David McDaid - Fit for Work Europe Summit 2013.pdf

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

Follow us on Twitter @FfWEurope

Check our website www.fitforworkeurope.eu

Take a look at our blog www.blog.fitforworkeurope.eu
http://www.fitforworkeurope.eu/http://www.blog.fitforworkeurope.eu/http://www.blog.fitforworkeurope.eu/http://www.fitforworkeurope.eu/


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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: [email protected]


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Why collaborate across sectors?

-100

-80

-60

-40

-20

020

40

60

80

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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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
http://www.fitforworkeurope.eu/http://www.blog.fitforworkeurope.eu/http://www.blog.fitforworkeurope.eu/http://www.fitforworkeurope.eu/

Documents

David McDaid - Fit for Work Europe Summit 2013.pdf