the right to work: innovative policies and good practices for persons with disabilities, 2012 good...

The Right to work: Innovative Policies and Good Practices For Persons With Disabilities, 2012

Good Practices Award (Certificate of Merit) For Asia & Pacific, 2012 Human Rights Award, Malaysia (2013)

1ST NAMIBIAN SOCIAL PROTECTION CONFERENCESAFARI, WINDHOEK8th JULY 2015

MOVING FROM PAYER TO PLAYER IN OCCUPATIONAL INJURIES & ACCIDENTS – THE CASE OF MALAYSIA

Social Security Organisation Malaysia Return to Work : Moving from Payer to Player The Business Case for Return to Work Success Factors Way Forward Conclusion

OVERVIEW

The Right to Work: Innovative Policies and Good Practices For Persons With Disabilities, 2012


MALAYSIA



Population: 30 million Land: 329,847 km2

45 Branch Offices

• Statutory Body Under the Human Resource Ministry• Currently insuring 15.2 million workers & 948,218 employers

(All workers with income of RM3000 and below).• Contribution of 2.25% of the average salary (1.25% Employment Injury Scheme (Funded by Employer) & 1% for Invalidity Pension scheme (Equally Shared by Employer & Employee)• Manage over 98,990 new Claims/per year

• Over 62,426 accidents • Over 18,491 permanently disabled• Over 18,073 claiming for invalidity (≈7000 certified invalid)

SOCIAL SECURITY ORGANISATION MALAYSIA





EMPLOYMENT INJURY

• Rated of contribution: 1.25% of employee’s monthly wage

• Paid solely by employer• Rate determined and not changed since 1971• Fully Funded scheme • Protection for work related commuting

accidents; industrial injury & Occupational Diseases

• Benefits: Medical Benefit Temporary Disablement Benefit Permanent Disability Benefit Constant Attendance Allowance Dependants Benefit Funeral Benefit Rehabilitation Benefit Educational Benefit

INVALIDITY PENSION

• Rated of Contribution: 1% of monthly wages equally shared between employer and employee

• Scheme introduced in 1974• Partially Funded• 24 hr. Protection for Invalidity from illness

or accident or death irrespective of cause. Death coverage from 1985

• Benefits: Invalidity Pension Survivors Pension Constant Attendance Allowance Funeral Benefit Rehabilitation Benefit Educational Benefit

INSURANCE SCHEMES



PREVENTION REHABILITATION COMPENSATION

“IDEAL CONCEPT” OF SOCIAL SECURITY IN MALAYSIA



PREVENTION REHABILITATION COMPENSATIONCOMPENSATIONCOMPENSATIONCOMPENSATION

COMPENSATIONCOMPENSATIONCOMPENSATION








COMPENSATIONCOMPENSATIONCOMPENSATIONCOMPENSATION

COMPENSATIONCOMPENSATION


COMPENSATIONCOMPENSATION

COMPENSATION

COMPENSATION

“PERCEPTION” OF SOCIAL SECURITY IN MALAYSIA

KEY SOCIAL SECURITY COMPONENTS



?

MOVING FROM PAYER TO PLAYER



INJURY

COMPENSATION&

UNMONITORED TREATMENT

(normally symptomatic)What after compensation?

New Approach through Case Management

INJURY

Compensation&

BiopsychosocialIntervention

&Continuous monitoring

Functional ImprovementsActivities of Daily Living

Social IntegrationRETURN TO WORK

Sustainable Social System

???

SOCSO’s RETURN TO WORK PROGRAM



This program is established with the objective of assisting SOCSO’s Insured Persons with employment injuries as well as those claiming for invalidity to be able to return to work using the case management concept and bio psychosocial approach.

RETURN TO WORK MODEL



RETURN TO WORK PROCESS



Functional Capacity

Functional Capacity Work Demand

Work Demand

Scenario 2

1. Medical Intervention2. Physiotherapy3. Occupational Therapy4. Prosthesis5. Orthotics6. Assistive Device

1. Job Coaching2. Reengineering Current Work

Processes3. Engineering New Work

Processes4. Workplace Modifications5. Reducing Workloads

(Duration)

RETURN TO WORK GOAL



Same Job

Similar Job

Different Job

Same Job Same Employer

Similar Job Same Employer

Different Job Same Employer

Same Job Different Employer

Similar Job Different Employer

Different Job Different Employer

RTW Goal

23456

1

CASE MANAGERS & JOB PLACMENT OFFICERS



41 CMs/DMs10 Job Placement Officers

THE BUSINESS CASE OF RETURN TO WORK



Legal Framework

Economic ImpactSocial Impact ?




Legal Framework

The recommendation provides that “where possible and appropriate”, social security schemes should provide, or contribute to the organization, development and financing of training, placement and employment (including sheltered employment programmes and vocational rehabilitation services for disabled persons, including rehabilitation counseling

ILO Convention 159 & Recommendation 169



Section 16(2)(c)In determining whether the claimant is suffering from invalidity, account shall be taken of any permanent improvement in the state of his invalidity which results or is expected to result from such measures of physical or vocational rehabilitation as may be offered to him free of charge by the Organization.Section 57 (1)An insured person suffering from or claiming to suffer from invalidity or permanent disablement may be provided by the Organization, free of charge facilities for physical or vocational rehabilitation

EMPLOYEES SOCIAL SECURITY ACT 1969



SECTION 40

(1) The Organization may, in addition to the scheme of benefits specified in this Act, promote measures or co-operate with existing institutions for the improvement of the health, occupational safety and welfare of insured persons and for the rehabilitation and re-employment of insured persons who have been disabled or injured and may incur in respect of such measures expenditure from the funds of the Organization within such limits as may be prescribed by the Minister.

(2) Measures under subsection (1) may include provision of artificial limbs and appliances, opportunities for gainful employment under suitable conditions and convalescent homes.

EMPLOYEES SOCIAL SECURITY ACT 1969



UNCRPD (Article 9)Biwako Millenium FrameworkIncheon StrategyPWD Act Malaysia, 2008

OTHER LEGAL FRAMEWORKS



• Prolonged absence, including absence from the workplace, is detrimental to a person’s mental, physical and social well-being.

Source: Canadian Medical Association 2004)• Safe, early RTW programmes improve performance,

regain functionality, and enhance their quality of life. Source: American Academy of Orthopaedic Surgeons 2004• Patient may not be well served in the longer term by

medical advise to refrain from workSource: UK Department of Works and Pension

INTERNATIONAL TRENDS ON RETURN TO WORK






ECONOMICAL IMPACT

BENEFIT VS CONTRIBUTION



2009 2010 2011 2012 20130

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

ContributionPayment

YEAR

Million (RM)

MYTH OR FACT



US GAO REPORT TO CONGRESSIONAL COMMITTEE : MARCH 1997

• Social Security Administration (SSA):– Disability Insurance(DI)– Supplemental Security Income (SSI)

• Return to Work outcomes:– less than 1:500 beneficiaries

• Bust!:– Congress reallocated payroll tax receipts estimated to total $500 billion

by the end of 2016 to the DI from Social Security Old Age and Survivors Insurance Trust Fund to DI Trust Fund to prevent impending insolvency.

• Recommendation and Conclusion of the report:– Social Security Disability Programs lag in Promoting Return to Work.– SSA Disability Program Redesign necessary to encourage Return to

Work.

COST OF ABSENTEEISM TO THE GDP



Cost of Absenteeism in 2012 = RM 100,000 per day

The additional cost of replacing absent workers and the loss due to sick leave amounted to 1% of Malaysia’s Gross Domestic Product (GDP) of RM 850 billion.

Source: Malaysian Medical Association (MMA)

ROI : SOCSO’s PERSPECTIVE



Cost vs Returns

Average Program Cost Per Insured Person

Average Returns to SOCSO$0.00

$1,000.00

$2,000.00

$3,000.00

$4,000.00

$5,000.00

$6,000.00

$7,000.00

$8,000.00

$9,000.00

$3,239.38

$7,884.06

Cost Analysis

Average Program Cost per Insured Person RM3,239.38 (≈US$1,063)Average Possible Returns (Social System) RM7,884.06 (≈US$2,588)

Net Benefit of(RM7,844.06 – RM3,239.38)= RM4,644.68

Other Social (qualitative) Benefits

+

DM program benefits outweigh costs by a 1.43 : 1

ratio.

N = 1008

ROI: INSURED PERSON’s PERSPECTIVE



0.00

100,000.00

200,000.00

300,000.00

3,298.38

318,323.96

Cost vs ReturnsCost Analysis

Average Program Cost per Insured Person RM3,239.38 (≈US$1,063)Average Possible Returns (Worker) RM318,323.96 (≈US$106,963)

Net Benefit of(RM318,323.96–

RM3,298.38)= RM 315,025.58

Other Social (qualitative) Benefits

+

DM program benefits outweigh costs by a 64.68 : 1

ratio.

N = 1008




SOCIAL IMPACT

SOCIAL & ECONOMIC IMPACT



COMPENSATION: INCENTIVE VS DISINCENTIVE



DETAILS RTW (RM) UNEMPLOYED

Salary (RM 3000.00 / mth) 36, 000 0.00

( - )Contribution (SOCSO: 14.75/ mth)(EPF Contribution (11%)

177.00

3960.00

0.00

Compensation: (Invalidity: 94% WIP)RM 1325 / mth (if he receives the pension)

15,900.00

TOTAL 31,863.00 15,900.00

QUALITATIVE ASPECTS I)Annual IncrementII)Career DevelopmentIII) Reintegration within SocietyIV) EPF – Retirement SavingsV) Social Protection - SOCSO

I)Burden to familyII) DepressionIII)Not ProductiveIV) Vulnerable to Poverty

PERKESO(Social Insurance

Fund)

Workers

Employers

+=

Contribution

BenefitsIncrease in Compensation

Reduction of healthy & productive workers

due to disability

What happens if we have lesser workers?

The Collapse of the Social

System

SUSTAINABLE SOCIAL SYSTEM



• Self Perceived Psychosocial Factors



QUALITATIVE BENEFITS

Skills

Career G

oals

Independence

Self Este

em

Self Confidence

Health Condition

Pain Tolerance0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

5.12 5.106.00 5.93 6.03

5.566.046.42 6.45

7.20 7.10 7.476.86 7.15

Before After

Before After

Skills 5.12 6.42

Career Goals 5.10 6.45

Independence 6.00 7.20

Self Esteem 5.93 7.10

Self Confidence 6.03 7.47

Health Condition 5.56 6.86

Pain Tolerance 6.04 7.15

VAS – 100mm

N = 1008

DEPRESSION, ANXIETY AND STRESS SCALES



Depression Anxiety Stress0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

16.0014.64

13.21

14.93

8.217.04

8.75

Before Programme After Programme

Before After

Depression 14.64 8.21

Anxiety 13.21 7.04

Stress 14.93 8.75

N = 1008

J Health Econ. 2003 202: 505-518A note on the effect on unemployment on mortalityGertham UG, Johannesson M.

RESULTS: Mortality experience of 30,000 Swedes followed for 10 to 17 years, concluding that unemployment increased the risk of death by nearly 50%.

EVIDENCE FOR RETURN TO WORK



2005 2007 2008 2009 2010 2011 2012 2014 2015

Pilot Project

National Launch

Job Placement Unit

2nd Expansion

Ministerial KPI

Early Intervention Project

5th RTW Conference

SOCSO Rehabilitation Center

MOU with MEF & MTUC

5 Case Managers

10 Case Managers

35 Case Managers

15 CDMPs 41 Case Managers

RTW Coordinators for Employers

2 States 5 States All States Established as a Department

10 Job Placement Officers

Over 90 Rehab Providers

1st RTW Conference

1 Job Placement Officer

6 Job Placement Officers

4th RTW Conference

Trained Case Managers in Indonesia

6 Private Rehab Providers

2nd RTW Conference

3rd RTW Conference

1st Job Carnival

6th RTW Conference

RETURN TO WORK MILESTONES



RETURN TO WORK STATISTICS



19556; 55%15750; 45%

RefferedMotivated

15750; 58%

11457; 42%MotivatedReturn to Work

Acute Stage,Rehabilitation,Job PlacementVocational Retraining

SUCCESS STORIES



Stakeholders Involvement & Participation Legal Framework & Mandate Case Management Multidisciplinary Approach Bio Psychosocial Intervention Early Intervention Evidence Based Strategies Infrastructure (One Stop Rehab Centre, Private & Govt Rehab Facilities) Parallel Programs (DET for Employers/Employees, RTWC, Technology (Websys) Working with Relevant Ministries Competencies of Case Managers Promotions (Videos, Testimonials, Conferences)

SUCCESS INGREDIENTS



SUCCESS INGREDIENTS



SOCSO’s REHABILITATION CENTRE, MALACCA

CHALLENGES



Poor Infrastructure (Transportation / Facilities in Rural Areas, Building & Design)

Legal Framework

Perception / Stigma

Cultural Factors/Attitudinal

Manpower

WAY FORWARD



• At least one (1) Return to Work Coordinator to be appointed in larger scale industries to facilitate workers with injuries and illnesses.

• Disability Management to be included as part of human resource management and to introduce this as a module or subject in Human Resource Management courses across public and private institutions

• Disability Management to be embedded in Occupational Safety & Health Policies within organizations.

WHY DECENTRALISATION ?



Manage over 98,990 new Claims/per year • Over 62,426 accidents • Over 18,491 permanently disabled• Over 18,073 claiming for invalidity* (≈7000 certified invalid)

• Case Managers are currently only managing 3.23 % of these cases. What about the rest ?

• SOCSO would need an additional 1196 CMs to manage these cases or 618 Case Managers to manage at least 50% of the cases.

MOU WITH KEY STAKEHOLDERS



Move from Payer to Player

Important to be Dynamic & Innovative

Holistic & Relevant Programs

Strong Business Case For Return to Work

Employment is a Human Right !

Look at the Ability & Not the Disability

Towards Economic Empowerment & Societal Reintegration

CONCLUSION





Thank you [email protected] HP: + 60126044467

“The best way to kill a man is to pay him for doing nothing…” (Félix Leclerc, Poet from Quebec)

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