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7/27/2019 David McDaid - Fit for Work Europe Summit 2013.pdf
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Investing in Healthcare: breaking down
the silos
Brussels, 16 October 2013
With the endorsement of the Lithuanian Presidency of the Council of the EU
In partnership with the European Economic and Social Committee
Co-chaired by Antonyia Parvanova MEP & Gianni Pittella, Vice-President, EP
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http://www.fitforworkeurope.eu/http://www.blog.fitforworkeurope.eu/http://www.blog.fitforworkeurope.eu/http://www.fitforworkeurope.eu/7/27/2019 David McDaid - Fit for Work Europe Summit 2013.pdf
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Investing in Healthcare: breaking down the silos
David McDaidEditor, EuroHealth & Personal Social Services Research Unit,
London School of Economics and Political Science andEuropean Observatory on Health Systems and Policies
Working across government departments to
promote return to work
Return on Early Intervention
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Working across governmentdepartments to promote return towork
David McDaid
Fit for Work Europe Summit on Investing in Health Care, Brussels,
October 2013
Personal Social Services Research Unit, London School of Economicsand Political Science and European Observatory on Health Systems and
Policies
E-mail: d.mcdaid@lse.ac.uk
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Why collaborate across sectors?
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020
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Social Welfare Health Sector
ResourceConsequences
Health Benefits
More Employment
Reduced costs to socialwelfare system
Costs of actionto healthsystem
Improved rate of employment So why should
health sectorinvest?
Collaborationwith shared
goals mayhave a betterreturn oninvestment
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7/27/2019 David McDaid - Fit for Work Europe Summit 2013.pdf
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Sweden: Co-ordinated budgets for vocational rehab
Extensive experiments since early 1990s Looking at different forms of collaboration between
Regional Health services
Municipal Social Services
National Social Insurance Administration
National Employment Services
1993- 1997 initially resources for rehab
transferred from social insurance to healthcareaim to reduce cost of sickness benefits
19942002social services & employment
services also involved in 8 municipalities
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Sweden: Co-ordinated budgets for return to work
Initial evaluations positive Improved collaboration & co-ordination
Led to 2003 Act on Financial Coordination of
Rehabilitation Measures Allowed local associations to be formed for
financial collaboration
Resources for rehabilitation pooled in a singlebudgetallocated for different rehabilitation
services
2008 Rehabilitation Chain reforms
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Swedish Rehabilitation Chain
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What difference
have these reformsmade?
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Swedish Social Insurance Authority 2013
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New claims for early retirement and disability
Swedish Social Insurance Authority 2013
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Rehabilitation Chain 2008 reforms
rehabilitation chain
Time restricted workingcapacity assessments havecontributed
Assessments at 91 and 181days
Only implemented in around20% of cases
Reduction in level ofbenefits after 1 year
Rehabilitation guarantee
with psychological supportfor MSD and Mental Health
Helps put more focus onearly intervention
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Sick leave / disability benefit trends
Hagglund 2010
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Are they effective?
In Sweden
still a lack of hard financial incentives between publicemployment services and social insurance administration.
Employers and occupational health services not incentivised to work
with insurance system to help in return to work; problem especially
for mental health problemsIf employment services responsible for paying sickness benefits from
its budget then more direct incentive to help reintegrate into work
Mandatory support only provided to those who have been
unemployed for more than 2.5 years through Work IntroductionProgramme
More focused on employment as an outcome target of rehabilitation
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Challenges for those who do not return to work
Re a report on those who reached one year on sickness
insurance (Arbetsfrmedlingen, Frskringskassan 2010 )
In following 6 months
2.5% returned to open employment
7% subsidised/sheltered employment
41% returned to sickness insurance after a waiting period50% unemployed or unidentifiable
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Joint budgeting across sectors more generally
Limited focus of evaluation on outcomes; largely on process; most
experience at local/regional level
But some success in initiatives to reduce road traffic casualties in England andprovide services for children
Evidence they can help overcome narrow sectoral interests by
Widening area of responsibility
Obtaining engagement and interest of different stakeholders
Promoting flexibility in funding
Ending the cross-sectoral blame game
Reduce need for complex contracts between different actors in different sectors
Arrangements can be poorly understood / implemented (UK Audit
Commission 2008, 2009, Swedish Audit Commission 2010)
Experience in England and Sweden suggests additional actions needed:
Inter-sectoral working relationships
Highlighting multiple benefits
Demonstrating economic benefits
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Factors to aid in implementation
Define problem / joint benefits of action
Identify all cross sectorial stakeholders / actors to be involved Understand what are their priorities and goalshow would joint
funding of an initiative add value from their perspectives
Vital to highlight non-health benefits; speak non-public health
language Sustained effort needed to build cross-sectoral working relationships
Employing co-ordinators (esp where not full integration of budgets)
Co-locate team members to help trust/ working relationships develop
A role for financial incentives Needs common set targets/performance indicators linked to appropriate
outcomes
E.g. incentivising employment services and employers alike
Highlight the economic case for cross-sectoral action
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In Conclusion
Some evidence that mechanisms to foster cross-sector working in
Sweden have been positive in promoting return to work
Downward trend in long term sickness absence over recent years and
supportive of early intervention strategy
New claims for long term sickness compensation (disability benefits)
falling; more noticeable for MSDs than mental health
Need to incentivise employers & public employment services; issuesre work capacity assessments
Sickness benefit payments fallen but no definitive economic
assessment conducted;
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Thank you for attending the Fit for Work
Summit 2013.
Follow us on Twitter @FfWEurope
Check our website www.fitforworkeurope.eu
Take a look at our blog www.blog.fitforworkeurope.eu
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