Transcript Slide 1
Re-employment & Health
Rogier van Rijn
Erasmus MC, department of Public Health
Unemployment: Europe
Unemployment rates 2012
6,4%
4,1%
Unemployment: The Netherlands
Unemployment rates 2012
12,6%
10,9%
7,9%
6,4%
6,4%
Unemployment and Health
unemployed (n=187)
employed (n=1485)
120
Self-rated health scale 0-100
100
80
60
40
20
0
general
health
physical
functioning
bodily pain
mental
health
social
functioning
vitality
role
limitationemotional
problem
Lower scores on all health dimensions for the unemployed
Health survey 2003 GGD Rotterdam
role
limitationphysical
problem
Unemployment and Health
Continue to be unemployed (n=918)
baseline
follow-up
Re-entered paid employment (n=47)
baseline
follow-up
Self-rated health (scale 0-100)
120
100
80
60
40
20
0
general
health
physical
functioning
bodily pain
mental
health
social
functioning
vitality
role
limitationemotional
problem
role
limitationphysical
problem
All dimensions of health improved among re-employed subjects
Health at baseline was better among subjects who returned to paid employment
Schuring et al. The effect of re-employment on perceived health. J Epidemiol Community Health. 2011;65(7):639-44
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
Re-employment; mean difference of 16% (IPS vs. control)
Hours worked; mean 23 hrs/ week in both groups
Mueser KT. The Hartford study of supported employment for persons with severe mental illness. J Consult Clin Psychol. 2004;72(3):479-90.
Effects: type of work
Percentage that worked at least one day
Voluntary work
Subsidized work
Regular work
IPS
Control
at 6 months
at 18 months
at 6 months
at 18 months
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
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)
Long-term unemployed subjects (age
< 50yr) with mental health problems
Sufficient labour market skills
Randomisation
Sufficient skills to be able to provide
answers in an interview
Questionnaire (baseline)
No
severe
acute psychiatric illness
Primary
outcomes;
No drug
addiction
or &being
homeless
perceived
mental
physical
health
Fit4Work
Control
(n=500)
(n=500)
Questionnaire
(12approach
months)
intersectoral
integrated
improving mental health
Questionnaire
months)
addressing
barriers in(24
socialand
labour force participation
work resumption
social participation
self-esteem
resilience
social problems
medical consumption
regular re-employment programme
Secondary outcomes;
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
Thanks for your attention
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