National systems and local services

1
National systems and local services the findings

• Richard Wynne, Work Research Centre, Ireland

2
National systems and local services the findings

• A comparison of the welfare, rehabilitation
  systems and other systems in 6 countries
• Austria, Finland, Ireland, Italy, the
  Netherlands, the UK

3
Types of welfare systems

• System type
• Welfare based
• Ireland
• UK
• Social insurance based
• Netherlands
• Finland
• Austria
• Mixed
• Italy

4
Types of welfare systems

• System philosophy
• Income replacement
• Ireland
• Italy
• Income replacement and RTW
• Austria
• Finland
• Netherlands
• UK

5
Types of welfare systems

• System delivery
• Ireland - Mix of public, semi-state and private
  sector provision
• United Kingdom - Mix of public and private sector
  provision
• Italy - Mixed
• Netherlands - Mix of private and public sector
• Finland - Mostly public and semi-state sector
• Austria - Mostly public sector

6
Funding levels and levels of claims
Country Funding levels Claims levels
Ireland Low levels of benefits, General funding base Low
United Kingdom Low levels of benefits, General funding base Moderate to high
Italy Moderate benefits Moderate
Netherlands High benefits, social insurance base High
Finland High benefits, social insurance base High
Austria Moderate benefits, social insurance base Moderate
7
The treatment of stress in legislation and
practice
Country Legislative basis and diagnosis status
Ireland Occupational stress as part of OSH legislation Unofficially accepted as a basis for welfare payments
United Kingdom Occupational stress as part of OSH legislation Unofficially accepted as a basis for welfare payments
Italy Occupational stress as part of OSH legislation
Netherlands Occupational stress as part of OSH legislation Burnout is recognised in legislation and diagnosis
Finland Occupational stress as part of OSH legislation Occupational stress is defined as not being an occupational disease
Austria Occupational stress as part of OSH legislation
8
The treatment of stress in legislation and
practice

• From the professional study, stress (and fatigue)
  is sometimes used as a cover for diagnosis of
  mental illness, social problems and other non
  medical reasons for absence

9
Adequacy of provisions for stress and long term
absence
Country Provisions for stress
Ireland Few legislative obligations Appropriate treatment is scarce and is usually uninsured Weak OSH system Courts set precedents on occupational stress liabilities
United Kingdom Few legislative obligations Appropriate treatment is scarce and is usually uninsured Weak OSH system Courts set precedents on occupational stress liabilities Provisions for stress related absence are the same as those from any other cause. Assessment of ability to work is ICD-10 and DSM-IV based - no provision for stress related problems Some back to work initiatives from DWP
Netherlands High level of obligations on employers Burnout is recognised as a legitimate cause of absence Well defined roles for OSH in RTW
10
Adequacy of provisions for stress and long term
absence
Country Provisions for stress
Italy Legislative provisions in relation to stress are weak and un-coordinated Return to work services are seen as being experimental Future changes may see more emphasis on psychosocial issues and on reintegration.
Finland Recent emphasis on psychosocial and psychological issues Increased focus on rehabilitation and collaboration between the major service providers High level of rehabilitation focus
Austria Social insurance based system provides schemes for stress prevention and rehabilitation Recent legislation allows for psychologists to be part of prevention activities
11
Responsibilities in the return to work process
AU SF IRE IT NL UK
Diagnosis PH PH, OSH PH PH PH, OSH PH
Treatment PH PH, OSH PH PH PH PH
Med rehab SI, PH SI, PH, OSH PH PH PH, OSH, Emp PH
Voc. Rehab TR TR, SI TR TR Tr, Emp TR
Assess PH, OSH PH, OSH, SI PH, OSH, PI PH, OSH, SI PH, OSH PH, OSH
RTW None Emp None None None Emp None
Funding SI SI SI SI SI, Emp SI
RTW rates
12
Conclusions