Cancer! Return to work? The situation in Belgium. EU-OSHA seminar 5th October 2017 Dirk Dhollander

Transcription

1 Cancer! Return to work? The situation in Belgium EU-OSHA seminar 5th October 2017 Dirk Dhollander

2 Content Introduction Legislation and evolution Daily practice and evolution Case of cancer

3 Belgium labour market challenged now Employer and his organisations Freedom in contracting people and in organising work Medical control for sick-listed (short-terme absence) Occupational health physician (OHP) and team Insurance for occupational accidents and diseases Employee and his organisations Health protection and nondiscrimination laws Social insurance physician (SIP) in Health insurance organisations providing the mandatory work incapacity insurance (long-term absence)... Unemployment benefit payment Co-management in parastatal supervising organisations : RIZIV, RVA, FBZ-FAO,

4 Competences in Labour market Social security and health Work incapacity benefit s and unemployment allowances RIZIV, health insurance sickness funds, RVA Labour market support Support => RTW for all unemployed VDAB(GTB), ACTIRIS, FOREM

5 Legislation No cancer-specific legislation The cancer patient as prototype of the chronic patient in return to work (RTW)

6 Legislation Evolution since 2005 in RTW process 1/ the past = stability emphasis on medical control (art 100 1), vocational rehabilitation and retraining as the exception

7 Work incapacity flow employees 0d-14d -1mth 6mth 1 year Art part-time work and voluntary work Invalidity + GRI ( RIZIV) Retraining Last job General labour market

8 Medicalisation through medical control of sick listed A vast army of doctors prescribing sick notes Patients and employers in a passive role A lot of reports that accentuate illness and work incapacity To little possibilities for control and little managing towards RTW Legitimating process = art100 Purge to long term absence INV Or ping-pong unemployed sick

9 Legislation vs implementation Evolution since 2005 in RTW process 2/ growing importance of art Part-time work in combination with incapacity benefit evolution from tolerance policy to common practice in RTW

10 Legislation Evolution since 2005 in RTW process 3/ guidance in RTW upgraded to a primary concern since 2009 (art 153) 4/ sensitization phase Study symposia, goodwill, role clarification, brochures, pilots, supported mostly by non-profit cancer organisations as VLK, LIKAS, pink ribbon, de stichting tegen kanker,

11 Daily practice shift Evolution since 2005 in RTW process 5/ pilot phases until 2016 successful cases, good practices 6/ agreements RTW involved parties : ZF-SIP, VDAB-GTB, RIZIV e.g. communication forms and procedures blockchain re-orientation agreements

12 Daily practice shift Evolution since 2005 in RTW process 7/ (oncologic) rehabilitation centres are entitled to (e.g. cancer) incorporate RTW as a new focus in the rehabilitation process 8/ multidisciplinary becomes the new normal (some degree of de-medicalisation) in oncologic rehabilitation, in SIP sickness fund, in OHP services, ICF instruments etc

13 Legislation Evolution since 2005 in RTW process 9/ the legislative phase ongoing January 2016: new sick note December 2016: re-integration procedures

14 Legislation New sick note jan 2016 Closed certificate Prescribing responsability Information also focussed on RTW Patient is involved

15 Legislation - December 2016: coordinated re-integration procedures mandatory for social security physician SIP and the occupational heath physician (OHP) installed by law with implications for employee and employer Mismatch? 70% ends in resignation, why? SIP and OHP get still lost in procedural formalities Street level bureaucrats challenged

16 Legislation Today 15/9/2017 last politic agreement communicated by the federal government: enforce monitoring sick leave prescription by GP s doable jobs for >60j old, at the end of a career more flex-jobs last but not least: new occupational juridical framework for RTW of chronic ill and disabled persons Challenge to make the re-integration procedure work Task forces Meanwhile

17 Cancer case What happens to the cancer patient who totters through Belgian labour market? How is the employer involved in the RTW process? Depends on goodwill. Cases OK. No mandatory working system of re-integration yet but Rentree procedure specific for cancer patients => coaching RTW / good practice enlarged mid 2017 in agreement between VLK/Rentree GOB network /health insurance organisations

18 Cancer case Breast cancer women 49 years old: why this example?

19 How it was and how it will change. in the future Breast cancer women 49 years old: Work situation. Diagnosis. Sick note. Curative evolution. Medical rehabilitation. Administrative situation: 1 year: invalid! Contacts with the social insurance physician. Planning RTW, re-integration procedure (different stakeholders involved). Starting part-time. Avoidable unpleasant surprise after three years! too late, always possible. Possibilities of a new start in another job than the previous job. Personal coach: from experiment to everyday practice? Lots of goodwill But still lots of uncertainties