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PubMed2000

[Development of second-line occupational health services: toward an integrated network of insurers and care providers].

OBJECTIVE: To describe the development of the second-line Occupational Health Services and the role of private insurance companies in it over the period 1994-1999. DESIGN: Descriptive cross-sectional study. METHOD: Data were collected in 1999 from written documents and supplementary interviews with the five largest private providers of disability insurance, the National Insurance Institute, nine Occupational Health Services of different natures and 24 institutions for second-line occupational health service. RESULTS: After the privatization of the Health Law in 1996 and parts of the Law on disability Insurance, most employers covered the risk of continued payment of wages in case of disability with private insurers. These attempted to keep claims down by active engagement in arbitration, treatment and diagnostics of disabled employees so as to counteract avoidable absenteeism. Under the influence of the insurance companies, a trend developed toward integrated nation-wide chains in which the services provided by insurers, by occupational health services and by implementing institutions are geared for one another. CONCLUSION: Commercial provision of Occupational Health Service is a new, demand-active form of care provision in which the financier plays a key part. This provision of services supplied important innovating impulses for health care in its entirety because of its large scale, strong protocolling of processes and management on the basis of continuous cost-benefit analyses. A lucid and socially acceptable regulation of commercial providers of occupational health services was lacking.

Health Personnel↗
PubMed2000

[Insurance medicine training--a cost-effective initiative].

A training program in insurance medicine for younger physicians in clinical practice is presented. The program is individualized, problem-based and oriented towards clinical practice. Physicians participate in the program for two or five working days--depending on the level of clinical competence--and the following items are stressed: case reports with clinical insurance medicine aspects, knowledge of ordinary work places among the general population, training in early rehabilitation, and awareness of the process of certification for sick leave. During the past three years 73 physicians at all levels of clinical competence, mostly in the specialties general practice and occupational health, have passed the training program. There are many positive spin-off effects of the training, as well as substantial reductions in the rate of physician certification for sick leave and for early retirement pensions in the region. In 1999 the average level of sick-leave utilization was two days less than the national average, a reduction in relative terms by about 50% from 1996, when the regional level was 20% higher than the national level. In addition, during the period 1996-1999 the number of appeals of decisions of the Regional Social Insurance Office has been reduced from 33% to 6% of all decisions in which physician certificates for sick leave played a role. A nation-wide introduction of such a training program might possibly reduce the state expenditure for sick-leave insurance by 3 billion SEK on a yearly basis (about 10% of the current sick-leave related expenditure).

Certification↗