Halonen J I, Solovieva S, Pentti J, Kivimäki M, Vahtera J, Viikari-Juntura E
Finnish Institute of Occupational Health, Helsinki, Finland.
Finnish Institute of Occupational Health, Helsinki, Finland Department of Epidemiology and Public Health, University College London Medical School, London, UK Faculty of Medicine, Clinicum, University of Helsinki, Helsinki, Finland.
Occup Environ Med. 2016 Jan;73(1):42-50. doi: 10.1136/oemed-2015-103131. Epub 2015 Oct 13.
Policies have been introduced to reduce sickness absence, but their effectiveness is largely unknown. In a natural experiment, we examined effects of legislative changes on return to work and work participation.
The source population consisted of up to 72,164 Finnish public sector employees with a permanent job contract in 2008-2011 (before) and in 2013-2014 (after). We used employees with a continuous sickness absence of at least 30 calendar-days (n=5708-6393), 60 compensated days (n=1481-1655) and 90 compensated days (n=766-932). We examined sustainable return to work (a minimum of 28 consecutive working days) with survival analysis as well as monthly work participation after a sickness absence, and annual gain in work participation after the intervention, using trajectory analyses.
Sustainable return to work after 60 days of sickness absence occurred earlier after the legislative changes (p value 0.017), although the effect reduced towards the end of the follow-up. There were no differences in return to work after a 30 or 90 days of sickness absence. The largest annual gain, postintervention versus preintervention, in monthly work participation was observed among employees with 60 days of sickness absence and was 230.9 person-years/10,000 employees. The corresponding annual gains among those with 30 days and 90 days of sickness absence were 51.8 and 39.6, respectively.
Our findings suggest that the legislative changes, obligating early notification of prolonged sickness absences as well as assessment of remaining work ability and possibilities to continue working, may enhance sustainable return to work in the short term. Other measures will be needed to enhance work participation, especially in the long term.
已出台政策以减少病假缺勤，但这些政策的效果在很大程度上尚不清楚。在一项自然实验中，我们研究了立法变化对重返工作岗位和工作参与度的影响。
研究对象包括2008 - 2011年（之前）和2013 - 2014年（之后）最多72164名签订了长期工作合同的芬兰公共部门员工。我们选取了连续病假至少30个日历日（n = 5708 - 6393）、60个补偿工作日（n = 1481 - 1655）和90个补偿工作日（n = 766 - 932）的员工。我们使用生存分析研究可持续重返工作岗位（至少连续28个工作日）情况，以及病假缺勤后的月度工作参与度，并用轨迹分析方法研究干预后的年度工作参与度增益。
病假缺勤60天后的可持续重返工作岗位情况在立法变化后出现得更早（p值为0.017），尽管在随访末期效果有所减弱。病假缺勤30天或90天后的重返工作岗位情况没有差异。在病假缺勤60天的员工中，干预后与干预前相比，月度工作参与度的年度增益最大，为230.9人年/10000名员工。病假缺勤30天和90天的员工相应的年度增益分别为51.8和39.6。
我们的研究结果表明，立法变化要求对长期病假进行早期通知，并对剩余工作能力和继续工作的可能性进行评估，可能会在短期内提高可持续重返工作岗位的比例。还需要采取其他措施来提高工作参与度，尤其是从长期来看。
