Occupational health care in small and medium-sized enterprises--introduction of services to craftsmen by using their professional networks.

In order to ensure equality of occupational health care among employees of small and medium-sized enterprises (SMEs) and of larger companies amendments in the regulations of the numerous German accident insurance funds had to be made to provide for full availability of services, as requested by German and European law. According to these amendments, sectors formerly exempted due to small size and due to lack of an adequate number of qualified personnel, had to be covered by occupational health care. In order to reach this target group new strategies of care delivery had to be developed, making use of pre-existing infrastructure and networks. In Germany, district trade association (Kreishandwerkerschaften) have proved to be very effective for introducing occupational safety and health care into SMEs by either hiring external multidisciplinary services or by establishing a common service to be used by all associated crafts establishments. In a study conducted by the Federal Office for Health and Safety at Work in 1996 (Boldt, Gille, & Grahl, 1997), 7 district trade association were looked at in detail for their strategies. The results were discussed and supplemented in a 2-day workshop.