Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2017

Open Access 01-12-2017 | Research article

Improving the effectiveness of sickness benefit case management through a public-private partnership? A difference-in-difference analysis in eighteen Danish municipalities

Authors: Malene Rode Larsen, Birgit Aust, Jan Høgelund

Published in: BMC Public Health | Issue 1/2017

Login to get access

Abstract

Background

The aim of this study was to investigate whether a multidimensional public-private partnership intervention, focussing on improving the quality and efficiency of sickness benefit case management, reduced the sickness benefit duration and the duration until self-support.

Methods

We used a difference-in-difference (DID) design with six intervention municipalities and 12 matched control municipalities in Denmark. The study sample comprised 282,103 sickness benefit spells exceeding four weeks. The intervention group with 110,291 spells received the intervention, and the control group with 171,812 spells received ordinary sickness benefit case management. Using register data, we fitted Cox proportional hazard ratio models, estimating hazard ratios (HR) and confidence intervals (CI).

Results

We found no joint effect of the intervention on the sickness benefit duration (HR 1.02, CI 0.97–1.07) or the duration until self-support (HR 0.99, CI 0.96–1.02). The effect varied among the six municipalities, with sickness benefit HRs ranging from 0.96 (CI 0.93–1.00) to 1.13 (CI 1.08–1.18) and self-support HRs ranging from 0.91 (CI 0.82–1.00) to 1.11 (CI 1.06–1.17).

Conclusions

Compared to receiving ordinary sickness benefit management the intervention had on average no effect on the sickness benefit duration or duration until self-support. However, the effect varied considerably among the six municipalities possibly due to differences in the implementation or the complexity of the intervention.
Appendix
Available only for authorised users
Footnotes
1
In some cases a person had two sickness benefit spells interrupted by a few weeks without benefits, e.g. because of holidays. To avoid such misclassifications, we coded two spells separated by a period of under five weeks without sickness benefit as one consecutive spell
 
2
In both the intervention and control municipalities almost 12% of the spells had a duration exceeding 52 weeks
 
3
As the clustered (robust) SEs may also be biased with few clusters [35:313], we report the conventional (unclustered) SEs for the intervention effects of the separate analyses of each of the six intervention municipalities. As a robustness analysis we performed an analysis with only one control municipality for each of the six intervention municipalities, i.e. a cluster-specific fixed-effects model [43]
 
4
2nd year before the initiation of the intervention is reference year in both of the figures and the robustness test.
 
Literature
1.
OECD. Sickness, Disability and Work: Breaking the Barriers. A synthesis of findings across OECD countries. Paris: OECD Publishing; 2010.
2.
Eurostat. Population and social conditions. Statistics in focus, 40/2009. Luxembourg: Eurostat; 2009.
3.
Greenberg PE, Kessler RC, Birnbaum HG, Leong SA, Lowe SW, Berglund MBA, et al. The economic burden of depression in the United States: how did it change between 1990 and 2000? J Clin Psychiatry. 2003;64(12):1464–75.CrossRef
4.
Yelin E, Callahan LF, The National Arthritis Data Work Group. Special article the economic cost and social and psychological impact of musculoskeletal conditions. Arthritis Rheumatol. 1995;38:1351–62.CrossRef
5.
The Danish Health and Medicines Authority, Danish Centre for Health Technology Assessment. Evaluering af udviklingen pa rygomradet i Danmark 1999-2004 (Evaluation of developments in the field of back pain in Denmark 1999–2004). Copenhagen: The Danish Health and Medicines Authority; 2006.
6.
Borg V, Nexø MA, Kolte IV, Andersen MF. Hvidbog om mentalt helbred, sygefravær og tilbagevenden til arbejde (White paper on mental health, sickness absence and return-to-work). Copenhagen: The National Research Centre for the Working Environment; 2010.
7.
Palmer KT, Harris EC, Linaker C, Barker M, Lawrence W, Cooper C, et al. Effectiveness of community and workplace-based interventions to manage musculoskeletal related Sickness Absence and Job Loss: a systematic review. Rheumatology. 2012;51(2):230–42.CrossRefPubMed
8.
Schaafsma F, Schonstein E, Ojajarvi A, Verbeek J. Physical conditioning programs for improving work outcomes among workers with back pain. Scand J Work Environ Health. 2011;37(1):1–5.CrossRefPubMed
9.
Hlobil H, Staal JB, Spoelstra M, Ariens GA, Smid T, van Mechelen W. Effectiveness of a return-to-work intervention for subacute low-back pain. Scand J Work Environ Health. 2005;31(4):249–57.CrossRefPubMed
10.
Van Vilsteren M, van Oostrom SH, de Vet HCW, Franche RL, Boot CRL, Anema JR. Workplace interventions to prevent work disability in workers on sick leave (Review). Cochrane Libr. 2015;10
11.
Franche RL, Cullen K, Clarke J, Irvin E, Sinclair S, Frank J. workplace-based return-to-work interventions: a systematic review of the quantitative literature. J Occup Rehabil. 2005;15(4):607–31.CrossRefPubMed
12.
Schandelmaier S, Ebrahim S, Burkhardt SCA, de Boer WEL, Zumbrunn T, Guyatt GH, et al. Return to work coordination programmes for work disability: a meta-analysis of randomised controlled trials. PLoS One. 2012;7(11):1–13.CrossRef
13.
14.
Loisel P, Buchbinder R, Hazard R, Keller R, Scheel I, van Tulder M, Webster B. Prevention of work disability due to musculoskeletal disorders: the challenge of implementing evidence. J Occup Rehabil. 2005;15:507–24.CrossRefPubMed
15.
Loisel P, Anema JR. In: Loisel P, Anema JR, editors. Handbook of Work Disability, Prevention and Management. New York, Heidelberg: Dordrecht, London, Springer; 2013.CrossRef
16.
Young AE, Wasiak R, Roessler RT, McPherson KM, Anema JR, van Poppel NMN. Return-to-work outcomes following work disability: stakeholder motivations, interests and concerns. J Occup Rehabil. 2005;15(4):543–56.CrossRefPubMed
17.
MacEachen E, Kosny A, Ferrier S, Chambers L. The “Toxic Dose” of system problems: why some injured workers don’t return to work as expected. J Occup Rehabil. 2010;20:349–66.CrossRefPubMed
18.
Andersen MF, Nielsen KM, Brinkmann S. Meta-synthesis of qualitative research on return to work among employees with common mental disorders. Scand J Work Environ Health. 2012;38(2):93–104.CrossRefPubMed
19.
Shaw W, Hong Q, Pransky G, Loisel P. a literature review describing the role of return-to-work coordinators in trial programs and interventions designed to prevent workplace disability. J Occup Rehabil. 2008;18:2–15.CrossRefPubMed
20.
Johansen K, Andersen JS, Mikkelsen S, Lynge E. Decision making and co-operation between stakeholders within the process of sick leave. A case study in A Danish municipality. Journal of Interprofessional Care. 2011;25:59–65.CrossRefPubMed
21.
Franche R-L, Baril R, Shaw W, Nicholas M, Loisel P. workplace-based return-to-work interventions: optimizing the role of stakeholders in implementation and research. J Occup Rehabil. 2005;15:525–42.CrossRefPubMed
22.
23.
Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655.CrossRefPubMedPubMedCentral
24.
Oakley A, Strange V, Bonell C, Allen E, Stephenson J, RIPPLE study team. Process evaluation in randomized controlled trials of complex interventions. BMJ. 2006;332:413–6.CrossRefPubMedPubMedCentral
25.
Aust B, Nielsen MBD, Grundtvig G, Buchardt HL, Ferm L, Andersen I, et al. Implementation of the Danish return-to-work program: process evaluation of a trial in 21 Danish municipalities. Scand J Work Environ. 2015;41(6):529–41.
26.
Martin MHT, Moefelt L, Nielsen MBD, Rugulies R. Barriers and facilitators for implementation of a return-to-work intervention for sickness absence beneficiaries with mental health problems: Results from three Danish municipalities. Scand J Public Health. 2015;43(4):423–31.CrossRefPubMed
27.
Martin MHT, Nielsen MBD, Madsen IEH, Petersen SMA, Lange T, Rugulies R. Effectiveness of a coordinated and tailored return-to-work intervention for sickness absence beneficiaries with mental health problems. J Occup Rehabil. 2013;23(4):621–30.CrossRefPubMed
28.
Martin MHT, Nielsen MBD, Petersen SMA, Jakobsen LM, Rugulies R. Implementation of a coordinated and tailored return-to-work intervention for employees with mental health problems. J Occup Rehabil. 2012;22(3):427–36.CrossRefPubMed
29.
Johansen K, Andersen JS, Mikkelsen S, Pass O, Raffnsøe S, Lynge E. Controlling sickness absence. A study of changes in the Danish sickness absence legislation since 1973. Health Policy. 2008;86:109–18.CrossRefPubMed
30.
Graversen BK, Larsen M, Arendt JN. Kommunernes rammevilkår for beskæftigelsesindsatsen (Framework conditions of Danish municipalities in relation to employment interventions). Report 13:14. Copenhagen: The Danish National Centre for Social Research; 2013.
31.
Høgelund J, Holm A, McIntosh J. Does graded return-to-work improve sick-listed workers’ chance of returning to regular working hours? J Health Econ. 2010;29:158–69.CrossRefPubMed
32.
Lund T, Labriola M, Christensen KB, Bültmann U, Villadsen E, Burr H. Psychosocial work environment exposures as risk factors for long-term sickness absence among Danish employees: Results from DWECS/DREAM. J Occup Environ Med. 2005;47(11):1141–7.CrossRefPubMed
33.
Nielsen MB, Hansen JV, Aust B, Tverborgvik T, Thomsen BL, Bjorner JB, et al. A multisite randomized controlled trial on time to self-support among sickness absence beneficiaries. The Danish national return-to-work programme. Eur J Pub Health. 2014;25(1):96–102.CrossRef
34.
Angrist JD, Pischke J. Mostly Harmless Econometrics. An Empiricist’s Companion. New Jersey: Princeton University Press; 2009.
35.
Poulsen OM, Aust B, Bjorner JB, Rugulies R, Hansen JV, Tverborgvik T, et al. Effect of the Danish return-to-work program on long-term sickness absence: results from a randomized controlled trial in three municipalities. Scand J Work Environ Health. 2014;40(1):47–56.CrossRefPubMed
36.
Aust B, Helverskov T, Nielsen MBD, Bjorner JB, Rugulies R, Nielsen K, et al. The Danish national return-to-work program – aims, content, and design of the process and effect evaluation. Scand J Work Environ Health. 2012;38:120–33.CrossRefPubMed
37.
Høgelund J, Filges T, Jensen S. Langvarigt sygefravær – hvad sker der og hvordan går det? (Long-term sickness absence – what is happening and how does it work?) Rapport 03:20. Copenhagen: Socialforskningsinstituttet (The Danish National Centre for Social Research); 2003.
38.
Stoltenberg CDG, Skov PG. Determinants of return to work after long-term sickness absence in six Danish municipalities. Scand J Public Health. 2010;38:299–308.CrossRefPubMed
39.
Bille R, Larsen MR, Høgelund J, Holt H. Falcks partnerskabsmodel på sygedagpengeområdet. Evaluering af et offentligt-privat samarbejde (Falcks partnership model in the area of sickness benefits. An evaluation of a public private partnership). Report 13:36. Copenhagen: The Danish Nation Centre for Social Research; 2013.
40.
Caroll C, Rick J, Pilgrim H, Cameron J, Hillage J. Workplace involvement improves return to work rates among employees with back pain on long-term sick leave: a systematic review of the effectiveness and cost-effectiveness of interventions. Disabil Rehabil. 2010;32(8):607–21.CrossRef
41.
Gabbay M, Taylor L, Sheppard L, Hillage J, Bambra C, Ford F, et al. NICE guidance on long-term sickness and incapacity. Br J Gen Pract. 2011:118–24.
42.
Gardner BT, Pransky G, Shaw WS, Hong QN, Loisel P. Researcher perspectives on competencies of return-to-work coordinators. Disabil Rehabil. 2010;32(1):72–8.CrossRefPubMed
43.
Cameron AC, Miller DL. A practitioner’s guide to cluster-robust inference. J Hum Resources. 2015;50(2):317–72.CrossRef
Metadata
Title
Improving the effectiveness of sickness benefit case management through a public-private partnership? A difference-in-difference analysis in eighteen Danish municipalities
Authors
Malene Rode Larsen
Birgit Aust
Jan Høgelund
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2017
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-017-4236-5

Other articles of this Issue 1/2017

BMC Public Health 1/2017 Go to the issue

Research article

Objectively measured sedentary behaviour and moderate and vigorous physical activity in different school subjects: a cross-sectional study

Research article

Rasch analysis of the participation scale (P-scale): usefulness of the P-scale to a rehabilitation services network

Research article

Smoking habits in French farmers: a cross-sectional study

Research article

The association between self-rated health and different anthropometric and body composition measures in the Chinese population

Study protocol

A PROgramme of Lifestyle Intervention in Families for Cardiovascular risk reduction (PROLIFIC Study): design and rationale of a family based randomized controlled trial in individuals with family history of premature coronary heart disease

Research article

An analysis of the effects of a campaign supporting use of a health symbol on food sales and shopping behaviour of consumers