Intervening in return to work after long term sickness absence : confronting the stakeholders views

Background
Acknowledging individual and societal consequences of long term sickness absence, a political awareness is raising in Belgium in favour of a more active reintegration policy. Since various stakeholders are implied and several legislations may apply, it was deemed necessary to analyse the interplay between regulations and the role of the respective interveners to optimise return to work practices. The study focused on workers who are still under contract.
Methods
To this purpose, 23 representatives of various categories of stakeholders were interviewed: social insurance physicians, occupational physicians, insurers, social administration services, employers, unions, employment advisers, etc… Interviewees were asked to describe their role, to identify difficulties in the execution of their mission and sources of conflict between legislations, and to propose improvements. The interviews were audiotaped and fully transcribed.
Results
Several barriers to worker reintegration were pointed out during the interviews. On individual level, the worker social situation and a lack of information influence the chance of a successful return to work. At the enterprise level, the enterprise size, quality of peer support and lack of financial incentives were often mentioned. Most remarks concerned legislation. In Belgian labour law, the employment contract may be ended if the employee is permanently unable to perform his current job, even though modified work would remain possible. For many stakeholders, a sustainable return to work is hindered by the complexity of legislation which was developed for different domains (disability benefits, unemployment, work accident, occupational disease) with little attention to transitions from one domain to the other, especially between benefit insurance and unemployment legislation. It was also stressed that the possibilities offered by the occupational health legislation are underused or inappropriately used.
Conclusions
Legal and financial security must be insured for the worker who is ready to enrol in a reintegration trajectory. Public authorities should promote better knowledge and implementation of reintegration policies and current legislation should be improved with an emphasis on a better collaboration between stakeholders.