceived to give most support by providing advice about and coordination with healthcare and employers. Sometimes the coordinator gave advice and coordination regarding the Social Insurance Agency, very occasionally the Public Employment Services. The coordinator gave least advice and coordination about social difficulties that hindered rehabilitation and RTW processes.ConclusionPeople with multimorbidity perceive rehabilitation coordinator interventions as important in all domains investigated. Lack of advice and coordination, or rehabilitation programs that were not modified to the complexities of individual’s circumstances, were associated with prolonged sickness absence, worse health, or social risk factors not being recognized.

Sick Pay and Absence from Work: Evidence from Flu Exposure

The system of sick-pay is critical for balancing the economic and health costs of infectious diseases. Surprisingly, most research on sick-pay reforms does not rely on variation in worker exposure to diseases when investigating absences from work. This paper studies the effects on absences from work of changes in health-insurance coverage of the first three days of sickness. We explore geographic variation in the prevalence of infectious diseases, primarily the seasonal flu, to provide variation in the need for sickness insurance. Estimates based on the Czech Structure of Earnings Survey imply that when sickness insurance is not available, total hours of work missed are not affected, but employees rely on paid and unpaid leave instead of sick-leave to stay home. The substitution effects are heterogenous across occupations and socio-demographic characteristics of employees, and suggest that workers do not spread infectious diseases at the workplace as a result of the absence of sickness insurance coverage in the first three days of sickness.

Factors associated with self-rated health among mineworkers in Zambia: a cross-sectional study

BackgroundThis study aims to examine miners’ working conditions and self-rated health status in copper mines in Zambia and to identify the conditions and factors necessary to improve the safety and health of mineworkers.MethodsA cross-sectional study using a self-administered questionnaire was conducted anonymously among copper mineworkers in Zambia in 2015 and 2016. Five targeted mining companies among 33 were introduced by the Mineworkers’ Union of Zambia. Study participants were recruited at the waiting space for underground work, waiting rooms of company clinics/hospitals, and/or at training sessions, which were places permitted by the target companies to perform data collection via convenience sampling. Bivariate analyses (e.g., t tests, Kruskal-Wallis tests, chi-square tests, or Cochran-Armitage tests) and logistic regression analysis were used to analyze differences in demographic characteristics and to compare their working conditions, health conditions, safety management at the workplace, and training opportunities by employment status.ResultsIn total, 338 responses were analyzed. Regular employees had better working conditions, including higher incomes (P = 0.001), more likely to be guaranteed sickness insurance by the company (P < 0.001), paid holidays (P = 0.094), and sick leave (P = 0.064), although the difference was not statistically significant. Mineworkers’ decreased self-rated health was determined by job category (adjusted odds ratio [AOR], 0.41; 95% confidence interval [CI], 0.21, 0.82; P = 0.012). Having experienced violence from the boss/manager (AOR, 0.54; 95% CI, 0.32, 0.91; P = 0.020) was negatively associated with better self-rated health in the crude odds ratio.ConclusionsAmong mineworkers in Zambia, nonunderground work and not having experienced violence from their boss/manager contributed to increased self-rated health. From the perspective of psychological safety and human security, the management of safety and the working environment, including human resource management and preventing harassment/violence, should be assured, especially for underground mineworkers.

Redefinicja idei w polskim systemie ubezpieczeń społecznych

The Polish social security system was partially re-defined in 1999, however, the re-definition concerned only retirement and accident insurance at that time (excluding sickness and disability insurance). This re-definition was based, among other things, upon a change in the concept of the system's functioning, from the principle of solidarity to the principle of individual precaution. This change meant, in fact, the privatization of the Polish social security system. Unfortunately, the implementation of the redefinition ideas resulted in a significant decline in the financial effectiveness of the social security system in Poland. This article presents the lack of uniformity of the social security system in Poland and the financial effects of the solutions that are being currently applied. The conclusions presented in the paper indicate the possible directions of corrective actions aimed at unifying the system to make it coherent and financially effective. The research method used for the purposes of the study was an analysis of documents (legal regulations regarding the social security system and financial reports of the Social Insurance Trust Fund (FUS). The research tool used to evaluate the financial efficiency of the existing solutions was the financial efficiency meter of the system, developed for the purposes of the analysis.

The Impact of COVID-19 on Economic Activity: Evidence from Administrative Tax Registers

We use population-wide tax register data to document the impact of the COVID-19 pandemic on firm sales, tax revenues, and sick pay in Sweden. The pandemic impact is identified using within-year, between-year, and geographical variation, and our data allows us to run placebo tests. Our findings confirm the large negative effects of the pandemic, but shed new light on their magnitudes and sensitivity to COVID-19 morbidity rates. Specifically, we find that the impact on VAT and firm sales was larger than on commonly used industrial and service production indexes, larger than the effect on electricity for industrial use, but less than the effect on excise taxes on air travel. The pandemic’s impact on short-term sick pay is large, but unlike tax payments, it does not vary with local infection rates, indicating behavioral responses to more generous rules for sickness insurance during the pandemic.

Predictive validity of general work ability assessments in the context of sickness insurance.

ObjectiveThe activity ability assessment is a Swedish method for assessing general work ability, based on self-reports combined with an examination by specially trained physicians, and, if needed, extended assessments by occupational therapists, physiotherapists and/or psychologists. The aim of this study was to analyse the predictive validity of the activity ability assessment in relation to future sick leave.DesignAnalysis of assessments in 300 case files, in relation to register data on sick leave.SubjectsPeople on sick leave (n =300, 32% men, 68% women; mean age 48 years; assessment at mean sick leave day 249).MethodsUnivariate and multivariate statistics.ResultsSelf-rated work ability was the only factor with predictive value related to future sick leave. Physicians’ evaluations lacked predictive value, except where the person had a limitation in vision, hearing or speech that was predictive of future decisions by the Social Insurance Agency. No sex differences were identified.ConclusionThe predictive value of the activity ability assessment for future sick leave is limited, and selfrated work ability is more accurate compared with an extensive insurance medical assessment. Self-rated work ability may be more holistic compared with insurance medicine assessments, which may be overly focused on individual factors. A practical implication of this is that the inclusion of contextual factors in assessment procedures needs to be improved.LAY ABSTRACTThis study investigates whether assessments of general work ability (i.e. a person’s ability to work in any job) can predict future sick leave. The assessment method was developed in the Swedish sickness insurance system, and consists of a self-assessment, and assessments by physicians and other healthcare professionals. The results show that assessments generally fail to predict sick leave, with the exception of the person’s own assessment, which is broader and takes more aspects into account. These results can be used to improve assessment methods, where it is especially important to pay attention to a person’s whole situation.

Graded Work, the Activation of Sick-Listed Workers and Employer Participation in Continental Europe

There is an increasing emphasis on activating workers on sick leave and on using their residual work capacity. This article compares activation via graded-work schemes in Germany, Austria, Switzerland and the Netherlands, with a focus on the role of employers. The analysis of literature sources and survey data reveals an ongoing reform activity, as well as great diversity in terms of employer obligations and incentives in the countries studied. These differences are very consequential for the intensity of employer efforts to activate sick-listed workers, even when comparing countries that otherwise share many institutional features. The distinction between public and privatised systems of sickness insurance, on the contrary, seems to be less relevant for the question of employer participation in activation. The findings are consistent with the expectation that less comprehensive employer participation is correlated with stronger selectivity in activation efforts. Depending on the prevailing approach in the individual countries and on developments to date, policy-makers are confronted with different challenges and priorities.

Social Insurance for Doctoral Students of Doctoral Schools

Abstract The reform of the doctoral student education system, resulting in a departure from conducting third degree studies in favour of doctoral schools, resulted in changes in the field of social security law. The status of a doctoral student receiving a doctoral scholarship has become independent grounds for compulsory retirement, disability and accident insurance. At the same time, it is the basis for voluntary sickness insurance. The author criticises the granting of doctoral students the right to acquire cover under this type of insurance. Their actual situation when receiving a doctoral scholarship is far different from the situation of other persons (grounds) covered by sickness insurance. The author also discusses the issue of coincidences of grounds for social insurance of doctoral students. The legislator categorised the collection of a doctoral scholarship in the group of absolute grounds for insurance. Unfortunately, it omitted in the regulation of Art. 9 sec. 1a of the Act on Social Insurance System a reference to the basis of the contributions on the received scholarship, which in extreme cases may lead to a significant extension of the doctoral student’s social insurance obligation.

Co kształtuje prawo do zasiłku chorobowego w polskim i niemieckim ubezpieczeniu chorobowym? Wybrane zagadnienia

Autor analizuje wybrane rozwiązania prawne w polskim i niemieckim ubezpieczeniu chorobowym, szukając odpowiedzi na pytanie, co determinuje kształt przyjętych rozwiązań prawnych w odniesieniu do zasiłku chorobowego. Czy polski i niemiecki ustawodawca, kształtując prawo do zasiłku chorobowego, opiera się wyłącznie na kategorii ryzyka socjalnego czasowej niezdolności do pracy, rozumianej jako niezdolność do pracy wskutek choroby pociągającej za sobą utratę zarobku, czy też posiłkuje się również innymi kryteriami? Analiza polskich i niemieckich rozwiązań prowadzi do wniosku, że ustawodawcy w wielu przypadkach odchodzą od kryterium ryzyka socjalnego, a prawo do zasiłku chorobowego determinowane jest często potrzebą, choć odejście od kryterium ryzyka socjalnego w obu ustawodawstwach ma miejsce nie zawsze w tych samych obszarach. Przeprowadzona analiza może być pomocna przy konstruowaniu prawa do zasiłku bardziej opierającego się na kryterium ryzyka socjalnego, które powinno być podstawową kategorią ubezpieczenia społecznego jako jednego z działów zabezpieczenia społecznego.

Universal health coverage as a global public health goal: the work of the International Labour Organisation, c.1925-2018.

We examine the efforts of the International Labour Organisation (ILO) to extend medical care under social security, through international conventions, advocacy and technical assistance. We consider the challenges faced by the ILO in advancing global health coverage through its labourist, social security model. The narrative begins in the interwar period, with the early conventions on sickness insurance, then discusses the rights-based universalistic vision expressed in the Philadelphia Declaration (1944). We characterize the ILO's postwar research and technical assistance as "progressive gradualism" then show how from the late-1970s the ILO became increasingly marginalized, though it retained an advisory role within the now dominant "co-operative pluralistic" model.

Social insurance reform and absenteeism in Vietnam

There has been very little research into sickness absence in Vietnam. This article reveals how the labor market might adjust to more generous illness benefits offered by the Vietnam Social Insurance Law. In the study, we combined the difference‐in‐differences and matching techniques and used data from four waves of the Vietnam Labor Force Survey. The results indicate that the generosity of the benefits positively links to both the incidence and the duration of sick leave. The article also sheds light on the mechanism underlying the relationship by disaggregating the effects on gender, income, and job tenure groups. The results support current government efforts to enhance the public social insurance system.Key Practitioner Message:•Sickness insurance affects sick leave incidence and duration;•Low‐income workers and female workers are sensitive to sickness benefits reform;•There is a link between job tenure and sick leave.

Kilka uwag w sprawie zasiłku chorobowego dla doktorantów pobierających stypendia doktoranckie

Niniejszy artykuł omawia kwestię możliwości łączenia stypendium doktoranckiego z za-siłkiem chorobowym. Ustawodawca, umożliwiając doktorantom dobrowolne przystąpienie do ubez-pieczenia chorobowego, przyznał im również prawo do świadczeń z tego ubezpieczenia, jednak w praktyce może być ono całkowicie iluzoryczne. Doktoranci zachowują bowiem prawo do stypen-dium doktoranckiego, które przysługuje obligatoryjnie wszystkim doktorantom, również w okresie stwierdzonej niezdolności do pracy z powodu choroby. Jeśli stypendium to zakwalifikowane zosta-nie jako wynagrodzenie uzyskiwane w ramach naukowoprawnego zatrudnienia, przepisy ustawy zasiłkowej wykluczałyby możliwość uzyskania zasiłku chorobowego. Przystępowanie do ubezpie-czenia chorobowego byłoby w tej sytuacji niecelowe. Nieuznanie zaś stypendium za sui generis rodzaj wynagrodzenia pozwalałoby na jednoczesne pobieranie zasiłku chorobowego i stypendium, co byłoby niezgodne z celem i funkcją zasiłku chorobowego oraz z systemowymi założeniami pol-skiego systemu ubezpieczeń społecznych.

Social Workers’ Compensation Models and the Czech Statutory Employer Liability Insurance

Abstract Czech workers’ compensation is “exemplified” by the adoption of the Worker’s Accident Insurance Act in 2006, four deferments of its effective date and then complete annulment of the Act. A temporary settlement aimed at resolving the incompatibility of the communist model of workers’ compensation for work accidents and occupational illnesses with the transition to a market economy after 1989 involved the implementation of statutory employer liability insurance for work accidents and occupational illnesses, outsourced to two private insurance companies; the current Czech government does not seem to have a know how to deal with it. The objective of this paper is primarily to advise the government using primarily the formulation and comparison of four basic social workers’ compensation models and furthermore considering the existing sickness, pension and health insurance systems. The choice of a social model is namely a matter of public choice, but intensive lobbying also constitutes part of these processes. The analyses result in a recommendation to “dissolve” the statutory employer liability insurance into a jointly collected social insurance contribution for sickness and pension insurance, and partly to transform the current accident benefits into increased sickness and pension benefit assessments and partly to cancel them.

The Judas kiss: On the work and retrenchment cures and the troubles they bring.

This Sounding Board article uses a number of societal stereotypes related to work and welfare to problematize the relationship between work and health, and how this relates to the prevention and management of work disability. It outlines current discourses in policy and research around these issues, and discusses some of the ethical implications of these discourses. The article concludes that the current policies on work disability and sickness insurance takes their point of departure in over-simplified accounts of the relationship between work and health, and that a more critical reading of the evidence is called for. The implications for research are also discussed, where a system-oriented perspective with attention to social gradients and the various working environments is called for.

The Use of Genetic Information in the Implementation of Insurance: Current Problems and Prospects for their Solution

Increasing the efficiency of risk assessment for the purposes of personal insurance is impossible without using the latest achievements of modern science. This translates into a growing interest in the use of genetic research results by insurers, which manifests itself not only in legislation and insurers’ practices, but also in international recommendations on personal medical data processing for insurance purposes. Based on analysis of foreign practices, the authors determine priority areas of respective legislation development, in particular, legislative recognition of a ban on insurers’ access to genetic data in the context of obligatory medical insurance and group insurance programs; granting insurers the right to use genetic testing results for the purposes of life insurance, personal accident and sickness insurance, voluntary medical insurance, if the sum insured exceeds a statutory threshold.&#x0D; &#x0D; The reported study was funded by Russian Foundation for Basic Research (RFBR) according to Research Project No. 18-29-14056.

IMPACT OF PENSION SYSTEM REFORMS ON PUBLIC FINANCE EXPENDITURES IN POLAND

System zabezpieczenia społecznego w każdym kraju, jeśli istnieje, odgrywa kluczową rolę we wspieraniu obywateli, jednocześnie stanowi duże obciążenie finansowe dla wydatków budżetowych państwa. W Polsce składa się on z systemu ubezpieczeń społecznych i opieki społecznej, systemu ubezpieczeń zdrowotnych, zasiłków dla bezrobotnych i świadczeń rodzinnych, z których wyliczono emeryturę, rentę inwalidzką, ubezpieczenie chorobowe i macierzyńskie, ubezpieczenie od wypadków przy pracy i choroby zawodowe i ubezpieczenie zdrowotne. Celem artykułu jest przedstawienie zmian, jakie zaszły w polskim systemie emerytalnym w latach 1999–2017 oraz wpływu tych zmian na wysokość wydatków publicznych. W badaniu dokonano weryfikacji hipotezy badawczej: często występujące zmiany w systemie emerytalnym mają negatywny wpływ na stan polskich finansów publicznych. Badaniem objęto lata 1999–2017. Podstawowymi materiałami badawczymi wykorzystanymi do przeprowadzenia analizy badań były sprawozdania z realizacji budżetu państwa, dane przygotowane przez Zakład Ubezpieczeń Społecznych oraz dane statystyczne uzyskane z Głównego Urzędu Statystycznego.

SICK PAY INSURANCE AND SICKNESS ABSENCE: SOME EUROPEAN CROSS‐COUNTRY OBSERVATIONS AND A REVIEW OF PREVIOUS RESEARCH

AbstractAll European countries have some form of compulsory insurance against the loss of income due to temporary disability. The insurance schemes vary widely between countries both in terms of measurable entities (such as the compensation level) as well as in unmeasurable traits concerning the actual implementation of the programs. In this paper we use European Labour Force Survey data to study how the measurable differences in the programs is associated with differences in absence rates. We also summarize the theoretical literature on insurance principles in this field. Based on the empirical literature we then discuss how different forms of incentives may affect the work absence rate.

Social validity for work ability assessments and official decisions – clients’ experiences

Abstract Background Professionals need to be able to express what is at stake during the decision-making process and the discrepancy between formal rules and practical rationality need to be bridgeable and transparent for outsiders. Investigations of social validity for work ability assessments are rare. However, the concept can provide valuable information upon the acceptability and comprehensibility of procedures and how professionals can increase clients’ participation. The purpose of this study was to investigate social validity for work ability evaluations within the sickness insurance system and the official decisions they lead to. Methods This was a longitudinal qualitative study using telephone interviews and files from the Swedish Social Insurance Agency. Clients (n = 30) were interviewed after their participation in a work ability evaluation as well as after receiving an official decision upon eligibility for sickness benefits. Data was analyzed using a deductive content analysis. Results Preliminary findings show that clients’ comprehensibility of the different tests and their composition were depending on whether the specific tests were perceived as clearly related to the clients’ difficulties and what information they had received. In order to receive a fair description of the client’s work ability, clients state that the work ability evaluation needs to be individually adapted and that the standardized structure is not relevant for all. What is acceptable and fair to one client could be unacceptable to another, depending on what arguments and information case-managers and evaluation professionals provided. Conclusions Authorities need to express and motivate the reasons for a diverse range of steps during clients sick-leave process, not only regarding official decisions. Social validity for work ability evaluations is depending on the provided information and the applicability to the clients’ situation. Key messages Social validity is depending on the provided information and the applicability to the clients’ situation. Authorities need to communicate clearly with clients through the whole sick-leave process.

The Parental Rights of a Prison Service Officer—the Father of a Child

The article describes leave related to childbirth and child raising available to the father of the child who is in a public service relationship with the Polish Prison Service. The child’s father has autonomous rights, that is, ones that are only vested in him (paternity leave), and subsidiary rights, which are vested in him but only in a situation where the child's mother does not exercise them (maternity leave), and equivalent rights, that is, those which he can exercise on equal terms with the child's mother (leave on the terms of maternity leave, parental leave, childcare leave). Cases in which a child's parents work in different employment settings are analysed. In this connection, the author discusses regulations concerning cases of parental leave in situations where the mother and father of a child have the status of PS officers, where the father of a child is a PS officer and the child's mother is employed or covered by social insurance in case of sickness and maternity, specified in the Act of 13 October 1998 on the social insurance system, under a title other than an employment relationship, for example when she is self-employed, and finally cases where a child's mother is not covered by sickness insurance at all.

Social insurance literacy: a scoping review on how to define and measure it

Purpose Sickness insurance and workers’ compensation systems decide on peoples’ eligibility for benefits, and are commonly based on medical certificates and assessments of work ability. Systems differ in the extent to which they preserve clients’ dignity and right to fair assessments. In this article, we define a new concept for studying interactions between individuals and systems: social insurance literacy, which concerns how well people understand the different procedures and regulations in social insurance systems, and how well systems communicate with clients in order to help them understand the system. Methods The concept was defined through a scoping literature review of related concepts, a conceptual re-analysis in relation to the social insurance field, and a following workshop. Results Five related concepts were reviewed for definitions and operationalizations: health literacy, financial/economic literacy, legal capability/ability, social security literacy, and insurance literacy. Conclusions Social insurance literacy is defined as the extent to which individuals can obtain, understand and act on information in a social insurance system, related to the comprehensibility of the information provided by the system. This definition is rooted in theories from sociology, social medicine and public health. In the next step, a measure for the concept will be developed based on this review. Implications for rehabilitation Social insurance literacy is a new concept that is based on theories in sociology, social medicine and public health. It provides conceptual orientation for analyzing factors that may influence different outcomes of peoples’ contacts with social insurance systems. The concept is of relevance for rehabilitation professionals since it focuses on how interactions between individuals and systems can influence the rehabilitation process. The study will in the next step develop a measure of social insurance literacy which will have practical applications for rehabilitation professionals.