Cancer! Return to work?The situation in Belgium

EU-OSHA seminar5th October 2017Dirk Dhollander

Content

• Introduction

• Legislation and evolution

• Daily practice and evolution

• Case of cancer

Co-management in parastatal supervising organisations : RIZIV, RVA, FBZ-FAO,…

Employer and “his” organisations

• Freedom in contractingpeople and in organisingwork

• Medical control for sick-listed(short-terme absence)Occupational health physician (OHP) and team

• Insurance for occupationalaccidents and diseases

Employee and “his” organisations

• Health protection and non-discrimination laws

• Social insurance physician (SIP) in Health insurance organisations providing the mandatory work incapacity insurance (long-term absence) ...

• Unemployment benefit payment

Belgium labour market …challenged now

Competences in Labour marketSocial security and health Work incapacity benefit’s andunemployment allowances

RIZIV, health insurancesickness funds, RVA

Labour market supportSupport => RTW for all unemployed

VDAB(GTB), ACTIRIS, FOREM

Legislation

• No cancer-specific legislation

• The cancer patient as prototype of the chronic patient in return to work (RTW)

Legislation

• Evolution since 2005 in RTW process

1/ the past = stability emphasis on medical control (art 100§1),

vocational rehabilitation and retraining as the exception

Work incapacity flow

employees6mth

1 year0d-14d -1mth

Art 100§2 part-time workand voluntary work

Invalidity + GRI ( RIZIV)

Last job General labour market

Retraining

Legitimating process = art100

A vast “army” of doctorsprescribing sick notes

A lot of reports that accentuateillness and work incapacity

To little possibilities for control andlittle managing towards RTW

Purge to “long term absence” INV

Patients and employersin a passive role

Medicalisation through medical “control” of sick listed

Or ping-pong “unemployed sick”

Legislation vs implementation

• Evolution since 2005 in RTW process

2/ growing importance of art 100§2

Part-time work in combination with incapacity benefit evolution from tolerance policy to common practice in RTW

Legislation

• Evolution since 2005 in RTW process

3/ guidance in RTW upgraded to a primary concern since 2009 (art 153)

4/ sensitization phase Study symposia, goodwill, role clarification, brochures, pilots, supported mostly by non-profit cancer organisations as VLK, LIKAS, pink ribbon, de stichting tegen kanker, …

Daily practice … shift

• Evolution since 2005 in RTW process

5/ pilot phases until 2016successful cases, good practices

6/ agreements RTW involved parties :ZF-SIP, VDAB-GTB, RIZIV

e.g. communication forms and proceduresblockchain re-orientation agreements

Daily practice … shift

• Evolution since 2005 in RTW process

7/ (oncologic) rehabilitation centres are entitled to(e.g. cancer) incorporate RTW as a new focusin the rehabilitation process

8/ multidisciplinary becomes the new “normal”(some degree of de-medicalisation) in oncologic rehabilitation, in SIP sickness fund, in OHP services, ICF instruments etc …

Legislation

• Evolution since 2005 in RTW process

9/ the legislative phase ongoing

----- January 2016: new sick note

----- December 2016: re-integration procedures

Legislation

New sick note jan 2016

– Closed certificate

– Prescribing responsability

– Information also focussed on RTW

– Patient is involved

Legislation

- December 2016: coordinated “re-integration procedures” mandatory for social security physician SIP and the occupational heath physician (OHP) installed by law with implications for employee and employer

Mismatch? 70% ends in resignation, why?

SIP and OHP get still lost in procedural formalities“Street level bureaucrats” challenged

Legislation• Today

– 15/9/2017 last politic agreement communicated by the federal government:• enforce monitoring sick leave prescription by GP’s• doable jobs for >60j old, at the end of a career• more flex-jobs• last but not least: new occupational juridical framework for RTW of

chronic ill and disabled persons

– Challenge to make the re-integration procedure work• Task forces• Meanwhile …

Cancer case

• What happens to the cancer patient who totters through Belgian labour market?

• How is the employer involved in the RTW process? Depends on goodwill. Cases OK. No mandatory working system of re-integration yet … but …

• Rentree procedure specific for cancer patients => coaching RTW / good practice enlarged mid 2017 in agreement between VLK/Rentree GOB network /health insurance organisations

Cancer case

• Breast cancer women 49 years old: why this example?

How it was and how it will change…. in the future

• Breast cancer women 49 years old:– Work situation. – Diagnosis.– Sick note. – Curative evolution. – Medical rehabilitation. – Administrative situation: 1 year: invalid!– Contacts with the social insurance physician.– Planning RTW, re-integration procedure (different stakeholders involved).– Starting part-time.– Avoidable ‘unpleasant surprise’ after three years! … too late , always possible.– Possibilities of a new start in another job than the previous job.– Personal coach: from experiment to everyday practice?

• Lots of goodwill • But still lots of uncertainties