The Social Insurance Institution of Finland, 00250 Helsinki, Finland.
Int J Environ Res Public Health. 2022 Apr 20;19(9):4990. doi: 10.3390/ijerph19094990.
The objective of the study was to follow the health care and rehabilitation use before, during and after long-term sickness absence (LTSA), and to compare the use by post-LTSA labour market situation in terms of disability pension and employment. Individuals aged 18-58 with a ≥30-day LTSA spell in 2015 ( = 2427) were included from the total population of the city of Oulu, Finland. Register data included LTSA spells, outpatient health care visits, inpatient care spells and rehabilitation spells, disability pensions (DP), employment dates, and demographic, socioeconomic and disability-related covariates. The study population was followed for one year before, and three years after the start of LTSA. Negative binomial regression models were utilized to examine covariate-adjusted use of the three service types and group differences. The use of outpatient health care peaked at the start of the LTSA spell, and adjusted for covariates, the height of the peak was similar regardless of post-LTSA labour market situation. Adjusted for covariates, those who transferred to permanent DP after an LTSA used more outpatient (predicted mean 4.87 for attendance days quarterly, 95% CI 4.36-5.38) and inpatient (predicted mean 84 days quarterly, 95% CI 0.62-1.06) health care than others during three years after the start of LTSA. Individuals not employed after an LTSA showed the highest and increasing level of rehabilitation use. The results indicate that Individuals returning to employment after an LTSA are provided with relatively high amount of early outpatient care, possibly aiding the return. For individuals not employed after an LTSA, rehabilitation is used quite frequently but rather late in the disability process. The frequent use of health care among future disability pensioners is consistent with their increasing health problems leading to retirement.
本研究旨在跟踪长期病假（LTSA）前后的医疗保健和康复使用情况，并比较残疾抚恤金和就业方面的劳动力市场状况。从芬兰奥卢市的总人口中纳入了 2015 年有≥30 天 LTSA 期的 18-58 岁个体（=2427 人）。登记数据包括 LTSA 期、门诊医疗访问、住院护理期和康复期、残疾抚恤金（DP）、就业日期以及人口统计学、社会经济和残疾相关的协变量。研究人群在 LTSA 开始前一年和开始后三年进行了随访。利用负二项回归模型检查了三种服务类型的协变量调整使用情况和组间差异。门诊医疗的使用在 LTSA 开始时达到高峰，并且在调整了协变量后，无论劳动力市场状况如何，高峰的高度相似。调整了协变量后，那些在 LTSA 后转为永久性 DP 的人在 LTSA 开始后的三年中，门诊（预测平均每季就诊天数为 4.87，95%CI 4.36-5.38）和住院（预测平均每季 84 天，95%CI 0.62-1.06）医疗的使用量高于其他人。LTSA 后未就业的人表现出最高且不断增加的康复使用水平。结果表明，LTSA 后重新就业的人获得了相对较高的早期门诊护理，这可能有助于他们重返工作岗位。对于 LTSA 后未就业的人来说，康复的使用频率相当高，但在残疾过程中相对较晚。未来残疾抚恤金领取者频繁使用医疗保健与他们不断增加的健康问题导致退休是一致的。
