Individual- and company level determinants of vocational rehabilitation: a multilevel study

Abstract

Backround Vocational rehabilitation (VR) is considered an important means to combat work ability problems and enable people to continue working despite health problems. We examined the magnitude of company level variation in VR and determined which individual- and company level characteristics are associated with access to VR due to mental disorders, musculoskeletal diseases, and other somatic diseases. Methods A 30% random sample of all Finnish private sector companies with more than 10 employees aged 25-62 years at the end of 2010 (5.567 companies with 300.601 employees) was followed up for incident VR for six years. Company size and industry, as well as gender, age, education, social class and sickness absence measured both at the individual- and company level, were used as explanatory variables in multilevel logit models. Results After controlling for the individual level covariates, companies accounted for 12% of the variance in VR. The proportion was largest in VR due to musculoskeletal diseases. VR was more common among women, older employees (except the very oldest age group), those with low education (particularly due to musculoskeletal diseases), low social class, and previous sickness absence. VR was more common in larger companies, and in construction and in health and social work, and less common in professional activities. VR was more common in companies with low proportion of highly educated employees and with higher sickness absence rates. Conclusions Company level variation in VR was substantial after controlling for individual level characteristics of the employees. The employer may have an important role in the prevention of work disability through vocational rehabilitation. Key messages Company level variation in vocational rehabilitation was substantial after controlling for individual level characteristics of the employees. The employer may have an important in the prevention of work disability through vocational rehabilitation.

Use of Health Services and Rehabilitation before and after the Beginning of Long-Term Sickness Absence—Comparing the Use by Employment and Disability Pension Transition after the Sickness Absence in Finland

“…The higher frequency of rehabilitation naturally signals not only access to, but the need for, rehabilitation. Individuals with a lower educational level or socioeconomic status tend to have poorer health [55,56] and are over-presented in rehabilitation activities in general [31,32]. Here, persons not employed after an LTSA had more than the average number of rehabilitation days after the start of LTSA even when all covariates, including chronic morbidity, were adjusted for.…”

“…Do those who return to employment, those who do not and those who end up on disability pension have distinctive health care or rehabilitation use trajectories? Is the labour market outcome of the LTSA spell associated with health care use or rehabilitation use levels when the roles of LTSA duration, LTSA diagnosis, or demographic, socioeconomic and disease-related covariates [8][9][10][11][12][13][14][15][16][17][30][31][32] are examined as well? Following health care and rehabilitation use before occupational disability can reveal distinctive profiles for groups with differing labour market outcomes of sickness absence.…”