From sick to fit: Case management gaining ground as work reintegration tool
With health care systems increasingly under pressure, and spending on disability benefits continuing to rise, a growing number of employers, governments and insurers are looking for ways to get injured or sick employees back to work. Patrick Moser, a Geneva-based journalist, reports.
According to the Organisation for Economic Co-operation and Development (OECD), its 34 member States spend on the average 1.2 per cent of GDP on disability benefits alone, and 2 per cent when including sickness benefits. In some countries this reaches as much as 5 per cent, or almost 2.5 times as much as what is spent on unemployment benefits.
In a bid to reverse the trend, many are turning to case management, an approach aimed at helping the reintegration of employees through tailor-made solutions.
“There are multiple wins,” says Bernd Treichel, an expert with the Geneva-based International Social Security Association (ISSA). “The employer wins by minimizing workers’ compensation costs, the employee wins by returning to work, and social security wins by not having to pay out long-term benefits for disability. And society wins because the supply of qualified labour continues to be there.”
Case management, which essentially provides a one-stop shop to coordinate various services and guide a person towards a solution best suited to his or her needs, is used across various settings, including psychiatric treatment, injury management, old-age care, and in the work environment.
In a professional reintegration context, a case manager will typically help a sick or injured person navigate through the maze of health and social services and coordinate with management and physicians in a bid to help the employee get back to the job, or if need be to a more suitable position, as soon as is safely possible.
Return-to-work programmes pay off
Many employers have found return-to-work programmes pay off.
The Swiss city of Zurich, for example, has recorded substantial savings since it introduced Case Management at Work as a pilot project in 2006. So far, the programme has cost CHF 13.58 million, and resulted in savings of CHF 19.33 million, a net gain of CHF 5.75 million for the city administration.
The city formally adopted the programme this year and now employs 22 case managers with the stated aim of reducing disability days while increasing job satisfaction among its 25,000 employees.
“It’s been very successful and has been well received by employees,” says Ursula Hess, spokesperson for the municipal administration’s human resources department.
Since it was launched in 2006, the number of employees on disability pensions has fallen from 151 in 2006 to 105 in 2009. Last year, 121 city employees were drawing full or partial disability pensions. In the first eight months of 2011, a total of 888 employees were in the case management programme, including 401 whose cases have now been resolved. Of those, 62 per cent are back at work and 10.6 per cent on disability pension.
“We have been in favour of the programme since the start… and there has been a good response from our members who made use of it,” says Canan Taktak, of the Swiss Union of Public Service Employees (VPOD).
A crucial element for the union is that it is up to the individual employee to decide whether to participate in the programme. “We are very sceptical of such programmes when they are compulsory and put pressure on employees solely to cut costs,” says Taktak.
Several leading Swiss companies, including the national railways SBB, have adopted similar programmes, some of them using in-house case managers and others contracting out to private companies. Cases range from teachers complaining of acute stress to locomotive drivers with deteriorating eyesight and workers suffering back pain.
“Fit for Work Services”
Other European governments are also looking at case management or comparable solutions to deal with health-related long-term work absences.
In the United Kingdom, the Government has given funding to 11 “Fit for Work Services” projects in different regions, including Scotland. The case-managed services “deliver early intervention support, as evidence suggests that work is generally good for health and that returning to work at the appropriate time is part of the recovery process,” the Government says on its “Health, Work and Wellbeing” web page.
Last year, 190 million working days were lost to absences in the United Kingdom, costing employers a total of 17 billion pounds sterling, according to a survey by the Confederation of British Industry and the Pfizer pharmaceutical group.
Long-term absences account for nearly a third of all time lost to sickness. In the public sector the proportion is even higher, with long-term health problems causing nearly half of days lost, according to the survey.
“Long-term absence is a concern, and costs associated with longer periods of ill-health are especially high in the public sector,” said Dr Berkeley Phillips, Pfizer’s UK Medical Director. “Many people with long-term health problems want to work and contribute to society, but the longer employees remain off work, the harder reintegration into the workplace becomes.”
Mental health issues are the single biggest cause of long-term absence, followed by musculoskeletal disorders, back pain and cancer treatment, according to the British report.
Case-managed return-to-work approaches are also drawing increasing interest from national social security agencies. “Social security systems have increased their focus on concepts of prevention, early intervention, rehabilitation and return to work,” ISSA’s Secretary General Hans-Horst Konkolewsky said at a regional conference in Stockholm earlier this year.
He cited in particular “proactive and preventive policy approaches that holistically address both traditional and new labour market challenges, for example by not only responding to the high levels of sickness and disability claims, but also by promoting higher rates of employability among beneficiaries”.
The OECD also sees such approaches as potential win-win strategies. “Helping people back to work… helps people avoid exclusion and have higher incomes while raising the prospect of more effective labour supply and higher economic output in the long term.”