re-employment & health rogier van rijn erasmus mc, department of public health
TRANSCRIPT
Re-employment & Health
Rogier van Rijn
Erasmus MC, department of Public Health
Unemployment: Europe
Unemployment rates 2012
6,4%4,1%
Unemployment: The Netherlands
12,6%
10,9%
7,9%
6,4%
6,4%
Unemployment rates 2012
Unemployment and Health
Lower scores on all health dimensions for the unemployed
Health survey 2003 GGD Rotterdam
0
20
40
60
80
100
120
generalhealth
physicalfunctioning
bodily pain mentalhealth
socialfunctioning
vitality rolelimitation-emotionalproblem
rolelimitation-physicalproblem
Se
lf-r
ate
d h
ealt
h s
cale
0-1
00
unemployed (n=187) employed (n=1485)
Unemployment and Health
Schuring et al. The effect of re-employment on perceived health. J Epidemiol Community Health. 2011;65(7):639-44
All dimensions of health improved among re-employed subjects
Health at baseline was better among subjects who returned to paid employment
0
20
40
60
80
100
120
generalhealth
physicalfunctioning
bodily pain mentalhealth
socialfunctioning
vitality rolelimitation-emotionalproblem
rolelimitation-physicalproblem
baseline follow-up baseline follow-up
Re-entered paid employment (n=47)Continue to be unemployed (n=918)
Se
lf-ra
ted
he
alth
(s
cale
0-1
00
)
What works and what does not?
Isolated health promotion programme no effect on health and work resumption
What works and what does not?
- Personal advisors and individual case management helped some people
- Many studies suffer from selection bias; more work-ready claimants
- Financial incentives; too low or too short
What works and what does not?
Summary
Poor perceived health among the unemployed
Re-employment health
Isolated health promotion programme not effective
Supported employment effective (USA, UK)
Integrating health promotion programmes with
re-employment activities
Fit4Work (F4W)
Unique collaboration between Municipal Health Services, Social Security Services and UWV in 4 largest cities of the Netherlands
Objectives: Gain quick and sustainable work in the labour force
Increase perceived health (mental, physical)
Fit4Work stands for: Rapid job search and job placement
Treatment of mental problems
Support and guidance to participants
Fit4Work initiatives
Cost-benefit analysis (in advance) of Fit4Work
Evaluation study of Fit4Work
Process evaluation Fit4Work
Cost-benefit analysis in advance of a new intervention
- Insight into where returns can be expected
- Social justification of the focus on the target population
- Insight in the information gathering for the cost benefit analysis afterwards
Cost-benefit analysis
Comprehensive understanding of costs and benefits
perspective of actors (e.g. clients, municipality)
the society as a whole (taxpayer)
Intervention Intermediate effects
Costs & benefits
Literature study
Interventions aimed at re-employment of the unemployed
Randomised controlled trials
Effects: re-employment, hours worked
Mueser KT. The Hartford study of supported employment for persons with severe mental illness. J Consult Clin Psychol. 2004;72(3):479-90.
Re-employment; mean difference of 16% (IPS vs. control)
Hours worked; mean 23 hrs/ week in both groups
Effects: type of work
More regular work, less subsidized work and voluntary work
Michion HJ. Effectiviteit van individuele plaatsing en steun in Nederland: Verslag van een gerandomiseerd gecontroleerde effectstudie. 2011. UMCG/Trimbos instituut
Voluntary work
Subsidized work
Regular work
Percentage that worked at least one day
Control
at 6 months at 6 monthsat 18 months at 18 months
IPS
Effects: other
Income and unemployment benefit
Increase of regular work income , benefits
Quality of life
Effects are not well known
Use of healthcare
Effects are not well known
Use of informal care
Effects are not well known
Total costs and benefits
Costs (-) and benefits (+)
Compared to regular re-employment programme
Costs Fit4Work -2.840
Production paid employment 7.010
Work related costs -220
Operating costs providing benefits 230
Expenditure health care & municipal facilities +PM
Criminality and disturbance +PM
Informal care +PM
Leisure time -PM
Quality of life +PM
Distortionary taxation 350
Total 4.530 +PM
Fit4Work initiatives
Cost-benefit analysis (in advance) of Fit4Work
Evaluation study of Fit4Work
Process evaluation Fit4Work
Evaluation study Fit4Work
Research questions
Which factors determine the reach and uptake of Fit4Work?
What are the effects of Fit4Work on perceived mental health, work resumption,
and social participation?
What are costs and benefits relative to estimated effects of Fit4Work?
Pragmatic Randomised Controlled Trial
Target population(n=1000)
Questionnaire (12 months)
Questionnaire (24 months)
Randomisation
Fit4Work(n=500)
Control (n=500)
Questionnaire (baseline)
Long-term unemployed subjects (age
< 50yr) with mental health problems
Sufficient labour market skills
Sufficient skills to be able to provide
answers in an interview
No severe acute psychiatric illness
No drug addiction or being homeless
Primary outcomes; perceived mental & physical health
work resumption
social participation
Secondary outcomes; self-esteem
resilience
social problems
medical consumption
intersectoral integrated approach
improving mental health
addressing barriers in social- and
labour force participation
regular re-employment programme
and medical care
Fit4Work initiatives
Cost-benefit analysis (in advance) of Fit4Work
Evaluation study of Fit4Work
Process evaluation Fit4Work
Process evaluation Fit4Work
Process evaluation consists of: Formative evaluation – implementation research
Summative evaluation - crucial element analysis
Research & Business Intelligence
Formative evaluation
Research questions: How well is the intervention adopted by the participating institutions and
are the essential elements delivered as intended?
Is the reach of the target population sufficient?
Methods: Interviews; participants of multidisciplinary teams
Document analysis; selection of intervention plans
Observation; attend multidisciplinary meeting
File analysis; analyse participant files
Summative evaluation
Research question: Which components are considered to contribute most to the primary and
secondary outcome measures?
Which subgroups seem to respond best to the Fit4Work intervention
Methods: Data analysis of questionnaires
Casuistic analysis of participants, drop-outs, re-employed persons
File analysis
