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Utilisation of nationwide register data to assess the effectiveness of changes in sickness insurance legislation on work participation and analyse sickness absence and disability retirement trends in Finland
Abstract
This paper presents examples of various ways of utilising for research purposes large nationwide registers, originally collected for administrative purposes. Merging registers with information on sociodemographic factors can help understand trends in work disability outcomes, such as sickness absence and disability retirement. Quasi-experiments can be designed utilising large register data to look at the effectiveness and cost-effectiveness of interventions on a societal level, such as legislative changes. Examples of such interventions include the introduction and amendment of laws determining the use of part-time sick leave in Finland and the so-called 30-60-90 rule, defining check-points for action for the occupational service provider, the employer and the employee in situations of prolonged sickness absence. Advanced analytical techniques, for example the construction of the propensity score, to increase comparability of studied groups, are especially feasible in large register data. We recommend using nationwide administrative register data for research purposes, where such data are available.
Tutkittu tieto sairauspäivärahan enimmäisajan jälkeisestä toimeentulosta on puuttunut Suomessa. Tutkimme työkyvyttömyyseläkkeelle siirtymistä, ansiotyö- ja työttömyysjaksoja, ammatillista kuntoutusta sekä uusia sairauspäivärahakausia kahden vuoden seurannassa henkilöillä, joiden sairauspäivärahan enimmäisaika oli tullut täyteen 2012. Tarkastelimme myös, miten päivärahaa saaneiden tausta oli yhteydessä enimmäisajan jälkeisten työkyvyttömyyseläkehakemusten yleisyyteen. Analysoimme kuvailevilla menetelmillä 70 prosentin edustavaa satunnaisotosta 18–60-vuotiaasta väestöstä hyödyntäen Eläketurvakeskuksen, Kelan ja Tilastokeskuksen rekisteritietoja. Tarkastelimme työkyvyttömyyseläkkeen hakemista ensisijaisena toimeentulolähteenä. Muita toimeentulon lähteitä tarkastelimme taustatekijöillä vakioituina prevalensseina käyttäen logistista regressioanalyysiä. Testasimme taustatekijöiden yhteyttä enimmäisajan jälkeisen 12 kuukauden aikaisen eläkehakemuksen todennäköisyyteen khiin neliö -testeillä. Enimmäisaikaa seuraavan vuoden aikana 68 % siirtyi työkyvyttömyyseläkkeelle, 14 % ei hakenut työkyvyttömyyseläkettä ja 18 %:lle ei myönnetty työkyvyttömyyseläkettä. Taustatekijöistä muu kuin toimihenkilöasema ja ansiotyön puuttuminen työkyvyttömyyden alkaessa selittivät vahvimmin työkyvyttömyyseläkkeen hakemista. Eläkettä hakematta jättäneet olivat usein ansiotyössä ensimmäisen seurantavuoden aikana (69 %). Hylkäävän eläkepäätöksen saaneista valtaosa sai työttömyysetuutta ensimmäisen (80 %) tai toisen (72 %) seurantavuoden aikana. Vuoden työkykyisyysajan jälkeen uudet sairauspäivärahakaudet olivat yleisiä. Sairauspäivärahan enimmäisajan täyttyminen merkitsee valtaosalla täyden työkyvyn menettämistä seuraaviksi vuosiksi riippumatta siitä, johtaako sairausjakso suoraan työkyvyttömyyseläkkeeseen. Pitkään sairauspäivärahalla olevien tilannetta pitäisi tukea tehokkaammin sairauspäivärahajaksojen aikana ja enimmäisajan lähestyessä. Erityisesti tämä koskee ansiotyön ulkopuolella olevia, joilta puuttuvat työterveyshuollon palvelut ja sairausvakuutuslain mukaiset, päivärahakauden sisäiset seurantapisteet.
Het 22e EUMASS congres was gecombineerd met de VG-dagen en vond plaats van 4 t/m 6 oktober 2018. 780 bezoekers uit diverse landen hebben het MECC in het zonnige Maastricht bezocht.
Objectives
We aimed to provide previously unestablished information on population-based differences in cause-specific sickness absence trends between occupational classes and further between four large industrial sectors within the different occupational classes while controlling for other socioeconomic factors and employment patterns. We focused on the period 2005–2013, during which the labour market underwent large economic and structural changes in many countries.
Design
Register-based panel data study.
Setting
Large representative datasets on Finnish wage earners aged 25–59 years.
Outcome measure
Annual risk of sickness absence (>10 working days) based on repeated logistic regression.
Results
Between 2005 and 2013, the proportion of employees with sickness absence decreased. Occupational class differences in sickness absence trends varied by disease group. Overall, the decrease in absences was smallest among lower non-manual employees. Sickness absence levels were highest in the health and social work sector and in the manufacturing sector within the non-manual and manual classes, respectively. Absences due to musculoskeletal diseases decreased temporarily during the peak of the economic recession in 2009, particularly in the manufacturing sector within the manual class. The decrease in absences due to musculoskeletal diseases was smallest in the trade sector within the lower occupational classes. Overall, education, income and employment patterns partly explained the differences in the absence levels, but not in the trends.
Conclusions
We found a complex interplay between the associations of occupational class and industrial sector with sickness absence trends. During the economic recession, absences due to musculoskeletal diseases decreased temporarily in a segment of wage earners who were known to have been hit hard by the recession. However, the trend differences were not explained by the measured structural changes in the characteristics of the study population. Both occupational class and industrial sector should be taken into account when tackling problems of work disability.
Aims:
Return to work (RTW) after prolonged sickness absence benefits both the individual and society. However, the effectiveness of legislation aiming to improve RTW remains uncertain. We examined whether sustained RTW and work participation were different before and after a legislative change enacted in 2012 (i.e. an intervention) that obligated employers to give notice of prolonged sickness absence to occupational health services.
Methods:
Two random samples (2010 and 2013) of the Finnish working aged population (70%, ~2.6 million each) were drawn. Using survival analysis, we assessed sustained RTW (≥28 consecutive working days) during a two-month follow-up after a sickness absence minimum of 30 calendar days in the pre- and post-intervention period. We also identified pathways for RTW with cluster analysis and calculated relative gain in work participation in the total sample and by several population subgroups.
Results:
In the total sample, sustained RTW was 4% higher and the mean time to sustained RTW was 0.42 days shorter in the post- than in the pre-intervention period. The estimates were larger among women than men and among those with mental disorders compared with other diagnoses. Changes in the pathways for sustained RTW indicated a 4.9% relative gain in work participation in the total sample. The gain was larger among those who lived in areas of low unemployment rate (20.6%) or worked in the public sector (11.9%).
Conclusions:
From 2010 to 2013, RTW and work participation increased among the employees with prolonged sickness absence, suggesting that the legislative change enhanced RTW. The change in work participation varied by population subgroup.
Objectives The aim of the study was to assess the effectiveness of the use of part-time sick leave at the early (first 12 weeks) stage of work disability due to mental disorder or musculoskeletal disease on sustained return to work (RTW) and overall work participation. Methods In a nation-wide register-based quasi-experimental study, we compared sustained RTW (ie, ≥28 consecutive days at work) and 2-year work participation between the part- and full-time sickness absence (SA) benefit groups (N=1878 in each group) using propensity-score matching. Persons who received partial or full SA benefit due to musculoskeletal diseases or mental disorders between January 1, 2010 and December 31, 2011 were eligible as cases or controls, respectively. Results A higher proportion showed sustained RTW after part- compared to full-time sick leave [absolute risk difference 8.0%, 95% confidence interval (95% CI) 5.3-10.9]. Moreover, the proportion of time at work was at a 10.5% higher level in the part- compared to full-time sick leave group. The prevalence of full disability retirement was almost three-fold among the full- compared to part-time sick leave group, whereas partial disability retirement was 4.5-fold more prevalent in the part- compared to full-time sick leave group. Conclusions The use of part-time sick leave during the first three months of SA enhances RTW and overall work participation during two years among persons with mental disorders and musculoskeletal diseases. The prescription of part-time sick leave can be recommended at an early stage of work disability.
To examine the effect of the new legislation on partial sickness benefit on subsequent work participation of Finns with long-term sickness absence. Additionally, we investigated whether the effect differed by sex, age or diagnostic category.
A register-based quasi-experimental study compared the intervention (partial sick leave) group with the comparison (full sick leave) group regarding their pre-post differences in the outcome. The preintervention and postintervention period each consisted of 365 days.
Nationwide, individual-level data on the beneficiaries of partial or full sickness benefit in 2008 were obtained from national sickness insurance, pension and earnings registers.
1738 persons in the intervention and 56 754 persons in the comparison group.
Work participation, measured as the proportion (%) of time within 365 days when participants were gainfully employed and did not receive either partial or full ill-health-related or unemployment benefits.
Although work participation declined in both groups, the decline was 5% (absolute difference-in-differences) smaller in the intervention than in the comparison group, with a minor sex difference. The beneficial effect of partial sick leave was seen especially among those aged 45-54 (5%) and 55-65 (6%) and in mental disorders (13%). When the groups were rendered more exchangeable (propensity score matching on age, sex, diagnostic category, income, occupation, insurance district, work participation, sickness absence, rehabilitation periods and unemployment, prior to intervention and their interaction terms), the effects on work participation were doubled and seen in all age groups and in other diagnostic categories than traumas.
The results suggest that the new legislation has potential to increase work participation of the population with long-term sickness absence in Finland. If applied in a larger scale, partial sick leave may turn out to be a useful tool in reducing withdrawal of workers from the labour market due to health reasons.
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To support sustainability of the welfare society enhanced work retention is needed among those with impaired work ability. Partial health-related benefits have been introduced for this target. The aim was to estimate the effects of partial sick leave on transition to disability pension applying propensity score methods.
Register-based cohort study.
Sample from the national sickness insurance registers representative of the Finnish working population (full-time workers) with long-term sickness absence due to musculoskeletal disorders, mental disorders, traumas or tumours.
All recipients of partial or full sickness benefit whose sick leave period had ended between 1 May and 31 December 2007 were included. The sample was limited to four most prevalent diagnostic groups-mental and musculoskeletal disorders, traumas and tumours. The total sample consisted of 1047 subjects on partial sick leave (treatment group) and 28 380 subjects on full sick leave (control group). A subsample (1017 and 25 249 subjects, respectively) was formed to improve the comparability of the two groups.
A three-category measure and a binary measure for the occurrence of disability pension on the last day of 2008 were computed.
Partial sickness benefit reduced the risk (change in absolute risk) of full disability pension by 6% and increased the risk of partial disability pension by 8% compared with full sick leave. The effects did not differ markedly for the two main diagnostic groups of musculoskeletal and mental disorders. In men, the use of full disability pension was reduced by 10% with a 5% increase in the use of partial disability pension, while in women the effects were close to those of the total sample.
Our findings suggest that combining work with partial sick leave may provide one means to increase work retention at population level. The use of partial sick leave could be encouraged among men.
Objectives We analyzed social security costs based on an earlier quasi-experiment that compared work participation between partial sickness beneficiaries and a matched group of full sickness beneficiaries. Methods Utilizing a population-based 70% representative sample, 1878 persons with part-time sick leave (intervention group) due to musculoskeletal diseases or mental disorders at an early stage of work disability and their propensity-score-matched controls with full-time sick leave were followed for two years. The outcome was the difference (absolute and relative) in social security costs between the intervention and control groups during follow-up. Costs of sickness absence, vocational rehabilitation, unemployment, and retirement days were calculated from national administrative registers. Results A cost reduction of €2395 per person per year [95% confidence interval (CI) -2890- -1899) was observed in the intervention compared with the control group. The cost ratio was 0.512 (95% CI 0.511-0.513). The largest savings were attributable to differences in the costs of retirement and vocational rehabilitation. The savings were higher for the second compared with the first follow-up year. Costs were saved across both genders and diagnostic groups, however, savings for women with musculoskeletal diseases were lowest. Conclusions Part-time instead of full-time sick leave, at the early stage of work disability due to musculoskeletal diseases or mental disorders, leads to considerable social security cost savings during two years, in correspondence with increased work participation and in addition to earlier reported health benefits. Part-time sick leave can be recommended from an economic perspective; however more consideration should be given to women with musculoskeletal diseases.
Introduction
Musculoskeletal diseases and mental disorders have remained the two leading causes of disability retirement in the Western countries for decades. Some evidence exists on the detrimental effect of economic recession on mental health. Previous findings suggest considerable differences in morbidity between occupational groups. Whether the economic recession widens occupational differences in work disability retirement due to the leading causes is largely unknown.
Methods
We used nationwide register data on Finnish residents aged 30–64 years. We examined occupational differences in full disability retirement due to musculoskeletal diseases (MSD) and mental disorders during 2005–2013.
Result
Between 2005 and 2013, the one-year cumulative incidence of full disability retirement due to MSDs and mental disorders decreased in both genders across all occupational groups. Occupational differences in disability retirement due to MSDs widened during the economic recession among women but not among men. However, the magnitude of excess risk for disability retirement due to co-occurrence of MSD with mental disorder (as compared to professionals as a reference group) for men in lower non-manual and manual occupations tended to increase. Occupational differences in disability retirement were reduced after controlling for occupational restructuring, the changing of employment patterns and sociodemographic factors during the follow-up period.
Discussion
Occupational differences in disability retirement due to MSDs and mental disorders, that are widened during economic recession, could be attributed to occupational restructuring and changes in employment patterns.
Objectives:
Women have higher sickness absence rate than men, but less is known of changes in this difference over time. We examined gender differences in sickness absence trends focusing on gender segregation in the labour market.
Methods:
We used large nationwide register data on Finnish wage earners aged 25-59 and generalized estimation equations based on repeated logistic regression to estimate the annual risk of sickness absence lasting at least 2 weeks.
Results:
Between 2005 and 2013, the age-adjusted proportion (%) of employees with all-cause sickness absence decreased from the initial levels of 10.6 among men and 15.1 among women by 16.7 and 13.6%, respectively. Among both genders, the largest decrease in sickness absence coincided with the peak of the economic recession in 2009. In sickness absence due to all causes and musculoskeletal diseases, also the excess decrease among men mainly occurred in 2009, and in sickness absence due to mental disorders 2 years later. In sickness absence due to all causes and musculoskeletal diseases, the increasing gender difference was mainly attributable to a larger decrease in sickness absence at the time of the recession in male-dominated groups, such as in manual and manufacturing work, than in other sectors and occupational classes. In mental disorders, the increasing gender difference was partly attributable to a later smaller decrease in sickness absence among female-dominated lower non-manual and lower income employment groups. The increasing gender differences did not result from differential distributional changes in employment or sociodemographic factors among the employed male and female populations. In fact, widening of the gender gap in sickness absence due to all causes and musculoskeletal diseases would have been even larger without faster increase among women in the educational level and in non-manual employment.
Conclusions:
Sickness absence decreased especially in male-dominated employment groups, resulting in a larger decrease in absences among men compared with women. More research is needed to ascertain whether these differential changes are attributable, for example, to reduced willingness to seek medical advice or increased presenteeism in male-dominated groups, or to increased work pressures in female-dominated groups. Selection mechanisms, i.e. men's increased ill-health-related exit from work through other routes than sickness absence, also cannot be ruled out.
In current research, the extensive family policies of the Scandinavian countries have been problematized and described as hampering women’s careers. However, mechanisms have been little investigated and the Scandinavian countries are often regarded as a single policy model. Based on an account of institutional variety we study gender gaps in hourly wages and access to authority positions in Denmark, Finland, Norway and Sweden and explore the importance of segregation, skills and work interruptions. The analysis uses pooled cross-sectional data from the European Social Survey (ESS) for 2004 and 2010. The results show that gender gaps vary both in size and regarding the mechanisms producing them. In particular, we find that gender segregation has a radically different impact in the four countries. The analysis suggests that the mechanisms linking family policies to labour market outcomes are more complex than envisaged in the current debate and point to the importance of comparing seemingly similar countries.
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