358 Return to workand work participation after changes in occupational health service and health insurance act. nationwide finnish register studies

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Abstract

Introduction

In many countries the social security legislation has been changed to support staying at work and return to work (RTW) from sickness absence (SA). However, the effectiveness of such changes is not well known. The aim was to assess the effectiveness of the introduction of part-time sick leave in 2007 and an amendment in its use in 2010 (enabling use at early stage of disability) on RTW and work participation. We also looked at RTW and work participation after the so-called 30–60–90 day rule was enacted in 2012, obligating, among others, early notification of prolonged SA (>30 days) as well as assessment of remaining work ability and possibilities to continue working (before 90 days).

Methods

We used nationwide register information on ill-health benefits, as well as employment and unemployment periods. Receivers of partial sickness benefit were compared with propensity-score matched controls of full sickness benefit receivers. For the 30–60–90 day rule, we followed-up (2–10 months) those who had a continuous SA of 30 calendar or 60 compensated days before and after 2012.

Result

Part-time sick leave at the early stage of disability enhanced return to work. Moreover, the proportion of time at work was at a significantly higher level in the part-time than full-time sick leave group. The prevalence of full disability retirement reduced and that of partial disability retirement increased among users of part-time compared with those with full-time sick leave. Work participation did not essentially differ after a SA of 30 calendar or 60 compensated days after the introduction of the 30–60–90 day rule.

Discussion

The use of part-time sick leave enhances return to work and overall work participation, and should be considered, when a person is not able to work full time. The 30–60–90 day rule seems not to have affected work participation during our follow-up times.

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