(cost)effectiveness of re-employment programmes for unemployed persons with health problems in the...
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(cost)effectiveness of re-employment programmes for unemployed persons with health problems in the Netherlands
Merel Schuring, Alex Burdorf
Department of Public Health
Erasmus MC Rotterdam
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� increase the proportion of population in work
� encourage staying longer in the workforce
Æ promote entering paid employment of non-employed persons
Participation law (January 2015):
� Municipalities responsible for re-integration of non-employed persons with health problems
Æ need for evidence on (cost)effective strategies to promote entering paid
employment of disadvantaged groups
Policy aims of the Dutch government
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Two well-established mechanisms Selection process:
Health problems are a barrier to enter paid employment AND health problems may cause loss of paid employment Causation process:
Unemployment may cause health problems AND re-employment may be beneficial for health
1. Health and employment
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Health promotion among unemployed persons: consider carefully !
1. Health and employment
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Paid employment is beneficial for health Æ paid employment as intervention to promote health
1. Health and employment
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2. Evidence on effective strategies to promote employment
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Mueser KT. The Hartford study of supported employment for persons with severe mental illness. J Consult Clin Psychol. 2004;72(3):479-90.
2. Evidence on effective strategies to promote employment
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Cost-benefit analysis: costs benefits Costs of the intervention € 2840
Delta Productivity regular work € 7010
Employer-related costs € 220
Operational costs social service € 230
Tax effects € 350
Total € 4530 * time horizon 4 years, minimum income, 23 hrs/week, 25% participants * societal perspective !
2. Evidence on effective strategies to promote employment
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Ministery of Social Affairs selected six local programmes:
� promoting employment of non-employed persons with health problems
� at least three stakeholders were involved in each programme
� municipal social services or benefits agency
� health insurance company
� other organisation: mental health services or temp agency
Aims:
1) What are barriers and facilitators in the implementation of the programme?
2) What is the effectiveness of these programme?
3) What are costs and benefits for different stakeholders?
3. Current research on local projects to promote employment
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Facilitators -integrated approach: working in ‘special teams’ of professionals from different
-disciplines (mental health, social welfare, benefit agency)
-active approach of employers (personal contact with employer and unemployed)
-first place than train, coaching after job placement
Barriers - municipal services: pressure to get as much clients into employment as possible
Æ invest in persons who are easily employable
- lack of money to invest in unemployed persons with health problems
Æ co-financing of the programme by health insurers
3. Current research on local projects to promote employment
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How can we investigate effectiveness of different employment strategies in a non-experimental setting?
Differences between target groups
� age, unemployment duration, educational level, marital status, mental or physical health status, motivation
Does a specific employment strategy result in more persons in employment than what would be expected based on the characteristics of the participants?
Inspired by the hospital standardized mortality ratio (HSMR), we developed the
standardized re-employment ratio (SRR)
4. Development of a new methodological approach
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1. Analysis of determinants of entering paid employment in different longitudinal cohort studies (Statistics Netherlands, STREAM)
2. Selection of factors that are most important in predicting the transition in employment
3. A prediction model estimates the probability of entering paid employment for each individual
the observed number of persons entering paid employment
the expected number of persons entering paid employment
SSR > 1 Æ the employment strategy results in more persons in employment than expected based on the characteristics of the participants
SRR =
4. Development of a new methodological approach
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Æ Selection of factors that are most important in predicting employment
STREAM (n=3355) (45-65 years) OR (95% CI)
Statistics Netherlands (n=2058) (18-65 years) OR (95% CI)
Type of benefit - unemployment - social security - disability
1 0.24 (0.14-0.41) 0.19 (0.14-0.27)
1 0.62 (0.48-0.81) 0.38 (0.29-0.50)
Age 0.90 (0.87-0.92) 0.95 (0.94-0.95)
Sex 0.69 (0.53-0.90) 0.91 (0.74-1.11)
Education - low - Intermediate - high
1 1.29 (0.96-1.74) 1.72 (1.23-2.40)
1 1.35 (1.10-1.67) 1.52 (1.14-2.02)
Married/living with a partner 1.19 (0.90-1.58) 0.84 (0.68-1.05)
Children in household 1.45 (1.10-1.92) 1.54 (1.23-1.93)
Poor perceived health 0.31 (0.22-0.43) 0.74 (0.60-0.91)
4. Development of a new methodological approach
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Predicted probabiilities
Quality of the model: • discriminatory power is high (AUC=0.836) • there is a large variation in probability of entering paid employment in the sample
4. Development of a new methodological approach
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Application of the model in ongoing research (6 Dutch re-employment programmes)
Registration (2014-2015):
� Characteristics of participants
� sociodemographic characteristics
� perceived health, work ablitity and motivation to work
� Entering paid employment of participants
Calculation of SRR (2015):
observed number of persons entering paid employment
estimated number based on characteristics of the participants
SRR =
4. Development of a new methodological approach
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1. Paid employment is beneficial for health
2. Evidence for a work/job placement strategy as part of a re-employment programme for unemployed persons with (mental) health problems
3. Facilitators for re-employment programmes for disadvantaged groups
� active approach employers (job carving)
� co-financing by health insurers
4. Ongoing research: development and application of a new instrument to evaluate re-employment programmes in a non-experimental setting
In conclusion
