The Belgian social security system: focus on return to work

RI Finland 19 oktober 2015   Saskia Decuman, Occupational therapist; Disability Case Manager; Expert research and development, Department of Benefit of the National Institute for Health and Disability Insurance

Content

• Belgium: a complex country• The Belgian social security system: very short• A new paradigm in work (dis)ability? Which shift?• Is work disability a problem? Some facts and

figures!• How is wage loss compensated by the NIHDI?• Return to work: which initiatives? Results?• Center of knowledge• Disability management

Belgium: a complex country

NGI Brussel 2001

Federal: NIHDI:Benefits due to sickness + private accidents+ reintegration

Regional:Employment serviceseg VDAB, GTB

Social Security in Belgium (1)

• Social security is a public system of social assurances.

• 3 systems of social security

Salaried persons

79%

Selfemployedpersons

12%Civil servants

6%

Its own reglementationIts own social protection

Its own methode of financing

Social Security in Belgium (2)

• The social security contains different sectors:

Salaried persons

Selfemployedpersons

Civil servants

Insurance for accidents at work X XInsurance for occupational diseases X XUnemployment XInsurance for medical care and benefits X X XPensions X X XFamily benefits X X XAnnual vacation X XBankruptcy X

Not working due to a disease or private accident:

more than paying benefits!

A new paradigm in work (dis)ability? (1)

• RTW is ‘rare’ and with period of sick leave• Focus was on the allocation of benefits:

paradigmashift by stakeholders is needed: eg. insurance physician: – Control but also

• Advise, information, guidance, … of the insured + treating team

• Socio-professional reintegration: pro-active– RTW– nuance– first contact: prognosis

• Importance of « early » intervention

A new paradigm in work (dis)ability? (2)

Is this paradigma shift applied?

Which shift?

Control + PASSIVE paying benefits

control + paying benefits (social security) + ACTIVE policy RETURN TO WORKOffering stakeholders the necessay tools!

Is work disabilty a problem? Some facts!

• From an « individual » perspective, work is:– in general terms: good for health and well being– ‘important’: has different meanings (financial added

value, identity, structure, social contact, …)• From a « society » perspective:

– high indirect costs– Belgian: increasing number of people on sick

leave/disability• From an « employer » perspective:

– costs– productivity/competences

Is work disabilty a problem? Some facts!

• Full stop RTW during work incapacity• In Belgian a complex situation

– legal framework (federal,

regional, …)– many different stakeholders:

employee, employer, family, general

practitioner, specialist, occupational physician,

insurance physician, occupational therapist, social

worker, job coach, … – Communication: what is permitted by whom?

• Difficult economic situation

Is work disabilty a problem? Some figures (1)

• Sick leave

• Work disability

2009 2010 2011 2012 2013 2014

E 391648 399075 413903 411845 412922 419940

SE 11706 11970 12309 12434 12889 12872

Totaal 403354 411045 426212 424279 425811 432812

2009 2010 2011 2012 2013 2014

E 245209 257935 269499 283541 299408 321573

SE 19459 20136 20315 20911 21415 22353

Totaal 264668 278071 289814 304452 320823 343926

30%

7%

Is work disabilty a problem? Some figures (2)

• Two periods

Update:Psychische stoornissen : 98 171 in 2012; 104 291 in 2013 en 112 648 in 2014MSA:              79 643 in 2012;  86.017 in 2013 en   94.884 in 2014

How is wage loss compensated by the NIHDI?

• Time frames– (Period of guaranteed pay) employer– Sick leave/ short time work incapacity/ primary

incapacity (< 1 year)• NIHDI• Social insurance physician

– Work disability/ long term work incapacity ( 1 year)• NIHDI• (Physician of) NIHDI on advise of social insurance

physician

• Statute: salaried (+ unemployed) versus self-employed• Evaluation loss of earning capacity (economic labour

capacity)

How is wage loss compensated by the NIHDI?

SALARIED PERSONS

• Sick leave (0-12 months)– Degree (%) of work incapacity: > 66%– Evaluation with regard to reference profession?

• < 6 months• > 6 months

– Level of income substitution: 60%

How is wage loss compensated by the NIHDI?

SALARIED PERSONS

• Work disability (> 12 months work incapacity)– Degree (%) of work incapacity: > 66%– Level of income substitution:

• Beneficiary with dependents: 65%• Single persons: 50%• Cohabitants: 40%

How is wage loss compensated by the NIHDI?

SELFEMPLOYED PERSONS

• Primary incapacity: < 12 months: evaluation in function of the last work as self-employed person

• Work disability: > 12 months: evaluation in function of the whole labour market

• Degree (%) of work incapacity: 100%• Level of income substitution: after one month: lump-

sum amount which varies according to their family situation and according to whether or not they have stopped their company

Return to work: which initiatives? Results?

• Work resumption with permission

• Retraining

Work resumption with permission

• Progressive RTW with permission • Declaration but not allowance before RTW: time lost• Also in period of garanteed salary• What can be allowed?

– < or or = 50% of the former working time– Progressive until working FT– FT but with productivity loss– Work adapted to functioning– …

• Pros for employee, employee and society• Attention: vacation

Work resumption with permission

Permissions between 2009-2013

2009 2010 2011 2012 2013

100§2 21850 23905 26772 28257 30833

23 155 128 118 121 119

23bis 1608 1687 1742 1581 1754

20bis 590 892 1180 1360 1548

41%

Retraining

• Retraining – re-orientation• Renewal of competences – new competences• Unfit for their own professional catagory (reference

profession)• Reintegration on the labor market in a adapted

professional category• Conventions with regional employment services

(see also presentation afternoon)

CENTER OF KNOWLEDGE

Center of knowledge (1)

• Center of knowledge – Vision and mission

• Knowledge about work incapacity: collection + making available

• Supporting the policy• (Inter)national networking

– Organisation and management• Daily coordinations: department

of benefits NIHDI• Guidance comittee: NIHDI,

academic world, Mutual Benefits Societies,

employees, employers

26

Center of knowledge (2)

• networks with (inter)national experts among others concerning disability management (current practices, education, …).

• stimulates and coordinates research in the field of work incapacity

• studies possibilities to implement the ICF (biopsychosocial view on functioning)

DISABILITY MANAGEMENT

Implementation of the DM-methodology (1)

• Definition and description of DM

The process in the workplace designed to facilitate the employment of persons with a disability through a coordinated effort and taking into account individual needs, work environment, enterprise needs and legal

responsabilities (International Labour Organisations, 2002).

Implementation of the DM-methodology (2)

• Definition and description of DM

… a proactive process that minimized the impact of an impairment (resulting from an injury, illness or

disease) on the individual’s capacity to participate competitively in the work environment (Shrey 1995)

Implementation of the DM-methodology (3)

• Definition and description of DM

The ultimate goals of worksite based disability management are to control workers compensation and disability costs and to

promote the sustained employment of workers with injuries and disabilities. Disability management strategies and interventions are

focused on three objectives

(1) Reducing the number and magnitude of injuries and illnesses

(2) Minimizing the impact of disabilities on work performed and

(3) Decreasing lost time associated with injuries, illnesses and resulting disabilities

(Shrey 1999)

Implementation of the DM-methodology (4)

ACTIVITIES FOCUSED ON:• Individual workers: development and

implementation of RTW-plans

• The organization: analysis of trends, cost benefit analysis, policies and procedures

• Society: establishment of policies that protect workers

Implementation of the DM-methodology (5)

KEY CONCEPTS• Early contact (2 levels)

– Informing person responsible for DM– Contact with the worker (or family);

formal and informal• Early intervention

– the longer away from work, the less

likely to return– personal consequences – loss of the competences– RTW as soon as possible, if needed gradual (task +

time)

Implementation of the DM-methodology (6)

• An interdisciplinary approach– ICF: beyond a medical approach range of experts – Rehabilitation: holistic

• Labor-management collaboration– E.g. committee with labor + management

representatives– Follow-up of development + operation of DM– Coordination with other programs– Involve all stakeholders– Education/information

Implementation of the DM-methodology (7)

• Interventions directed at both the worker + the workplace– Jobmatching: requirements + capacities– Avoid faillure: as risk of not at all RTW– Goals are not always aligned

• Case management– Central point of contact– Liaison – (C)RTWC: detects barriers + determines how (+who)

to resolve

Implementation of the DM-methodology (8)

• Injury prevention (health and safety)• Health promotion

Key for activating social security

RTW

Health promotion Health and safety

Implementation of the DM-methodology (9)

Why have a DM-program?

Benefits DM Costs no DM

Wage of individuals Cost of recruitment/replacement

Workplace morale Loss of skills, experience and knowledge

Ensure that legislative requirements are met

Loss of productivity

Costs for society Turnover

Meaning of work Workplace conflict

Costs for e.g. rehabilitation Work oad pressure

DM: OK! BUT do we have the necessary competences?

We need some education!

Offering the NIDMAR curriculum (adapted) followed by a certification process

The future is bright?

• Awareness

• Communication – coordination

• Studies policy recommendations

• Reintegration plan

Questions?

saskia.decuman@riziv.fgov.be