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
 [email protected]