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1. Labour Policies
Moderator: Regina Pernice (24)
RECURRING ISSUES
Rights -based approaches and collective responsibility approaches (quota systems)
were considered alongside more partnership-based approaches throughout the
workshop. Philosophical beliefs undercut this comparison.
COSTS
Who pays - employer or state?
Whose responsibility - employer/ state /insurer?
Examining the full costs - e.g. social and financial costs to the individual.
ROLE OF THE ENTERPRISE
Distinctions between the role of the enterprise and that of the state or community.
Obligation policies versus persuasion policies to retain.
Differences between JR and RTW policies
ATTITUDES
Changing the way that Disabled Workers are viewed by employers
Mainstreaming disability policies to promote inclusion and increase positive
attitudes.
IMPLEMENTING POLICY
Policies need to be marketed and implemented positively - not just written.
Market the disabled worker to the employer
Increase the professionalism of vocational rehabilitation education.
THE 'MIDDLE WAY'
Sharing responsibilities
Reducing adversarial relationships
Considering the 'business goals'.
SPRU
ILO
SOCIAL POLICY RESEARCH UNIT
GLADNET
Compensation and Benefits.
Moderators: Ilene Zeitzer and Nancy Lawand (18)
THREE KEY STRATEGIES
1. Part-time work - either as a permanent solution or as transition back to full
employment.
2. Replacement rates - should this be a % of the 'average wage' or the disabled
worker's last wage?
3. Use and availability of trial work periods.
ISSUES FOR FURTHER INVESTIGATION.
New paradigm in the way disability is perceived. Challenge the medical
dominance, consider disability as a continuum; include the new face of disability-
mental illness, youth and women with a work disability.
Barriers
Are there common sets of barriers to the development of linkages across systems?
Barriers to: consumer control, case management and cross program cooperation.
Can we maximize flexibility to overcome barriers and get away from 6 one size fits
all?
The role of competition.
The effect of competition in RTW services. Will this provide incentives for
services to develop? Will competition improve accountability or is accountability
best achieved through public services.
SUMMARY
How should effective benefits policy be researched? For example, mapping of the
experience of different disabled workers through a national system.
SPRU
ILO
SOCIAL POLICY RESEARCH UNIT
GLADNET
Employment Support and Rehabilitation Services
Moderators: Steve Lavery and Pauline Winter (23).
RECURRING ISSUES DURING THE WORKSHOP
Responsibility - government, employer, or community?
New World/Old World approaches (individual empowerment Vs dependence)
Change strategies - incremental versus immediate.
ROLE OF THE MARKET- Paternalistic approaches compared to an active free
market approach.
TICKET/VOUCHER SCHEMES- will these schemes create a market for new
services? Will this empower users?
'CREAMING' - is this a consequence of flat-rate service agreements and would a
graded system work? Is this ultimately the responsibility of government to regulate?
EQUITY ISSUES - the comparative levels of support for road accident victims, those
injured at work, injured through sport and those who become sick.
OUTCOMES - which outcomes should be measured (e.g. milestones, inputs, outputs,
outcomes)? Consider outcome-based payment models. Consider a worker's self-
motivation to achieve rehabilitation.
WHO PAYS - should the risks be shared or become solely the employer or state
responsibility?
ROLE OF JOB COACHES - should this role be provided by external experts
(professional counsellors) or internal natural supports (co-worker job coaches)?
ATTITUDES - noting public sector intolerance of disabled employees.
EMPLOYER AS PARTNER - in comparison to more adversarial or distant
relationships.
SPRU
IIO
SOCIAL
POLICY
RESEARCH
UNIT
GLADNET
Adaptation of Work and The Workplace
Moderator: Anders Karlsson (15)
WORKPLACE ATTITUDES
Co-worker attitudes to disabled workers influence take-up and implementation of
adaptations and flexibility.
ROLE OF TRADE UNIONS
Trade Unions can assist retention of disabled workers by raising disability
awareness, e.g. Educate the membership with 6 It may be you tomorrow!'
Joint labour-management return-to-work committees can play and important role in
work adaptation.
INFORMATION
This can be valuable but often too little, too much, too irrelevant or too complex to
access.
Information on adaptations/ flexibility can be of value to all workers at the
enterprise.
Information networks such as the Job Accommodation Network and Employers
Forum on Disability are valuable models.
COSTS
Employers who employ disabled workers should not be penalized by having to
contribute to workplace adaptations etc.
Smaller enterprises find it more difficult to absorb costs.
Need to examine the actual costs versus the 'perceived' costs of adaptations.
DIVERSITY POLICY
This is promoted as a benefit to employers but is the inclusion of disabled workers
in a diversity policy of value to the enterprise.
Consider disability as 'human variation'- - this reduces the dichotomy of disabled
and non-disabled.
SPRU
HOF
SOCIAL POLICY RESEARCH UNIT
GLADNET
Enterprise Strategies
Moderator; Dan Kearns ( 20)
Recognize different sub-populations of disabled worker at the workplace.
Workers may be encouraged to self identify for state support.
Employers may apply strategies at the probationary period of employment to
assess suitability of disabled workers.
Paradoxes exist where seemingly equitable workplace policies may discriminate
against disabled workers ( e.g. years experience and training)
The enterprise environment is dynamic and standardized/prescriptive responses
may not be useful.
(52) INFORMATION SUPPORT TO THE WORKPLACE
Provide case studies.
Provide databases and on -line advice
(52) SUPPORTING SMALL AND MEDIUM ENTERPRISES (SME's)
Provide a range of support models for the SME's to apply to the enterprise
Support certain trades most used in SME's or tailor the training specifically
Provide external support services and support SME employer networks
(51) LEGISLATED FRAMEWORK TO SUPPORT EFFECTIVE DISABILITY
MANAGEMENT AT THE WORKPLACE
Regulation of the rehabilitation provider at the workplace
Legislated responses to injury and illness at work
(46) CO-ORDINATION OF DISABILITY MANAGEMENT AT THE
WORKPLACE
The role of job coaches to mediate between supervisor, & support agencies.
The use of cross-departmental committees at policy and practical levels - and/or
Labour- management committees.
(35) VOLUNTARY CODES OF PRACTICE
Develop these as international best practice models or checklists.
SPRU
ILO
SOCIAL POLICY RESEARCH UNIT
GLADNET
Key issues in employment policy
Changes in the structure of the labour market and conditions of employment
reduce the scope of public policy and increase enterprise autonomy.
Business communities, locally, nationally and internationally, have the
opportunity to regulate their own practices and to use their trading influence
to promote equitable job retention.
There is a need to identify, at national and local levels, those areas of the
labour market where job retention is most problematic and to consider where
policy interventions might best be directed.
Individual rights movements are a growing force in Europe. Models of
disability discrimination legislation are evolving in more interventionist
systems. Definitions of disability, procedures for enforcement and mediation
and accommodation requirements will have differential effects on employers'
ability to retain workers with disabilities, as well as on disabled workers'
opportunities to claim their rights under the law.
Requirements to accommodate - to adapt the work and workplace so that the
individual with disabilities is not disadvantaged - are key to a coherent job
retention strategy and can bridge the gap between conflicting definitions of
disability. Including accommodation requirements in compensation systems
as well as in rights legislation is a way forward.
Measures to promote job retention can have negative consequences for
individuals with disabilities wanting to take up work or move to a new
employer. Perverse effects have been noted in both collective and individual
rights-based approaches. But selective hiring to avoid those who pose a
financial risk is particularly associated with policies which aim to reduce the
incidence and duration of disability-related claims and consequently reduce
costs to the employer. An equitable strategy for job retention and return to
work requires effective non-discrimination measures to prevent risk selection
at the recruitment stages.
Insurance-related financial incentives are increasingly dominating the
enterprise response to disability and have a part to play in supporting job
retention. But these policies also may have negative effects on those disabled
workers who are actively discouraged from claiming compensation or are
1
pressed to return to the job too early. Job retention may not always be in the
best interests of the disabled worker.
With increasing enterprise responsibility for containing the costs of disability
there can be room for discretion in choosing whom to support. Non-
discrimination legislation is a significant element in the return to work
strategy where companies have incentives to retain the workers they most
value.
The effectiveness of the different approaches to linking employment
protection to receipt of sickness, disability or injury benefit should be
explored further. The spectrum ranges from stringent requirements on the
employer to retain the beneficiary, to negotiated interventions on the part of
the benefit agency. There can be lessons for countries where such
arrangements do not exist, or exist for only a subset of workers with
disabilities.
As the emphasis shifts to early intervention and rehabilitation, securing the
job of the disabled worker is increasingly necessary. The issue of how to
identify and support the costs to the employer has become a priority.
As responsibility shifts from government to employers and disabled
employees the need is highlighted both for collective representation of
disabled people in planning for job retention and for individual advocacy in
the workplace. New models of advocacy are developing as persons with
disabilities within employing organisations and labour unions form alliances
to provide support to their peers.
2
DEVELOPING STRATEGIES
So far, the key issues in relation to the five themes of the study have been identified. In this
concluding section we highlight some of the most significant cross-cutting issues relevant to the
study countries.
Part-time working
Part-time working is growing overall and in some countries is actively promoted in national
policy. There are signs of benefits and compensation arrangements increasingly responsive to the
particular needs of persons with disabilities for part-time opportunities. Outside the enterprise,
employment support services and provision for adaptations of the work and workplace need to
be oriented for supporting part-time work in general, and to opportunities for combining work
with benefit in particular.
The small enterprise
Small firms have a marginal position in most of the policies and programmes which support job
retention and return to work. Although some noteworthy successes have been reported in
reaching out to small enterprises (such as the French fund AGEFIPH's programme) they have less
capacity to bear the costs of a worker who becomes disabled, few structured incentives to do so,
and limited resources to find out about and use external sources. Strategies for job retention may
need to be tailored specially to the needs of small enterprises, for example by offering more
generous funding towards making accommodations for workers with disabilities.
Equitable support for job retention
As job retention increasingly becomes an enterprise concern, and direct provision by statutory
agencies takes a less prominent role, there is more discretion for the employer. Particularly where
enterprise retention activity is driven by the need to contain costs to the business, employees who
are more valued can be selected for support and rehabilitation to the disadvantage, it seems, of
less qualified and easier to replace workers. Inequities might be reduced in part by adjusting the
employer incentive structures. Advocacy in the workplace and legislation to prevent
discrimination in employment appear to be important mechanisms to counter any tendency
towards selectivity.
Disincentives to recruitment of disabled workers
Risk selection is a commonly reported effect of policies which protect the employment of disabled
workers and of policies which encourage or require enterprises to retain workers who become
disabled. Employers are more likely to screen job applicants to avoid hiring someone who might
become sick and so impose costs on the enterprise. This tendency could be inhibited by disability
discrimination legislation, although discriminatory recruitment practices cannot be entirely
overcome, or by mechanisms to support the costs to the employer of employees with abnormally
high levels of sickness absence.
Long-term support for workers with disabilities
Policies for early intervention and work resumption may not always be in the best interests of
disabled workers and need to be supplemented by medical surveillance and longer-term support
1
on the job. Equally, a strategy for job retention should not exclude the maintenance in
employment of individuals who were disabled before entering employment.
Supporting enterprise-based activity
External services will need to be oriented towards bringing support to the enterprise at the time
that it is needed and enabling the enterprise to deploy its own resources to support disabled
workers. Access to advice. and services for. adaptation of work and workplace needs to be
simplified and resources need to be better co-ordinated to facilitate direct use by employers.
Ergonomic assistance needs to be promoted and more attention paid to the person-technology-
work interface.
Identifying excluded groups
A coherent-strategy. for job retention and return to work needs to consider who is intended to
benefit. The focus on early intervention and work resumption tends to leave out of the picture
workers who are more severely disabled and who encounter barriers in re-entering the labour
market, for example after a disabling accident or long-term illness. A focus on short-term absence
also ignores the situation of workers whose continued employment is at risk because of
unreported illnesses which do not manifest themselves in sickness absence.
Co-ordinating the players
The need for improved co-ordination between multiple players emerges as a key issue across the
thematic areas of the study. Achieving co-ordinated programmes is increasingly problematic as
new players, with quite different objectives and philosophies, enter the arena.
Keeping the job open
As the emphasis shifts to early intervention and rehabilitation, ensuring that the worker with
disabilities has a job to return to is critical. The effectiveness of the different approaches to
linking employment protection to receipt of sickness benefit or injury. compensation could be
explored, as could the roles of benefits and compensation bodies in facilitating work resumption.
The costs to enterprises of keeping jobs open for returning workers need to be identified and
mechanisms found to ensure that it is worthwhile for the employer to do so.
Accommodating disability
Requirements to accommodate - to adapt the work and workplace so that the individual with
disabilities is not disadvantaged - are a key element in a coherent job retention strategy.
Compensation systems which prioritise job retention appear to be strengthened by the inclusion
of accommodation requirements. Including accommodation requirements in compensation
systems as well as in disability-discriminate legislation reduces inequities in treatment between
those who are covered by compensation programmes and those who are not. In the absence of
enforced requirements, employers need to be convinced that it is economically worthwhile to
invest in adaptations. Where responsibility should lie for the funding of individual adaptations is
an issue for debate.
Learning from enterprise strategies
Fundamental to the Project is the intervention between enterprise policies and practices and
national policy and regulation. Across the study countries, enterprises are developing new ways
of managing the occurrence and consequences of disability. Partnerships between enterprise
2
actors and policy makers need to be developed to facilitate the exchange of good practice
between public and private sectors. The International Research Project on Job Retention and
Return to Work Strategies for Disabled Workers seeks to stimulate and develop such an exchange
through the active participation of enterprise actors, disabled people's organisations and policy
makers in phase two of the Project.
3
GLADNET
SPRU
SOCIAL POLICY RESEARCH UNIT
International Research Project on Job
Retention and Return to Work
Strategies for Disabled Workers
Key Issues
Research Co-ordinator
Patricia Thornton
Social Policy Research Unit
University of York, UK
ILO
INTERNATIONAL LABOUR OFFICE
GENEVA
GLADNET
SPRU
SOCIAL POLICY RESEARCH UNIT
International Research Project on Job
Retention and Return to Work
Strategies for Disabled Workers
Key Issues
Research Co-ordinator
Patricia Thornton
Social Policy Research Unit
University of York, UK
INTERNATIONAL LABOUR OFFICE GENEVA
Copyright © International Labour Organization 1998
Publications of the International Labour Office enjoy copyright under Protocol 2 of the Universal
Copyright Convention. Nevertheless, short excerpts from them may be reproduced without
authorization, on condition that the source is indicated. For rights of reproduction or translation,
application should be made to the ILO Publications Bureau (Rights and Permissions),
International Labour Office, CH-1211 Geneva 22, Switzerland. The International Labour Office
welcomes such applications.
ISBN 92-2-111137-7
First published 1998
The designations employed in ILO publications, which are in conformity with United Nations
practice, and the presentation of material therein do not imply the expression of any opinion
whatsoever on the part of the International Labour Office concerning the legal status of any
country, area, or territory or of its authorities, or concerning the delimitation of its frontiers. The
responsibility for opinions expressed in this report rests solely with its authors, and publication
does not constitute an endorsement of those opinions by the International Labour Office or by any
of the other project sponsors.
Reference to names of firms and commercial products and processes does not imply their
endorsement by the International Labour Office, and any failure to mention a particular firm,
commercial product or process is not a sign of disapproval.
ILO publications can be obtained through major booksellers or ILO local offices in many
countries, or direct from Customer Service, ILO Publications, International Labour Office, CH-
1211 Geneva 22, Switzerland. A catalogue or lists of new publications are available free of
charge from the above address.
CONTENTS
Page
ACKNOWLEDGEMENTS
iii
PREFACE: THE PROJECT EXPLAINED
V
1.
INTRODUCTION
1
2.
THE PARTICIPATING COUNTRIES IN CONTEXT
6
3.
JOB RETENTION ACTIVITY IN THE STUDY COUNTRIES
12
4.
DISABILITY EMPLOYMENT POLICIES
17
-
Key issues
27
5.
BENEFIT COMPENSATION PROGRAMMES
29
-
Key issues
37
6.
REHABILITATION AND EMPLOYMENT SUPPORT SERVICES
39
-
Key issues
48
-
7.
ADAPTATION OF WORK AND WORKPLACE
50
-
Key issues
62
8.
ENTERPRISE STRATEGIES
64
-
Key issues
72
9.
DEVELOPING STRATEGIES
74
APPENDIX
ACKNOWLEDGEMENTS
The Research Co-ordinator gratefully acknowledges the contributions of the many Project
partners who made this report possible and wishes to thank:
The International Labour Organisation and GLADNET (the Global Applied Disability Research
and Information Network on Employment and Training) for initiating and supporting the
International Research Project on Job Retention and Return to Work Strategies for Disabled
Workers.
Project Co-sponsors: International Labour Organization; Human Resources Development,
Canada; Association Nationale de Gestion du Fonds pour l'Insertion Professionnelle des
Handicapés (AGEFIPH), France; the Ministry of Labour and Social Affairs, Germany; the
National Institute for Social Insurances, the Netherlands; the Swedish Council for Work Life
Research; the Department of Education and Employment, UK; the Post Office, UK; and the
Social Security Administration, USA.
Project Research Advisory Group members: Regina Pernice and Neil Lunt, Massey
University, New Zealand; Edwin de Vos, NIA-TNO, Amsterdam; Erwin Seyfried, Research Unit
for Vocational Training, Labour Market and Evaluation, Berlin; Monroe Berkowitz, Rutgers
University, New Jersey; Eskil Wadensjö, Swedish Institute for Social Research; Stockholm;
Wolfgang Zimmermann, National Institute of Disability Management and Research, British
Columbia, Canada; Michael Mendelson, Caledon Institute of Social Policy and Terry Sullivan,
Institute for Work and Health, Toronto, Canada; and Bob Ransom and Gabriele Stoikov,
International Labour Office, Geneva.
National Informants:
CANADA: Morley Gunderson, Centre for Industrial Relations, University of Toronto; Alina
Gildiner, Department of Community Health, University of Toronto; and Andrew King, National
Institute of Disability Management and Research and United Steelworkers of America.
FRANCE: Pierre Grapin, Thibault Lambert, Najiba Fradin, Tahar Tizroutine, Association
Nationale de Gestion du Fonds pour l'Insertion Professionelle des Handicapés; Danielle Jafflin,
Chantal Halimi, Michèle Coda-Vailant, Caisse Nationale de l'Assurance Malaide; and Isabelle
Mérian, Fédération des Associations Gestionnaires et des Etablissements de Rééducation pour
Handicapés.
GERMANY: Martin Albrecht and Hans Braun, Centre for Labour and Social Policy, University
of Trier.
NETHERLANDS: Boukje Cuelenaere and Rienk Prins, AS/tri Research and Consultancy Group.
iii
NEW ZEALAND: Regina Pernice and Neil Lunt, School of Health Sciences and School of
Social Policy Studies and Social Work, College of Humanities and Social Sciences, Massey
University.
SWEDEN: Anders Karlsson, Swedish Council for Work Life Research.
UNITED KINGDOM: Stephen Duckworth and Peter McGeer, Disability Matters Inc; and Daniel
Kearns and Patricia Thornton, Social Policy Research Unit, University of York.
USA: Paul O'Leary, Bureau of Economic Research, Rutgers University; with David Dean,
Bureau of Disability and Economics, University of Richmond.
Social Policy Research Unit publications and information office, technical and secretarial support
unit and administration office staff: Lorna Foster, Ruth Dowling, Julie Williams, Sally Pulleyn,
Teresa Frank, Jenny Bowes and Catherine Duncan.
Research staff at the Research Co-ordination Unit: Dan Kearns and Andrew Nocon.
****
I would particularly like to acknowledge the encouragement and support of Willi Momm and
Bob Ransom at the ILO, the assistance of Dan Kearns in the Research Co-ordination Unit, and
the dedication of my colleagues Lorna Foster and Sally Pulleyn to the production of this
publication. Special thanks are due to Regina Pernice, Neil Lunt, Edwin de Vos, Erwin Seyfried,
Eskil Wadensjö and the team at the Canadian National Institute of Disability Management and
Research for their substantive contributions to this report.
Patricia Thornton
Research Co-ordination Unit
Social Policy Research Unit, University of York, UK.
April 1998
iv
PREFACE: THE PROJECT EXPLAINED
1. The International Research Project on Job Retention and Return to Work Strategies for
Disabled Workers breaks new ground by examining the inter-relationships of public and
enterprise policies and practices as they affect the retention and return to work of disabled
workers. The enquiry encompasses public policies to promote employment of disabled people;
benefit and compensation programmes; employment support and rehabilitation services;
provision to adapt work and workplace; and measures developed and implemented by the
enterprise. The Project aims not only to identify successful policies and practices which are
transferable from one country to another but also to inform the development of effective, efficient
and equitable job retention and return to work strategies for disabled workers. The ultimate
objective is to develop strategies which can be put into effect in the workplace.
2. The Project is an initiative of the International Labour Organisation (ILO) and the Global
Applied Disability Research and Information Network on Employment and Training
(GLADNET). The Project was designed to link research with the current and emerging concerns
of governments, employers and workers. It reflects ILO and GLADNET joint aims of
establishing a base for cross-national research and strengthening links between research analysis
and policy reform in the field of employment of disabled people.
3. The Project has been constructed in two phases. The first descriptive and exploratory phase
culminates in May 1998 at the Washington Symposium organised by the USA Government. The
Symposium brings together stakeholders and researchers from the participating countries to
debate the key issues emerging and to formulate a relevant and realistic plan for more focused
research and development work in phase two of the Project.
4. Responsibility for the Project rests with the ILO (Employment and Training Department,
Vocational Rehabilitation Branch). The design, implementation and analysis of the research in
phase one was the responsibility of the Research Co-ordination Unit established at the Social
Policy Research Unit, University of York (UK) in April 1997.
5. Eight countries participated in phase one: Canada, France, Germany, the Netherlands, New
Zealand, Sweden, the United Kingdom and the USA. National governments, agencies and, in
one country, a private sector organisation, as well as the ILO, contributed to the phase one
budget. Australia joined the project at a later stage.
6. The Project recruited national informants from research institutes in all eight countries to carry
out desk-based research. During the second half of 1997 national informants completed a
standard Schedule of Questions developed by the Research Co-ordination Unit to describe
policies and practices, document evidence of their effects and provide grounded commentary on
how policies and practices interact. The Research Co-ordination Unit provided on-going support
to informants.
V
7. In six of the eight countries, research specialists in the main areas of enquiry helped to
develop the design and methodology, analyse the data and draft the Key Issues Paper. The
research experts, the research co-ordinators and the ILO representatives met together as a
Research Advisory Group.
8. Eight country reports, based on national informants' responses to the Schedule of Questions,
have been prepared for publication at the Washington Symposium by the Research Co-ordination
Unit, with financial support from the ILO; printing costs were met by the US Department of
Labor.
9. This Key Issues Paper, which draws on the eight country reports, has been prepared for
participants at the Washington Symposium. It aims to inform, to stimulate debate and to pave
the way for constructive discussion of questions for further exploration through cross-national
collaboration. In particular, the Paper:
identifies policies, programmes and practices which can support job retention and return to
work, and considers their effectiveness within their national contexts
identifies barriers and facilitators to effective policies and practice in national systems
addresses the potential transferability of particular policies and programmes from one
national system to another
begins to construct strategies for job retention and return to work which link policies and
programmes efficiently and equitably.
10. The Washington Symposium was designed as an integral part of the Project to bring together
actors within government, agencies and enterprises who are involved in developing,
implementing and managing policies, representatives of disabled people and researchers. The
Symposium offers participants opportunities to:
bridge the knowledge gap, both across and within participating countries
compare perspectives on job retention policies and practices
explore the potential for and constraints on transfer from one national system to another
collaborate in a research and development programme to achieve gains for disabled workers,
enterprise and governments.
11. A report based on the Symposium discussions and conclusions will be prepared by the
Research Co-ordination Unit and distributed to participants.
12. Phase two of the Project will cover additional countries and will consist of in-depth research
on priority issues and on promising strategies for job retention.
Copies of the 'Methodology Paper' and the 'Informant Briefing and Schedule of Questions' may be obtained from
the Research Co-ordination Unit, Social Policy Research Unit, University of York, York, YO10 5DD, UK.
vi
1.
INTRODUCTION
1.1
A new focus on job retention
A combination of developments has led to a new international interest in the situation of workers
whose continued employment is at risk because of illness or disability. For workers with
disabilities, staying in work has generally become more difficult, with deregulation of the labour
market and pressures on enterprises to sustain competitiveness in an increasingly global market,
leading in many countries to 'downsizing' and casualisation of labour. On the other hand, rising
compensation costs mean that dismissal is no longer the automatic response to the occurrence
of disability. Enterprises in some contexts now find retention a cost-effective option and have
developed their own practices for managing disability.
Pressures on budgets for public services and benefits, and political and ideological change, are
encouraging states to disengage from centrist disability employment policies and services and to
reassess their role vis-à-vis the employer. New public policy approaches include increasing
employers' responsibilities to prevent and manage the occurrence of disability, financial
incentives to minimise benefit and compensation claims, and marketisation of services which can
help people with disabilities to retain employment. These shifts are by no means universal, and
long-established regulatory approaches continue to offer disabled workers some protection and
support in the face of labour market change.
In many ways, recent developments to promote access to employment by people with disabilities
favour the retention of working people who become disabled. Consider, for example, new
concepts of disability as the product of barriers in the environment; laws which emphasise rights
of disabled people in work; and pressure led by disabled people's movements to combat
discrimination on grounds of disability. It is nevertheless significant that disabled people as an
organised lobbying force have not taken ownership of job retention issues and remain focused
mostly on entry to work. But policies designed for 'disabled people' may not be adequate to
support the continuing employment of all those workers whose capacity to continue in the job
is affected through ill health or disability: those with 'new' occupational diseases, those with
fluctuating conditions whose permanency cannot be gauged, and those whose (invisible)
disabilities do not fall within the scope of legal definitions.
A new focus on job retention thus requires us both to re-think the balance between public policy
regulation and discretionary enterprise practice, and also to acknowledge that the population
whose continued employment is affected extends beyond those identified, or who self-identify,
as disabled.
1.2
Who are 'disabled workers'?
In this study, the term 'disabled workers' is broadly defined. It covers individuals who become
disabled, injured or ill, whose prospects of continuing or advancing in employment are
jeopardised when an acquired impairment, illness or deteriorating condition physical or mental
presents difficulties in fulfilling the requirements of the job, reduces earning capacity or affects
1
other rewards of working. They may or may not qualify under legal definitions of disabled
persons. The term also covers disabled workers whose working capacity is not diminishing but
whose continued employment is nevertheless threatened by prejudice or discrimination, or by the
loss of supports which have maintained them in the job.
1.3
What do we mean by job retention and return to work?
For the purpose of this study, 'job retention' means staying with the same employer, with the
same or different duties or conditions of employment, and includes return after a period of paid
or unpaid absence. 'Return to work' refers to the resumption of employment by a worker who
has crossed the threshold from a continued employment relationship into non-employed status;
the main interest of the study is in policies and practices which return the disabled individual to
work at an early stage.
1.4 What are job retention policies?
A starting point for the Project is that enterprises have their own policies and practices which
determine job retention. The national institutional, economic and regulatory framework creates
the scene within which they operate, but ultimately enterprise policies and practices determine
who is hired, dismissed or retained. How job retention at the enterprise level is encouraged,
complemented or constrained by public policies is a central question for the Project.
We adopt a broad interpretation of public policy to include not just regulation but also non-
interventionist and voluntaristic approaches. A stance against intervention in the affairs of
companies through regulation or incentives is itself a public policy which creates space for other
policy developments, such as voluntary change in employment practices whether for reasons of
business advantage or out of social responsibility.
Many countries do not distinguish job retention aims within their general policies to promote
employment, policies which are often dominated by programmes to increase access to
employment for disabled people who are out of work or have never worked. Alternatively, job
retention may be identified as a distinct approach which requires special legislation, incentives
and programmes. Public policies and services dedicated to job retention are, however, recent
phenomena found in only a few of the study countries. Early return to work policies which focus
on early intervention once the job is lost, are also comparatively recent in most.
Some broader-based policy measures with catch-all objectives (first time entry, re-entry and
retention) such as human rights and anti-discrimination legislation and quota-levy schemes, as
well as some schemes which set out mainly to promote entry to work, may have unexpected or
unintended effects in keeping in work people who become disabled.¹ Rather than restrict the
enquiry to policies and services designated for job retention and/or return to work, the study
1
The Americans with Disabilities Act (ADA) was mainly introduced to encourage access to work, although job
retention has been the major outcome. A consequence of the German quota is 'internal recruitment' for the quota
calculation of employees who become disabled, and minimal new recruitment of disabled workers.
2
'interrogated' a range of policies to identify their job retention or return to work effects. In some
instances, then, we are imposing analytical categories on a broad range of activities, while in
others we are reporting on policies and practices with clear job retention or return to work remits.
Developing strategies for job retention may mean re-orienting existing policies in that direction,
as much as inventing new policies.
1.5
Understanding the policy implementation process
Identification of policy intentions and outcomes is only part of the picture. It is the way in which
policies are put into practice the process - which determines their effects on job retention and
return to work. Accordingly, the study aimed to map the range of actors in the process, the
positions they adopt and their inter-relationships, and to begin to understand the constraints and
facilitating factors, both within and across the various organisations concerned with job retention
and return to work. A closer understanding of the dynamics of process may be pursued in phase
two of the Project.
1.6 How do policies and practices interact?
There is much to learn from initiatives in the study countries designed to promote job retention
and return to work and from more broadly-based policies which also have those effects. But their
success may be impeded by conflicting policies or practices or by inadequate links to other
programmes, services or facilitators in the national system. A further aim of this project,
therefore, is to examine the dynamics within national systems with a view to identifying ways
in which elements might interact more effectively and efficiently.
The research was designed around five 'themes'2 in eight national systems:
public policies to promote employment of disabled people
benefit and compensation programmes
employment support and rehabilitation services
adaptation of work and workplace
enterprise strategies.
A national 'system' in the context of this study refers to the many 'elements' within a country³
which influence the retention or early return to work of disabled workers. These elements take
the form of policies (laws, rules, operating principles), programmes (structures for
implementation and funding), practices (operating processes) and players (policy makers,
agencies, representative bodies, service providers, actors within the workplace and so on). The
five 'themes' outlined above represent conceptual groupings of these elements within the national
2
Although suitable housing, transport and personal care are essential to sustain employment for many disabled
workers they were not specifically addressed in the study. No specific questions were asked about access to health
services.
3
Where the provincial jurisdictions govern within a federal country, such as Canada, the notion of a 'national'
system is problematic.
3
system. Elements operate independently, or in combination, within and across the themes, and
can be interpreted in terms of system dynamics.
1.7
What are the Project's yardsticks?
The elements within the system and their dynamics are measured against four yardsticks: activity,
effectiveness, efficiency and equity.
Activity refers to the degree of effort and interest, as well as resources, devoted to job retention
and return to work within each national system. The concept does not imply measurable 'inputs';
it is, rather, a barometer of the national climate.
Effectiveness refers both to the quantitative and qualitative effects (intended and unintended) of
policies, programmes and so on and to results of the interactions (efficiency). The project
recognises that what is 'effective' is contested among government departments, enforcement
agencies, service providers, employers and other workplace actors, and workers with disabilities
themselves. Disabled workers' perspectives on desirable outcomes are under-represented in the
study so far.
Efficiency refers to the interactions between elements, both within and across themes. It is
assumed that job retention is more likely to be achieved if elements within national systems work
together more efficiently. It is also assumed that more efficient systems will be less costly; cost-
effectiveness will be investigated in phase two of the Project.⁴
Equity refers to the coverage within the system of sub-populations of disabled workers. It is
assumed that effective and efficient policies and practices must also be equitable (or fair). In
phase one, attention was given to the distribution of opportunities for work retention across the
public and private sectors, industry, occupation and tenure, and to how policies and practices
impact on disabled workers depending on type of disability, age, gender and minority grouping.
Equity between those in work and out of work is also an issue. Without a corresponding policy
commitment to improving access to employment, promotion of job retention and return to work
may disadvantage those who have never worked or are long-term unemployed, and may reinforce
existing inequalities in the distribution of employment opportunities, notably among women and
indigenous or visible minorities. An effective job retention strategy may have undesirable side-
effects if long-term disabled people seeking employment are not hired when priority is given to
retaining workers with newly acquired impairments.
4
Given that costs and benefits are distributed across workers with disabilities, private sector employers, private and
quasi-governmental agencies and providers, private and public insurers and a number of government departments,
the calculation of cost-effectiveness will necessarily be restricted to efficiency gains within parts of the system.
4
1.8
How transferable is practice from one system to another?
The Project assumes that, through researching national systems, obstacles and solutions to job
retention and return to work can be identified and practical proposals formulated for application
in other systems, to improve the prospects of disabled individuals who wish to stay in work. It
is assumed that certain ideas for 'good practice' can be transported from one national setting to
another, provided that the contexts in which they operate are well understood.
The larger Project aim is to formulating potential strategies to support job retention and return
to work. Some of these strategies are 'minor' collaborations or synergies between elements, not
necessarily comprehensively linked across the system but potentially transferable from one
setting to another. Others are more developed. It is expected that in phase two minor strategies
can be developed and combined into more comprehensive or 'grand' strategies.
These aims are highly ambitious and the obstacles should not be under-estimated, as the
following extract from the Canada report demonstrates:
The employment policies described so far were not designed as part of a co-
ordinated strategy to facilitate the job retention of disabled persons. Each policy
generally has its own rationale, with disabled workers usually being just one of
the many groups that have access to a program, and with job retention usually not
being a specific objective, although it may well be facilitated by the policies.
5
2.
THE PARTICIPATING COUNTRIES IN CONTEXT
Eight countries participated in phase one of the Project: Canada, France, Germany, the
Netherlands, New Zealand, Sweden, the United Kingdom and the USA. 5 In several dimensions,
the eight countries cluster into two groups: the predominantly English-speaking countries⁶ and
the four mainland European nations⁷. We summarise, in general terms, some of the more striking
differences reflected in their approaches to employment of disabled people. In the next section
we report on job retention and return to work activity in the eight national systems.
2.1
Labour market policies
National labour market policies create the framework within which policies for disabled people
operate and jobs are kept or lost. The study did not set out to detail the differences within
national policy approaches to regulation of the labour market, chart trends or chronicle changes
in political direction.⁸ We nevertheless can draw a simple distinction between traditions of
labour market intervention in the countries of mainland Europe and less interventionist stances
taken by Anglophone⁹ countries. In the more regulated German, French, Dutch and Swedish
systems, laws which control how workers are hired, the conditions of their tenure and how they
are dismissed provide the foundation for public employment policies to protect persons with
disabilities. Less regulated approaches, in the USA, New Zealand and the UK, avoid imposing
such constraints on business activity.
2.1.1 Measures to support job creation
Across mainland Europe wage subsidies, recruitment grants and relief of national insurance
contributions are widely used to create jobs for long-term unemployed and other disadvantaged
groups including disabled people. There are also special incentive schemes in Germany, France
and Sweden to promote employment of disabled people. Swedish active labour market policies
positively favour disabled people. Incentives are a relatively new feature of Dutch policy,
however.
The UK has not developed wage subsidies specifically for disabled people in the competitive
labour market, although if unemployed they will benefit from a new 'Welfare to Work'
programme which includes recruitment incentives. Active labour market programmes developing
in federal Canada may benefit unemployed persons with disabilities; wage subsidies operate at
provincial levels, some specifically for workers with disabilities, as in Quebec.
5
Australia joined the project at a later stage and is not included here.
6
Canada is bi-lingual. New Zealand is a bi-cultural state.
7
The UK, Sweden, the Netherlands, Germany and France are members of the European Union.
8
The Appendix presents economic development and employment-related data in statistical form.
9
It is not possible to characterise the federal/provincial systems in Canada. The country report indicates a current
reluctance amongst governments to introduce or sustain costly labour market policies and regulations if they
jeopardise business investment decisions and job creation.
6
Public subsidies to employers are incompatible with the free-market philosophy in the USA. 10
2.1.2 The role of labour unions
Generally, the level of trade union membership has been falling, most dramatically in New
Zealand (by over 50 per cent in ten years). Collective bargaining is most dominant in the
countries of mainland Europe, where very high proportions of employees are covered. In the
Anglophone countries, where company and plant level bargaining predominate, coverage is
highest in Canada, while only one in ten are covered in the USA. Collective agreements in the
workplace are one of the more important vehicles by which trade unions can advance policy for
the employment of persons with disabilities; in France the law in favour of the employment of
disabled people encourages enterprise-level agreements to formulate and implement plans for the
recruitment and retention of disabled workers.
2.1.3 Severely disabled people in employment
The mainland European countries all have large and expanding sheltered employment sectors to
which certain severely disabled people entering the labour market may be directed. 11 In the
Netherlands, for instance, there are almost no people with learning disabilities¹ in open
employment. Although the idea of supported employment in competitive employment is taking
hold in mainland Europe, it has not achieved the same degree of ideological importance as in the
Anglophone countries, where segregated employment has generally fallen out of favour and
where severely disabled people have more opportunities for competitive open employment. This
difference in policy emphasis must be borne in mind when considering strategies for maintaining
the employment of those people who are already disabled when taking up employment.
2.2 Disability employment law
The two groups of study countries practice different concepts of law which translate into
contrasting approaches to achieving the common social aim of reducing inequalities between
disabled and non-disabled people in employment. In the predominantly English-speaking
countries employers are expected to respond to individual claims and precepts of civil rights. In
the countries of mainland Europe, on the other hand, laws impose obligations on employers to
behave in predetermined ways towards defined groups protected by the law. In France, Germany
and the Netherlands disabled people may benefit from the law only after they have been assessed
against specified eligibility criteria. These differences are illustrated by two contrasting
legislative approaches: quota systems and disability discrimination legislation.
10 An exception is a tax credit scheme which promotes employment of targeted low-income groups including
referred individuals with disabilities undergoing vocational rehabilitation.
11
In France around 90,000 mostly in centres d'aide par le travail (CAT); in Germany approximately 140,000 in
sheltered workshops; in the Netherlands around 80,000 in social employment organisations; in Sweden 30,000 in
SAMHALL (Thornton, P. and Lunt, N., 1997, Employment Policies for Disabled People in 18 Countries: A Review,
York: Social Policy Research Unit, University of York).
12
'People with learning disabilities' or 'people with learning difficulties' are the accepted terms in UK and
European Commission English-language usage when referring to individuals with 'intellectual disabilities'; the
equivalent terms 'mental retardation' or 'mental handicap' are not now acceptable.
7
2.2.1 Quota systems
Employment quotas for many years have played some part in the disability employment policies
of most countries of Europe.¹³ The 'quota-levy' is the main pillar of national disability
employment policy in Germany and France (since 1987). To over-simplify two complex
schemes, employers must employ a target percentage of recognised disabled workers or pay a
levy which is redistributed, through a fund, both to support the costs to employers of employing
disabled people and to finance measures to promote the employment of recognised disabled
workers.¹⁴
Quota systems (and the special protection against dismissal which applies to beneficiaries of the
German law) are based on principles of collective obligation towards disabled people - an
obligation which rests on society as a whole, implemented by employing organisations as societal
representatives, and overseen by agents of the state. In most Anglophone countries such notions
of obligation and redistributive justice are contrary to principles of individual rights and, certainly
in the USA, to the employer's right to hire.
2.2.2 Human rights and anti-discrimination legislation
All four English-speaking countries have human rights or anti-discrimination legislation. Human
rights legislation protects individuals against discrimination on a range of grounds, including
disability, and in a range of areas, including employment. New Zealand has a Human Rights Act
(1993), all Canadian jurisdictions have human rights statutes covering disability (dating from
1977), and protection against discrimination on grounds of disability is guaranteed by the
Canadian Constitution.
The USA and the UK have anti-discrimination legislation specific to disabled people, with
specific provisions relating to employment; the Americans with Disabilities Act (ADA) 1990¹⁵
and the Disability Discrimination Act (1995). Under human rights and anti-discrimination
legislation the individual has to initiate a complaint. The complaint may be resolved by
conciliation, or legal action by the complainant or an independent commission may result.
In mainland Europe, legislation which covers discrimination on grounds of disability is as yet
rare, although disabled people's organisations campaigned vigorously to achieve rights in the
new European Treaty and advocate rights-based legislation at national level. Recent amendments
to the constitution in Germany and the penal code in France to protect people from discrimination
13
An unenforced quota in the Netherlands has a low profile among the several employment promotion measures
in a rapidly changing system.
14
The calculation of quota fulfilment is complex. Certain disabled workers (e.g. very severely disabled, blind
people, young and older workers, new recruits) count for more than one. Contracting with sheltered workshops
counts towards the quota. In France, enterprises can meet the quota in full by signing an agreement to formulate
and implement an integration plan.
15
The ADA 1990 marked the culmination of many disability rights laws (and other civil rights legislation)
beginning with the 1973 Rehabilitation Act and developed by Congress and the various states.
8
on grounds of disability may have symbolic importance but as yet little or no practical effect.
Legislation to protect disabled people from discrimination in working life, including a duty on
employers to make adaptations, is likely to be introduced in Sweden, however.
2.2.3 Protection against dismissal
The differences between the two groups of countries also can be illustrated by approaches to
preventing dismissal of disabled people. In the example of Germany and the Netherlands, a
recognised disabled worker has automatic protection under the law, unless approval of dismissal
is granted to the employer by an agency of the state. In the Anglophone countries, disability
discrimination laws come into effect only after the person with disabilities has been dismissed
and if discrimination on grounds of disability can be demonstrated. In this way, employers are
inhibited, rather than prohibited, from dismissing a worker with disabilities.
In this context, it is important to note that employees in European Union countries have some
form of protection against dismissal, depending on permanency of employment contract, number
of hours worked and a minimum period with the employer. In the USA, employees have no
statutory protection against dismissal. Thus, the ADA, combined with the Family and Medical
Leave Act 1993 which gives employees (in firms of over 50 employees) a right to up to 12 weeks
sick leave and to return to their job (or an equivalent) within that period, offers significant
'protection against dismissal' in the US context.
2.3 Policies to promote 'good employment practices'
Disability discrimination laws prompt employing organisations to adapt their recruitment and
employment practices in reaction to the requirements of persons with disabilities. 'Equal
employment opportunity' is a more pro-active policy approach. It encourages, or requires,
employers to examine their recruitment and employment practices and make changes to equalise
opportunities in accessing, maintaining and advancing in employment.
Such policies are evident in the Anglophone countries in the study. In New Zealand, public
service departments must develop their own equal employment opportunity policies, produce an
annual programme and publish results, monitored by a state commission, for specified groups
including people with disabilities. A short-lived legal requirement on the private sector has been
replaced by promotion of voluntary action. The UK has had a long-standing preference for
'persuasion' policies rather than legal requirements. Good employment practices in recruitment
and retention of disabled people have been promoted by non-statutory codes of practice and by
schemes to encourage self-identification as good practice employers, in both public and private
sectors. Governments, the social partners and some voluntary organisations have promoted the
business advantages of reaching out to a disabled customer base through employing disabled
workers.
In Canada people with disabilities are one group covered by the Federal Employment Equity Act
(and similar legislation in Quebec). Under this Act (which applies only to federal public
servants, Crown corporations and federally regulated firms employing 100 people or more)
9
employers must identify barriers limiting employment opportunities, and develop and implement
a plan to promote a fully equitable workforce. Voluntary employment equity operates at the
provincial level. Affirmative action of this kind has not been successful in increasing the
numerical representation of workers with disabilities although, as it also applies to women as a
special group, women with disabilities may have benefited.
2.4 Benefit and compensation systems and rehabilitation
Completely separate insurance programmes exist in Canada and the USA to compensate for
specified work-related injury or illness. In New Zealand the compensation programme is
restricted to people disabled through accident (work-related or not). In the Canadian provinces
and in New Zealand there are separate authorities which administer the funds for payment of
work injury compensation, while in the USA the main actors are private insurance carriers who
play an essential role in the administration of the programmes alongside the States. As it is in
the interests of the funds or insurers (and fundamentally the firms who pay the insurance
premiums) to reduce compensation payments, these systems also provide for rehabilitation and
return to work support. The result is that workers with disabilities covered by these
compensation schemes receive quite different, and usually better, benefits and services than
workers who become disabled through other causes.
In the countries of mainland Europe and the UK, workers are insured against work-related injury
or illness within the wider social insurance system. The arrangements for compensation and
levels of benefit differ in some countries if disability is work-related but, generally speaking,
beneficiaries do not receive different services from those who become disabled through other
causes. 16 The links between social insurance compensation and rehabilitation are most
pronounced in Germany and Sweden. Germany has a principle of 'rehabilitation before pension'
where the insured person's public pension fund should first provide medical and then vocational
rehabilitation. The Swedish national social insurance agency has extensive responsibilities,
together with employers, for ensuring that workers re-acquire lost working capacity as soon as
possible.
The UK social security department, which pays industrial injury compensation, has no
responsibilities for rehabilitation. Nor does the social security agency in New Zealand. The
prime function of the social security agencies in the USA and Canada is also to administer
benefits, although they may purchase vocational rehabilitation services for selected beneficiaries
with disabilities. Here it is important to understand that the English-speaking countries
traditionally have had 'all or nothing' social security disability benefits systems where
beneficiaries have only very limited opportunities to earn while receiving benefits. The countries
of mainland Europe, on the other hand, pay partial, as well as full, benefits according to
remaining earning or working capacity. Their systems allow a partial benefit to be combined
with income from paid work; and in Sweden and the Netherlands this is basic to sickness and
disability benefit policy.
16
In Germany there is separate statutory occupational accident insurance but the Rehabilitation Harmonisation Act
stipulates that the various insurance funds provide similar rehabilitation measures.
10
Companies in the USA and Canada commonly purchase private health coverage and insurance
for their employees against the risk of disability. These employee benefits are an important part
of the US system as there is no universal health care. There is a growing private insurance
market in the UK, and in the Netherlands evidence of insurers following the US model of funding
return to work services to minimise employers' compensation payments.
2.5 Employment support services and adaptations
In Sweden, France and Germany substantial funding is devoted to employment supports for
disabled people and their employers (including training, adaptations, technical aids, wage
subsidies, recruitment grants and direct services). The funds gathered through the quota-levy
systems are major sources of financial and practical support to assist French and German
employers in meeting their obligations towards disabled people. Public expenditure on re-
integration of disabled people into working life is very low in the Netherlands, and reforms have
been proposed to improve use of available funds.
Disabled people in Sweden and the UK can apply to earmarked funds for practical aids and
personal assistance in work. Help to disabled people specifically for support in employment is
unusual in other countries. Adaptive equipment and assistive devices for independent living are
well-developed in several countries but rarely tailored to supporting employment.
A central tenet of disability discrimination legislation and some human rights laws (New Zealand
is an exception) is that individuals with disabilities should not be put at a disadvantage in
meeting the requirements of the job. This means that 'accommodations' or 'adjustments' should
be made to the individual's work or working environment, such as modifying the equipment they
use, making the workplace accessible or modifying the work schedule. Accommodation
requirements are built in to some workers' compensation programmes in Canada. Only limited
public funding for adaptation of the workplace and for making accommodations for workers with
disabilities exists in Canada and the USA. There some businesses can be reimbursed for some
of the costs through the taxation system, but, unlike in the other six countries, there is no system
of grants.
2.6 Enterprise activity
The opportunity and impetus for the enterprise to develop and implement its own strategies for
employment of persons with disabilities vary from country to country. Sweden, for example,
reports that the framework of state regulation squeezes out any opportunity for independent
activity. Yet in New Zealand, where employers can act relatively freely, employers are thought
to see employing people with disabilities as a threat to efficient employment practices and a risk
to profitability. Independent enterprise activity is most developed in the USA where employers
have almost no statutory obligations in the employment field but have economic incentives to
adapt their employment practices. Larger employers in the USA have developed a variety of
activities and programmes intended to prevent disabilities from occurring and to minimise their
costs. These activities are considered in more detail later.
11
3. JOB RETENTION ACTIVITY IN THE STUDY COUNTRIES
In the previous section we highlighted the commonalities and differences in national approaches
to promoting employment of persons with disabilities. Here we summarise job retention activity
within the eight national systems and highlight the key features and developments.
3.1 Countries of mainland Europe: summaries
The Netherlands' income and labour policy is undergoing rapid change. Strategies to reduce
high sickness absence rates and costs to the disability benefit system have led to new
responsibilities on employers: to identify and reduce risks in the working environment; contract
with occupational health advisers; contact absent employees; and draw up individual work
resumption plans. Penalties on employers were resisted and strategy has shifted markedly
towards financial incentives, introducing employer responsibility for sick pay (for up to 12
months) and, since 1998, requiring them to contribute to the disability insurance scheme (or use
the private insurance market) to insure against the costs of the first five years of disability.
Uniquely in Europe, part of the firm's premium is differentiated, depending on claims
experience. A consequence of these incentives has been 'risk selection' at the recruitment stage
and legislation has been passed to prevent medical screening. Take-up of incentive subsidies for
wage costs and adaptations is very low. Most adaptations for job retention are carried out by the
company. The system focuses on short-term sickness absence, and rehabilitation of longer-term
disabled people has low priority.
Job retention also has an increasingly high policy profile in Sweden, a country with a strong work
ethic. Policy emphasises prevention of disability through improvements to the working
environment. Established duties on employers to promote healthy work environments and make
adaptations for individual needs in the workplace have been followed by initiatives to reduce
sickness absence. Employers now have responsibilities for the first weeks of sick pay and in cases
of sickness absence must plan for rehabilitation. As in the Netherlands, the sickness and disability
benefits system has been tightened to reduce costs of sickness absence and long-term disability
benefits. Ear-marked funding for adaptations in the workplace is substantial but under-used. A
short-term national fund dedicated to improving working conditions has demonstrated to
employers that workplace improvements can lead to economic gains. In a highly regulated
system, employers have little opportunity for independent action. There are some examples of
social partners' initiatives to promote employment opportunities for people with disabilities.
In France, concern about the outflow of disabled workers from employment at a time of high and
rising unemployment prompted programmes in support of retention. Since the 1987 reforms to
disability employment law, larger enterprises under the quota-levy system are encouraged to
develop integration plans, covering retention, rehabilitation and training, as an alternative to
paying the levy, and the body that administers the levy fund (AGEFIPH) works pro-actively with
large combines. The quota system itself is tailored more towards encouraging recruitment.
AGEFIPH interventions include temporary financial support to retain employees who become
disabled while practical help is arranged, diagnostic advice and grants towards adaptations.
12
Employers' associations are active in promoting job retention but most enterprise activity is
framed by the law. The proportion of state expenditure devoted to employment rehabilitation is
low. Return to work activity is dispersed among a range of agencies and providers and improved
co-ordination has been a priority. Considerable national effort is devoted to job creation and
subsidies to reduce unemployment among disabled people and other disadvantaged groups.
In Germany, the quota-levy scheme allows employers to keep in their employ (often in light
work) those, mostly older and long-term employees, who acquire health limitations. By
encouraging them to register, employers can fulfil the implicit social contract, and avoid the
uncertainty attached to new recruitment of disabled workers and the embarrassment of paying
large levy dues. The current economic conditions force firms to shed labour, however. Works
councils and disabled persons' representatives have effective roles in procedures which require
employers to obtain external permission to dismiss a registered severely disabled person. Return
to work is a strong institutional feature, supported by the various pension funds which invest in
rehabilitation as a first resort before payment of pension. Interventions by these funds veer
towards retraining and new employment opportunities, rather than efforts to accommodate the
disabled person with their existing employer; a 1997 review by the Federation of Pension Funds
has proposed a redirection towards job retention to improve efficiency. Various support services
and subsidies for (re)entry to work may be used for retention. Some interventions are specifically
designed to support efforts by enterprises to retain workers who become disabled.
3.2 Emerging issues: mainland Europe
Principles of social responsibility to disabled workers have been difficult for enterprises to
sustain in the face of down-turns in the economy and may be difficult to re-establish in times
of economic boom.
Principles of social solidarity are eroding fast in the Netherlands, with decreasing public and
political will to support the massive costs of the disability benefits system and rapid
privatisation of the disability insurance system.
A response to the rising costs of sickness and disability benefits in the Netherlands and in
Sweden has been to shift responsibilities from the state to the enterprise (most dramatically
in the Dutch system) both for payment of sickness benefit and for early intervention to reduce
sickness absence.
Occupational health services are becoming key players (as in the Netherlands) as enterprises
take on more responsibilities for retention of workers who become disabled.
Differentiated insurance premiums, as an incentive to Dutch employers to prevent employees
entering the disability benefits system, is a new development in Europe.
Job retention is mainly a social insurance policy issue, although in France, where the costs
of disability pensions have not escalated, the prime movers are the employment department
and the quota-levy fund agency.
Regulatory systems tend to circumscribe independent action by the enterprise but may also,
as in the case of the French reforms of 1987, stimulate new initiatives to support retention.
The substantial budgets of quota-levy funds and the fund raised from pay-roll taxes in
Sweden are important facilitators of job retention.
13
Works councils and trades unions play reactive roles in defending rights not to be dismissed
and in France and Germany are particularly active in reaching agreements to further job
retention policies within the enterprise.
Employers' networks for disability seem best developed in France, where employers'
associations and disability associations are also active providers of services to support job
retention and return to work.
3.3 The Anglophone countries: summaries
In Canada, requirements to re-employ and accommodate the return to work of injured workers
are a new and emerging area in workers' compensation (in Ontario, Quebec, British Columbia
and New Brunswick). These changes, as well as restrictions on eligible claims, have been driven
by the need to restore the financial viability of the compensation funds. Since 1998, the Ontario
scheme has been re-oriented towards prevention of workplace injury to meet this aim, and
responsibility for first intervention for retention or return to work is shifted from the
compensation board to the employer and employee. Insurance premiums which relate to the rate
of claims (known as 'experience rating') offer some incentives to employers to prevent
compensation claims. A reported adverse effect is pressure on injured employees to drop claims
or to return to work before they are ready. There are no other public policies specifically for job
retention but a shift in emphasis from more general policies that improve access to work to those
that promote job retention is reported, reflecting a general concern about the inadequacy of 'equal
opportunities' and the need for policies which deliver outcomes. Reasonable accommodation
requirements are considered key to such a strategy. The Canadian report notes that pressure on
governments to reduce deficits is shifting to employers more of the costs of services (such as
vocational rehabilitation) and of transfer payments.
In terms of USA national priorities, reducing numbers on the disability benefit rolls receives
greater attention than policies to support employees who are at risk of becoming unemployed due
to a disability. However, the ADA and FMLA combined, backed by occupational health and
safety legislation, have had significant effects on job retention practices. Employers are
responsible to pay medical and indemnity benefits for work-related injury and, because insurance
premiums relate to claims, there is an incentive, particularly for large firms, to reduce the
occurrence of disability and return the employee to work as soon as possible. However, workers'
desires to achieve the best rates of compensation and litigation reduce possibilities for early
intervention. Larger firms operate some form of 'disability management' system for claims
handling, prevention of disability, accommodation of workers with disabilities and so on.
Workers who become seriously ill or injured are eligible for vocational rehabilitation (VR) under
all State workers' compensation programmes and participation is mandatory in 15 jurisdictions.
Return to the same job, modified if necessary, with the same employer, takes priority. VR
services are either administered by a State workers' compensation or public VR agency, or
financed by private sector insurance carriers or self-insured employers. As in Canada, options
are limited for persons with disabilities not covered by workers' compensation or employers'
own benefit plans. Federal/State VR is oriented towards first-time entry to employment,
particularly serving people with severe disabilities, and federal expenditure on VR is very low.
14
In New Zealand, the single programme which positively affects job retention is the accident
compensation and insurance scheme which, like workers' compensation boards in parts of
Canada, provides case-managed rehabilitation services. Return to work is negotiated and not
mandatory, while rehabilitation is a right. Again, 'experience rating' is a built-in incentive to
employers to retain workers who acquire disabilities. Supplements to the income of returning
workers who are unable to work full time also serve as incentives to employers. A pilot scheme
allows approved employers to take on the total management of claims for the first year following
injury. Support services are directed towards access to employment and maintenance of people
with disabilities who find jobs. The recent Human Rights Act and promotion of equal
employment opportunities appear to have little impact on enterprise behaviour and the New
Zealand report suggests that employment of people with disabilities is not a priority in a highly
competitive climate.
In the UK, the rising costs to the state of disability benefits combined with long-standing political
concern about 'benefits dependency' and disincentives to work, and employment services for
disabled people directed towards (re)entry to employment, have meant that policy for job
retention was left in the hands of the employers. The new government has begun to stress the
importance of preventing disabled people from leaving employment (and so claiming benefits).
A 'new deal' has been announced as part of the new Welfare to Work approach, although specific
design details are only now beginning to emerge. There are few incentives to employers to retain
disabled workers. The recent Disability Discrimination Act, which follows years of
encouragement to adopt good disability employment policies, may impact on employers'
retention practices and encourage voluntary initiatives instituted by leading-edge employers.
Practical help to disabled people for workplace access supports people who become disabled in
employment but vocational rehabilitation plays a marginal role in the system. Employers'
networks on disability focus on access to work more than job retention.
3.4 Emerging issues: Anglophone countries
The excessive compensation costs to workers' compensation and accident compensation
boards in the USA, Canada and New Zealand have stimulated measures to encourage
employers to retain those injured workers who are able to return to work.
Requirements on the employer to re-employ and accommodate an injured worker are found
in some Canadian provinces.
Experience rating, where the cost of insurance is related to the disability record of the
company, is an incentive to retain workers who become disabled.
Injury and accident compensation systems discriminate against workers who become disabled
for other reasons. The latter have restricted opportunities for compensation, for income
maintenance benefits and for rehabilitation.
Adversarial compensation systems reduce possibilities for job retention.
In the New Zealand scheme rehabilitation is a right. Rehabilitation is mandatory in some
Canadian compensation schemes and in a minority of US workers' compensation
programmes.
15
4.
DISABILITY EMPLOYMENT POLICIES
All eight countries have developed policies which influence enterprises' employment practices
with regard to workers with disabilities. For example, enterprises are encouraged, or required,
to avoid discriminating on grounds of disability, to refrain from discharging disabled workers,
to keep jobs open for workers absent on sick leave, or to make it easier for the disabled worker
to do the job. Of course, special measures for workers with disabilities are only part of the
picture, and policies which apply to all workers also affect the job security of those who are
disabled.¹
17
4.1 The changing labour market
Job retention and return to work strategies for workers with disabilities are challenged by changes
in the structure of the labour market and in employment conditions in many countries.
Structural changes include a growth in service industries and a decline in traditional industrial
sectors, a shrinking public sector, streamlining of large firms, 'out-sourcing' and a growth
of small employers and of self-employment.
Employment opportunities are increasingly 'non-standard', including part-time jobs (which
may involve very low hours), short-term contracts and agency employment.
These changes expose the shortcomings of some regulatory approaches which exclude small
firms, require minimum periods of employment before disabled workers can take advantage of
the law, or exclude part-time workers. Workers with disabilities in emerging labour sectors can
miss out through restrictive coverage of work-injury regulation and of compensation systems.
Women in part-time work, transient workers and some minority ethnic groups concentrated in
small businesses or self-employment are particularly disadvantaged.
Agency working and subcontracting not only remove some disabled workers from the reach of
the law but also change the nature of employers' obligations towards them. In the changing
labour market there is an increasing role for public policy to support self-regulation among
enterprises. For example, companies may choose to exercise financial leverage on subcontractors
to demand of them standards in employment practice, just as governments may do through the
device of contract compliance.
The advent of the 'flexible' labour market can bring opportunities for some disabled people.
Some needs may be met through re-allocation of tasks to create 'light duties', flexible hours, job-
sharing, part-time working, home-working and tele-working. These solutions often fit with
employers' needs to reduce labour costs. But what are the benefits of flexible employment to the
worker with disabilities and what are the costs? Opportunities for flexible employment are by
no means universal. The German report comments on limited room for manoeuvre with
increasing competition and pressure for efficiency measures. Other countries report narrow profit
margins in some service industries and limited scope for flexibility in stream-lined public sectors.
17
The Ideas-2000 Project is exploring the question of whether generic policies are more effective than special
programmes in increasing the employment of persons with disabilities.
17
The new labour market requires employees to be functionally flexible, and undertake ongoing
training and re-skilling. If this human resource management ethos leads to less rigid employment
structures disabled workers may stand to benefit. Flexibility, and tailoring solutions to individual
needs, are key elements in successful job retention strategies. But how far is 'flexibility' part of
the culture of those industries where workers become disabled?
Should public policy follow the flow of the changing labour market or stand against the tide to
protect the interests of employees, including disabled workers? Should it, for example, advocate
that workers with disabilities should 'hitch a ride' in the growth service-sector 18 or direct effort
to supporting job retention in declining industrial sectors? Deciding on the balance between
these extremes is the first step towards a strategy for job retention and return to work of workers
with disabilities.
4.1.1 Job retention and the small firm
Many of the legal measures which promote job retention do not apply to firms with fewer than
a set number of employees. Changing employment conditions, rationalisation of large enterprises
and the growth of small firms indicate that the already large number of excluded people with
disabilities is set to increase.
Laws are commonly framed to allow alteration of thresholds; for example, the ADA threshold
was gradually raised during the implementation phase, as was that in the law which introduced
the quota-levy system in France. The UK government is to lower the minimum size of firm
covered by the DDA. Deciding where to draw the line is not straightforward. Thresholds are set
to take account of enterprises' ability to comply with the legal requirements, enforcement
agencies' capacity to oversee their adherence and the costs of supporting beneficiaries under the
law. If bringing smaller enterprises within the scope of law is to be effective, they will need
practical advice and extra funding for the costs of compliance, particularly where there is a
requirement to accommodate disabled workers, and minimal bureaucratic requirements.
4.2 Policy approaches
Policies are influenced by different assumptions about why job retention and return to work are
desirable objectives, about the parts that the state, employers and employees should play in
achieving them, and about the relative roles of legislation, financial incentives, publicly-funded
support and voluntary action.
At an analytical level, we can identify three main types of policy approach and corresponding
public policy measures:
collective responsibility - exemplified by quota systems, affirmative action, protection against
dismissal, wage subsidies, promotion of the socially responsible firm
18 Yelin, E. and Trupin, L. (1997) 'Successful labour market transitions for persons with disabilities: factors
affecting the probability of entering and maintaining employment, draft paper prepared for Conference on
Employment Post the Americans with Disabilities Act', Washington DC, November 17-18.
18
individual rights - exemplified by anti-discrimination and human rights legislation, equal
employment opportunity policies, information and guidance
business incentives - appeals to companies' financial interests through experience rated
insurance premiums, diversity policies, promotion of the 'business case'.
Clearly, employment policies are not uniform and often in a state of flux, with different forces
at work within national systems and different actors taking different positions. But employment
policies within the study countries can be broadly characterised according to these analytical
types. In some systems one type of approach stands out while in others a mix can be observed.
An emerging development overlays these three broad approaches. Pressures to reduce
expenditure on disability benefits or injury compensation claims, alongside other fiscal pressures,
have led to shifts of responsibility to the employer from the state. In some systems, increasing
employer responsibility is now viewed as a sustainable policy approach, supported by the
argument that workplace rehabilitation and early work resumption are better solutions for the
individual, as well as less costly to the state.
4.2.1 Target groups
These policy approaches target different populations. Measures based on collective responsibility
and individual rights generally are designed to support employment of individuals with enduring
disabilities. While most of these laws are framed to include workers who become disabled, and
in practice they are often the main beneficiaries, they are normally conceived as measures to
promote and maintain the employment of individuals who are disabled when they take up work.
Status as a disabled person is the passport to the rights and privileges of the law.
Policies based on business incentives, and the emerging policy line of increasing employer
responsibilities, concern workers who become or are at risk of becoming ill or disabled. Workers
are targeted for interventions because of their status as an insured person or because of their value
to the company. We do not know how many meet legal definitions of a 'person with disabilities'.
It seems that these policies favour the retention of workers with short-term disabilities or
disabilities that are simple to accommodate; they do not necessarily have a right to return to work
and sometimes are required to co-operate in the return to work process.
4.3 Maintaining the employment relationship
Maintaining the employee's connection with the employer is clearly essential if the other
supports for job retention - income supplements in work, support services and rehabilitation in
the workplace, and adaptations of work and workplace - are to be put in place. We report some
public policy approaches, examine some of their interactions with other elements in the system,
and explore their potential transferability to other systems.
Looking across the study countries we find two public policy approaches:
maintaining the connection with the employer during sickness absence or medical treatment
legal protection against dismissal on grounds of disability.
19
The first approach targets workers with short-term disabilities. The second targets those with
more enduring or permanent disabilities. Because of the different policy orientations in many
systems one or other of these groups of disabled workers misses out. The challenge for a job
retention strategy is to identify and remove anomalies within systems, to make sure that workers
with both short-term and long-term disabilities benefit, and to prevent one group gaining at the
expense of the other. The first step, however, is to examine effectiveness and equity in the
different approaches to maintaining the employment relationship.
4.4 Keeping the job open during sickness absence
We found two main mechanisms for keeping the job open during sickness absence: linking
employment protection to social insurance or workers' compensation; and disability leave.
4.4.1 Linking employment protection to social insurance benefits
One potentially useful approach is to legislate to protect the employment of recipients of social
insurance sickness or disability benefits. This can apply both where the insurance agency pays
the benefit and where the employer is responsible. In Sweden, where the employer now pays
during the first two weeks of sickness absence, as a general rule there is no question of dismissal
while the person is receiving national sickness insurance benefit. In the Netherlands, where the
employer is now responsible for payments for up to five years, a disabled employee may be
dismissed only after two years and only with permission from the authorities. In those countries,
the employer is legally required to have arrangements for rehabilitation in the workplace and to
initiate action to support the return to work. Compliance is monitored, though less stringently
in Sweden. The current policy approach in the Netherlands is founded on business incentives,
while in Sweden employers are expected to respond to legal obligations with few extra
incentives.
In France, a newly disabled person who is work-injured or who receives a disability pension has
protection against dismissal for the duration of the period of sick leave and, if found fully fit, will
return to the job. Otherwise, the employer must reassign the person to another job. Medical
judgements are important in determining the outcome and if resettlement within the enterprise
is impossible, dismissal may ensue. The disabled person may challenge the decision in the
courts. The quota-levy system serves as an incentive to retain disabled employees.
Where retention is mandatory, as in these examples, effectiveness relates to the incentive
structures, the mechanisms for control, and the rehabilitation infrastructure to support the
worker's return to the job.
4.4.2 Linking employment protection to injury and accident compensation
In Canada, USA, New Zealand and Germany, workers who suffer work-related injuries or
accidents fall within separate compensation programmes which provide for rehabilitation as well
as financial compensation. The priority in all systems is to return the disabled worker to the
original employer. There are three main approaches: requirements to reinstate the injured worker,
business incentives and intervention strategies.
20
In some Canadian workers' compensation schemes there is now a re-employment requirement.
In Ontario (the example given) the employer is required to reinstate and accommodate the injured
worker in their former job, or in a comparable job with comparable wages, if return is within two
years of the injury. 19 If the employer is reluctant to re-employ, mediation follows and some kind
of settlement is achieved in three-quarters of cases. In the long run, the employer can be fined
but not forced to reinstate the worker. Recent changes to the law place the responsibility on the
employer and employee to make and maintain contact, whereas previously the workers'
compensation board drew up a rehabilitation plan. As a rule in the Canadian systems, companies
receive rebates on their insurance contributions if claims decrease and this is an incentive to
employers to assist the return to work effort. However, it may lead employers to resist workers'
claims for compensation.
Although State workers' compensation laws in the USA generally do not forbid discharge
following the onset of a work-related injury or illness, there are business incentives to return the
injured worker to work as soon as possible. Employers are responsible for paying medical and
indemnity benefits. As such benefits are either company-insured or experience rated when
insurance is purchased, their cost is related to the disability record of the employer. However,
there are also incentives to injured workers to maximise their awards by not returning to work.
Disputes over liability and over the degree of occupational impairment tend to lead to lengthy
legal and medical assessment procedures. Litigation is a barrier to return to the job. No
information is available on numbers of disabled workers staying in work or their characteristics.
Evaluation of overall effectiveness is hindered by the involvement of a range of insurers.
The accident compensation scheme in New Zealand (ACC) emphasises early intervention to gain
the co-operation of the employer at the start so that the person retains their place of work. There
is no requirement on employers to take back the accident-injured person and no litigation. Most
(90 per cent) retain their jobs with medical compensation only. Experience rating, introduced
in 1993, is intended as an incentive for retention. A further incentive is temporary payment by
ACC of earnings-related entitlements so that the person may return to the job part time.
Intervention to gain the co-operation of the employer is also a useful approach in Germany.
Under the statutory occupational accident programme, as for other employees absent undergoing
rehabilitation measures, there is no legal arrangement to keep the job open.2 Employers are
encouraged to do so, or offer vacancies, through mediation by the specialist case managers
(Berufshelfer) who give priority to returning persons undergoing rehabilitation to their original
occupational branch. A substantial part of the rehabilitation effort is devoted to these measures
and it seems that many larger companies do keep the original job open or find temporary light
19 Of those injured workers (50 per cent of the total) receiving vocational rehabilitation through the programme and
re-entering the workforce, three-quarters returned to their employer in 1994 and 1995.
20 Dismissal is possible if the period of absence is long, if health limitations are likely to be enduring, and if
retention is against the interests of the company. If the works council refuses to approve the dismissal the employer
must pursue the case in the labour courts. If the absent person is a registered severely disabled person, permission
must be sought from the Hauptfursorgestelle, which is usually granted.
21
jobs until the previous job can be resumed. Economic constraints make this increasingly
difficult. There are some incentives in the shape of integration benefits but employers' insurance
premiums are not set according to the record of the individual firm. Overall, however, the
German rehabilitation system tends to promote retraining and return to a new employer. Indeed,
return to the previous occupation is explicitly avoided if it poses a continuing risk to the person's
health.
The outcomes of these approaches are hard to assess. Hard data in terms of jobs retained or lost
have limited explanatory value. There are lessons to be learnt - for both injury compensation
schemes and social insurance programmes - by examining elements in the process: the role of
the physician in determining fitness for work; the procedural obstacles to settling claims; and
how case managers access employers and achieve co-operation. The populations covered by
injury and accident-related schemes and by social insurance schemes differ, however.
Compensation programmes which are restricted to injury or illness that 'arises out of and in the
course of employment', and the accident compensation schemes, tend to focus on injuries
associated with a particular event. They are ill designed for degenerative, accumulative, stress-
related and over-use conditions. Pressures on the financial viability of workers' compensation
programmes are leading to even more restrictive definitions of eligible illnesses; under the new
provisions in Ontario, for example, stress is ruled out and chronic pain is under review.
Anomalies appear if parallel state programmes provide different levels of benefit or rehabilitation
for those who cannot claim that their condition is work-related or who are excluded from
coverage of the programme. The issue is most acute where eligibility for and access to social
security benefits is restricted (by means-testing or long-waiting periods, for example). Critics
of the dual system of accident compensation and social insurance in New Zealand consider it
inequitable and socially divisive.
In North America, where workers' compensation programmes are of long standing, the private
insurance market has stepped into the breach and employers purchase insurance for their
employees. Although it is observed that some USA enterprises have begun to break down the
distinction between work-related and non-work-related disabilities, and to provide similar claims-
related services for both, this is not the norm and more valued employees who are difficult to
replace tend to be selected for interventions.
4.4.3 Disability leave
Disability leave can be useful for individuals with short-term disabilities whose contracts of
employment provide limited job security. This is exemplified by the USA Family and Medical
Leave Act (FMLA) of 1993, the many State statutes and voluntary initiatives which preceded it,
and good practices by employers not covered by the law. Under the FMLA, private employers
(with over 50 employees) and public agencies must meet requests from employees for up to 12
weeks' leave to recover from a serious health condition or for family reasons. If return is within
12 weeks, the employer is obligated to give the employee their former or an equivalent position.
22
A drawback with this approach is that individuals have to claim their right to leave: research into
the operation of the FMLA found that individuals were reluctant to ask because they feared that
they might lose their job or their work would suffer. A problem associated with taking leave is
that the individual then has a history of lost working time and can find it difficult to change
employer. Employers are thought to be unwilling to hire them because of the risk of the cause
recurring. Such instances of discriminatory hiring are difficult to prove under the ADA.
Voluntary 'disability leave' has been piloted by a UK voluntary organisation for blind people
with some employers. The employer is encouraged to support the return to the job of employees
on short-term absence (who may not qualify for protection against dismissal or who may be
discouraged from returning) and to help in the process by making temporary or longer-term
adjustments. Practice is promoted by the business case that it is financially worthwhile to the
company to retain the employee. The USA experience indicates that mandated medical leave,
established on a foundation of voluntary practice, in combination with accommodations for
returning workers required by the ADA, has had a significant impact on job retention, especially
benefiting blue-collar workers.
4.5 Preventing dismissal on grounds of disability
Laws which prevent dismissal on grounds of disability can benefit workers who become disabled
as well as those who are already disabled. Three models are considered.
4.5.1 Protection against dismissal in Germany
Germany provides an example of a negotiated approach to protecting the jobs of permanently
disabled workers. The employer must consult the disabled persons' representative (such a
representative is obligatory in firms with more than five severely disabled workers) and the works
council, before applying to the authorities for permission to dismiss a registered severely disabled
person. The parties are expected to work towards negotiated settlements, and three-quarters of
cases of retention are achieved without official procedures. The opinions of the internal
representatives are very influential in the process. If the authorities intervene they may provide
advice on adaptations and financial support to retain the disabled worker.
The down-side of this approach is the negative impact on employers' hiring decisions. Because
assessment as a disabled person does not measure working capacity, registered severely disabled
persons who experience no difficulties in working life also benefit from the protection against
dismissal. Severely disabled workers have an extra five days leave, for which the employer pays.
On the other hand, the effect of the German quota-levy system has been to protect newly disabled
employees from dismissal. Employers press those, mainly older, workers who experience health
problems to register. 'Internal recruitment' accounts for 80 per cent of those recorded for the
purpose of the quota. At the same time, employers can meet the 'reciprocity expectations' of
their employees, demonstrating loyalty to them and fair treatment.
23
4.5.2 Non-discrimination legislation
The German approach, where the employee has automatic protection until dismissal is granted,
contrasts with the individual rights approach found in human rights and disability discrimination
legislation. While it is against the law for the employer to dismiss a person on grounds of
disability, legal procedures usually come into effect only if a complaint of unfair dismissal is
made, that is, after the job has been lost. If the complaint is settled the employee may be
reinstated.
The 'omnibus' human rights legislative approach - covering other groups, as well as people with
disabilities, experiencing discrimination in all walks of life - may have different effects from
legislation specific to disabled people in employment. A drawback with omnibus legislation is
that the rights of disabled workers can have a low profile and other groups' interests can
dominate. Equal employment opportunity or employment equity laws may interact, however, and
raise workplace actors' awareness of disabled workers' rights not be discriminated against.
Disability discrimination acts generally cover broadly defined populations of individuals with
long-term impairments that limit daily activities, but may also encompass progressive conditions,
past disability, being perceived as disabled, and emotional disorders that generally fall outside
popular conceptions of disability. Disability is viewed as a relationship between the individual
with impairments and the working environment, which means that the employer has to make
reasonable changes to the work or workplace so that the disabled person is not put at a
disadvantage in carrying out the requirements of the job.
Evidence from the USA indicates that the ADA supports job retention. Over half of the 75,600
charges filed up to end November 1996 were for discharge violations and the majority were
resolved by mediation. The pattern of recorded disabilities of those complainants suggests that
they were workers who became disabled, rather than individuals who were disabled when they
took up the job. The USA report comments that the ADA has helped to protect the jobs of blue-
collar workers who receive fewer employee insurance benefits. Only one in ten of all complaints
were for hiring violations, possibly reflecting the difficulties faced in proving discrimination in
recruitment decisions; and, clearly, the number of persons with disabilities applying for jobs will
be much lower than the number of existing employees covered by the law. The numbers of
complaints filed or cases resolved by mediation are inadequate measures of the effectiveness of
non-discrimination legislation, however. Only by looking inside the enterprise will it be possible
to assess the impact of such laws in preventing dismissal occurring in the first place.
To take advantage of non-discrimination laws, persons with disabilities need to know their rights,
feel empowered, have confidence in the system, and have the resources to drive a sometimes
costly and time-consuming process where the outcome is uncertain. Without advocacy, the
rights-based approach may favour the better educated and more affluent; rights commissions with
powers to investigate employment practices may help to redress this imbalance. We need to
know more about the consequences of the adversarial process on employer/employee
relationships and on the quality of working life for the person who returns to work.
24
Different ways of resolving disputes have different outcomes. Conciliation has the advantage
to the employee of earlier resumption of work and avoidance of the stress of litigation. On the
other hand, a public decision against the employer may bring changes in practice which are of
benefit to a wider population of disabled workers than the successful claimant alone.
We need to know more about how best to frame non-discrimination legislation to help the
enterprise to support individual rights in employment. The precision of the legislation,
consistency of court decisions and the detail of codes of practice all affect ability to plan
appropriate changes.
4.5.3 Building disability into employment security law
The approach in Sweden combines requirements to make adaptations with the option of
individual action. Under the general employment security law, reduced working capacity is not
grounds for dismissal. 21 Rather, the employer is expected to take action to make the work easier,
using externally provided aids, to transfer the employee to less demanding tasks or to initiate
rehabilitation measures. The employee or the union can take the employer to court for groundless
dismissal and damages may be awarded; cases are hard to win, however. It is thought that overall
the law inhibits arbitrary dismissal and disabled employees have strengthened job security
compared with other workers. This does not protect disabled workers against discrimination.
Survey evidence shows that employees have lost their jobs or been pressed to resign on account
of their disability, and a law against discrimination in working life is to be introduced.
Swedish employment security law is complemented by working environment and social
insurance laws which place responsibilities on employers to adapt the working environment to
the needs of functionally disabled workers and to ensure that rehabilitation needs are identified
and acted upon, so that working capacity is restored as soon as possible. Definitions of target
groups are very general and do not obviously conflict. Difficulties in the system appear to stem
from the lack of 'sticks' and 'carrots', and from unclear responsibilities and disjunctive practices
among the various governmental agencies, rather than from conflicting public policy objectives.
A related way forward might be to make it easier to claim unjust dismissal on grounds of
disability under employment law. In Canada, mechanisms to prevent unjust dismissal only
indirectly cover dismissal on grounds of disability and such a case is likely to be difficult to
22
prove.
21 Dismissal is allowed if the person cannot carry out work of any significance but the employer must use all
available means to avoid dismissal.
22 In Canada all employees have common law protection against wrongful dismissal (that is, the employer must
show just cause for dismissal); while disability itself is not 'just cause', some of its consequences, such as excessive
absenteeism or incompetence to perform the job could be grounds for dismissal. There is also a grievance procedure
for employees covered by a collective agreement and statutory protection under employment standards for non-
union employees.
25
4.6 Supporting employers' costs
Generally, the employer bears the costs of keeping the job open for a returning employee.
Identifying and supporting those costs are central to a job retention strategy. An initiative by
AGEFIPH, the body administering the French quota-levy fund, provides short-term financial
support to retain a worker who becomes disabled (as defined by the law) and to allow adaptations
to be made. This is requested primarily by traditional blue-collar industries, and beneficiaries are
mostly older, male and with low educational qualifications, and with motor impairments.
4.7 Transferability across systems
Some of these measures supporting job retention are imbedded in national systems and do not
lend themselves easily to replication in others. Approaches founded on collective responsibility
have developed in a socio-political context where decisions are made in a consensus-oriented
way, where there is a history of employment issues being decided more co-operatively between
labour unions and management, and a social contract between employers and employees. Rights-
led approaches are found in more adversarial systems. Some systems take for granted the
necessity of professional assessment, classification and registration of disabled people, while in
others such processes are unacceptable to persons with disabilities.
Transference across English-speaking countries of measures based on precepts of individual
rights has been facilitated by a 'common law' legal system, a common language, and solidarity
among disabled people's movements with a shared commitment to civil rights for people with
disabilities. Transplantation is easier in a receptive climate where rights legislation to prevent
discrimination on grounds of sex and race has already had an impact. In the USA and the UK²³
disability discrimination legislation was introduced into less interventionist systems where
enterprises were encouraged through business incentives or good practice initiatives to change
their employment practices. USA experience suggests that non-discrimination legislation will
have more impact on retention if founded on existing good practices, backed by heightened
public acceptance of the rights of persons with disabilities. Disability discrimination legislation
requires a relatively broad definition of disability which enables individuals to self-identify under
the terms of the law.
The idea that business advantages might flow from a diverse workforce which includes disabled
people is gaining ground in the USA, New Zealand and the UK. Whether this relatively weak
form of incentive has any impact on job retention is hard to say. Financial incentives to retain
disabled workers appear increasingly relevant as more responsibilities pass from state to
enterprise and as employers find it difficult to reconcile duty with business objectives. Insurance-
related incentives to employers, first developed in injury and accident compensation schemes,
are now found in the special circumstances of the Dutch disability insurance system. In other
social insurance systems risks are shared. Private insurers are positioned to influence enterprise
job retention strategies in systems where the costs of disability fall to the employer.
23 While the UK had a quota scheme until the passage of the DDA (1995) it was almost unused and the main thrust
of government policy was to promote voluntary adoption of good employment practices.
26
4.8 Key issues in employment policy
Changes in the structure of the labour market and conditions of employment
reduce the scope of public policy and increase enterprise autonomy. Business
communities, locally, nationally and internationally, have the opportunity to
regulate their own practices and to use their trading influence to promote
equitable job retention.
There is a need to identify, at national and local levels, those areas of the labour
market where job retention is most problematic and to consider where policy
interventions might best be directed.
Individual rights movements are a growing force in Europe. Models of
disability discrimination legislation are evolving in more interventionist
systems. Definitions of disability, procedures for enforcement and mediation
and accommodation requirements will have differential effects on employers'
ability to retain workers with disabilities, as well as on disabled workers'
opportunities to claim their rights under the law.
Requirements to accommodate - to adapt the work and workplace so that the
individual with disabilities is not disadvantaged - are key to a coherent job
retention strategy and can bridge the gap between conflicting definitions of
disability. Including accommodation requirements in compensation systems
as well as in rights legislation is a way forward.
Measures to promote job retention can have negative consequences for
individuals with disabilities wanting to take up work or move to a new
employer. Perverse effects have been noted in both collective and individual
rights-based approaches. But selective hiring to avoid those who pose a
financial risk is particularly associated with policies which aim to reduce the
incidence and duration of disability-related claims and consequently reduce
costs to the employer. An equitable strategy for job retention and return to
work requires effective non-discrimination measures to prevent risk selection
at the recruitment stages.
27
Insurance-related financial incentives are increasingly dominating the
enterprise response to disability and have a part to play in supporting job
retention. But these policies also may have negative effects on those disabled
workers who are actively discouraged from claiming compensation or are
pressed to return to the job too early. Job retention may not always be in the
best interests of the disabled worker.
With increasing enterprise responsibility for containing the costs of disability
there can be room for discretion in choosing whom to support. Non-
discrimination legislation is a significant element in the return to work strategy
where companies have incentives to retain the workers they most value.
The effectiveness of the different approaches to linking employment protection
to receipt of sickness, disability or injury benefit should be explored further.
The spectrum ranges from stringent requirements on the employer to retain the
beneficiary, to negotiated interventions on the part of the benefit agency. There
can be lessons for countries where such arrangements do not exist, or exist for
only a subset of workers with disabilities.
As the emphasis shifts to early intervention and rehabilitation, securing the job
of the disabled worker is increasingly necessary. The issue of how to identify
and support the costs to the employer has become a priority.
As responsibility shifts from government to employers and disabled employees
the need is highlighted both for collective representation of disabled people in
planning for job retention and for individual advocacy in the workplace. New
models of advocacy are developing as persons with disabilities within
employing organisations and labour unions form alliances to provide support
to their peers.
28
5. BENEFIT AND COMPENSATION PROGRAMMES
The benefit system for individuals who become disabled in work typically comprises several
parts. Under social insurance and occupational insurance schemes, there are occupational injury
or accident compensation programmes, sickness benefits, rehabilitation benefits and disability
benefits. Within the privately-insured sector, there can be sickness or short-term disability
programmes and long-term disability benefit schemes to which employers or employees, or both,
contribute. In some cases, compensation is a combination of several forms of payment.
The basic questions from the disabled worker's point of view are: how the benefit arrangement
which applies to them enables them to stay with the existing employer, or leads them to leave
their employment; how it assists them in the process of returning to work or presents obstacles;
and how it encourages the disabled person to return to employment or is a disincentive to doing
so. For the individual whose working capacity, or ability to earn the previous wage, is reduced
by disability, an additional consideration is how far the benefit enables them to resume work part
time.
The design of the benefit or compensation programme is important in determining if persons with
disabilities will retain their jobs or return to employment, as well as the conditions of that
employment. To understand the possibilities and the constraints, we need to consider:
the level of benefit
rules for granting benefits
partial benefit options
options to combine work and benefit
opportunities to obtain or retain benefits during rehabilitation
possibilities to use benefits for the transition back to work.
The design of social and occupational insurance schemes also influences the actions taken by
employers. Changes in the compensation system may influence the behaviour of both employers
and employees.
5.1 Sickness benefit and compensation systems
If an individual becomes injured, sick or disabled while in employment, the type of benefit
arrangement to which he or she is entitled in the first instance will affect opportunities to stay
with the existing employer.
5.1.1 Sickness benefit programmes
In a minority of study countries, there is comprehensive coverage for all insured workers under
a single pay or sickness benefits scheme. In countries with separate work or accident injury
schemes, sickness benefits for those who are not covered are paid variously by the employer (in
the first instance) through a private insurance scheme taken out by the employer (or less, usually,
funded by the employee contributions) or by a state-financed scheme. Private insurance coverage
is most prominent in the USA.
29
The period of employer responsibility for sickness benefit varies substantially. For example, in
the Netherlands by the end of 1997 responsibility had been extended to 52 weeks; in the UK the
employer is responsible for sick pay for up to 26 weeks and there is now no separate sickness
benefit scheme; in Sweden at the time of the study the employer sick pay period was four weeks,
though it has since been reduced to two.
Employer sick pay in New Zealand extends for only one to two weeks, depending on the terms
of the individual's employment contract; while statutory sickness benefit, if repeatedly renewed,
can be paid indefinitely.
In the USA, there is no statutory sickness benefit. There, private sickness and 'short-term
disability' benefit programmes typically last up to 26 weeks; while the mandatory 'temporary
disability insurance' programmes in five states, to which employees contribute, can pay benefits
for between 26 and 52 weeks.
In the absence of protection to keep the job open, such as the Family and Medical Leave Act in
the USA or statutory protection against dismissal, extended employer sick pay can provide a link
to enable return to the job and, if the costs are sufficiently high, the employer has an incentive
to maintain contact and support return to work. Otherwise, once the employer period of payment
has ended, as the New Zealand report notes, individuals must attempt themselves to negotiate
their return to work with an employer on whose goodwill they are dependent, and are vulnerable
to job loss.
Employer responsibility for sick pay or sickness benefits may be linked to statutory rehabilitation
responsibilities, as is the case in the Netherlands and Sweden where the employer is required to
follow up absent workers and plan for work resumption, overseen by the social insurance
agencies.
In the statutory schemes for sickness benefit in the less regulated countries the social insurance
authority's mandate is limited to claims handling and there is no remit to intervene with the
employer to promote return to the job or to provide rehabilitative services to the disabled
employee.
5.1.2 Workers' and accident compensation schemes
In Germany, Canada, USA and New Zealand, there are quite separate compensation schemes for
workers who become disabled through work-related injury, illness or accident, and they all have
rehabilitative components. In Germany, the principle of 'rehabilitation before pension' applies,
and the concept of compensation encompasses much more than cash benefits. The statutory
occupational accident fund provides a comprehensive range of assistance in kind, as well as
monetary benefits, notably to support the expenses of undergoing vocational rehabilitation
measures such as training.
30
The form in which damages are paid for work-related injury may affect the incentive to return
to work. In some Canadian workers' compensation systems a lump-sum amount is payable for
non-economic loss. The Canadian report speculates that if the payment is made as an initial lump
sum, rather than graduated payments as an annuity, it may be used to finance job search activities,
although the opposite point of view is that a large sum might support exit from the labour market.
In New Zealand, lump-sum payments for pain and suffering and loss of enjoyment of life have
been abolished, and substituted by an independent living allowance to assist with the additional
costs of disability.
In the USA, most states provide cash damages for permanent occupational, rather than income
replacement for lost earnings. This has the advantage that there is usually no disincentive effect
to employment once a settlement in reached, since benefits are paid irrespective of current work.
However, the pursuit of personal injury damages in the USA system in an incentive not to return
to work.
The pension payments in Germany similarly take the place of damages and are not offset against
income from work, thus promoting efforts for job retention and return to work.
5.2 Benefit levels
In systems where there are separate work or accident injury programmes, compensation levels
and ceilings may be different for an individual whose disability is accident or work-related than
for someone who becomes disabled for other reasons and receives a private insurance disability
benefit or a statutory sickness benefit. Access criteria, such as qualifying periods in employment
or the number of "waiting days' before the benefit can be claimed, also differ.
Benefits are commonly set as a percentage of lost earnings capacity. Less usually, the percentage
impairment is used as the basis for calculating compensation. In one country, benefits are not
earnings related and a flat rate is paid.
Most country reports comment on the assumed disincentive to return to work of a high level of
compensation compared with earnings lost, but little research evidence is provided on how the
'replacement rate' influences the disabled worker's decision on whether to return to the job or
not.²⁴ Some econometric studies looking at replacement rates in the USA and Canada have
shown that higher benefit rates in workers' compensation schemes are associated with lower
probabilities of returning to work. Few studies have distinguished between return to the original
employer and to a new employer, however. The replacement rate theoretically affects the
employer's decision whether to retain or let go the worker who becomes disabled. These
questions might usefully be pursued in phase two of the project by describing and comparing
models for determination of replacement rates in different systems.
24 Given the breadth of the themes reviewed, no specific information was requested about replacement rates.
31
Clearly, the wage the disabled worker can expect to return to also affects the decision. Where
partial benefits are combined with wages, the total can be equivalent to or less than, pre-disability
earnings. Country reports note that this presents significant incentives and disincentives to job
retention, although again there is little hard evidence cited. As there seems to be increasing use
of partial benefits, the incentives and disincentives within them may warrant study.
There are, of course, other influential factors in the return to work decision, including the social
rewards of participating in employment and the quality and suitability of the work on offer. The
availability of rehabilitation and support to return to work may reduce, but not overcome, the
financial disincentives in benefit systems, as can support to negotiate the procedural obstacles.
An examination of incentives to return to work thus also needs to take into account the value to
the worker of such benefits in kind in an optimal benefit 'package'.
5.3 Incentives to the employer
One way of making employers more predisposed towards retaining the worker who becomes
disabled, and also encourages employers to take measures which prevent occupational injuries,
is to introduce various forms of incentive in the compensation systems. These can be introduced
in a number of ways. The employer can be obliged to pay wages for a period of sickness; as
noted, this can vary from a few weeks to up to a year. Use of waiting periods, where the
employee receives no compensation for the first days, is a strategy to reduce costs. The most
complete way is to oblige the employer to pay for all costs related to sickness, occupational injury
and disability - compensation as well as rehabilitation and labour market programmes - for his
or her employees.
5.3.1 Experience rating in insurance schemes
More common incentives are the various types of experience rating systems found within the
work and accident injury programmes.
In Germany, Canada and New Zealand, firms are classified by industrial sector, depending on
how prone they are to occupational injuries, and different contribution rates apply. In Ontario,
for example, where the system is financed from payroll taxes, the rate is 1.3 per cent of the
insurable payroll in the government sector and 8.5 per cent in construction. The grouping of
firms can be quite broad, or finely tuned with a large number of industry categories, as in New
Zealand. The aim is to avoid subsidising occupational injury prone industries, rather to spread
the risks over all employers according to a principle of collective responsibility.
This industry-wide rating system can be overlain by firm-specific arrangements, such as extra
charges or reductions in the contribution rate; in Germany, for example, this possibility is seen
as an incentive to act to prevent occupational accidents and work-related illnesses. Rebates for
low claims records are reported from Canada.
Experience rating of individual firms is most developed in the USA. There, very small
employers pay a rate that reflects the experience of all firms in that line of business but larger
firms (covering 85 per cent of workers) pay a rate adjusted to reflect their actual claims
32
experience, and the rate for very large firms is based entirely on experience and not related to the
industry average.
As from 1998, experience rating of firms has been operating in the Netherlands, combining an
industry-wide rate with the firm's own record of preventing claims on the disability benefits
system.
Firm-specific, rather more than industry-wide, experience rating is an incentive to the employer
to rehabilitate and retain the disabled employee, as it is in the employer's interests to reduce the
number and duration of claims. It may also have a negative effect on disabled workers if they
are discouraged from making claims.
Private insurance plans can also be experience rated but, as they are not mandatory, employers
faced with rising premiums due to poor ratings have the option of restructuring, reducing
coverage or shifting some of the costs to employees, or even eliminating the plan.
Given the increasing interest in insurance-based incentives, further research might usefully
explore the effectiveness of different rating systems in terms of job retention.
5.3.2 Disincentives to hiring
A general problem is that the employer's incentive to avoid hiring people with expected high
incidence of health problems increases. A potential employee's expected incidence of sickness,
occupational injury and disability depends for example on age, gender, education and of course
health status at the time of recruiting. If the employer's costs of sickness, injury and disability
increase, the employer will invest more in screening people for potential health problems before
hiring them. This could be counteracted by special exemptions for the people that are hired who
have health problems.
Special provision in Sweden protects the employer from the additional costs; an employer can
receive compensation for sick pay for employees suffering from illnesses which can be assumed
to lead to a large amount of sick leave.
5.4 Rules for granting benefits
Not only the replacement rates but the rules for granting benefits and the application of the rules
are of importance in explaining why workers who become disabled stay in employment. In
several countries there is a reported shift towards stricter regulation and application, for example,
that the rate of lost capacity (or degree of disability) should be higher, that factors (such as age,
or the availability of suitable jobs) should not be allowed to influence the decision, or that
rehabilitation measures should be tried before granting compensation.
In deciding on the level of compensation to encourage the return to work, there may be trade-offs
to be made. Systems that reduce the monetary incentive to return to work are more likely to have
more stringent administrative requirements on employers and employees so as to encourage the
33
return to work. 25 The equity consequences of the interaction between the rules and the benefit
levels need to be carefully considered in developing a strategy for job retention.
5.5 Return to the job with partial benefits
An option available to recipients of workers' compensation, sickness and short-term disability
benefits in some systems is to return to the job part-time. Part-time options may make it easier
for workers with disabilities to remain in the labour market in both the short and the long run and
so reduce the prevailing tendency for early exit from the labour market. They may also help the
worker gradually to regain full working capacity.
It is not easy to gauge how far these options are being utilised and whether there is any shortfall
in provision. It is reported that in the USA, most (about 80 per cent) worker's compensation
programmes provide partial benefits for individuals who return to work at reduced capacity.
Among workers' and accident compensation programmes, the arrangement in New Zealand for
part-time return to work is of some interest. The wage paid by the employer is supplemented by
earnings-related entitlements from the compensation corporation until pre-accident earnings
levels are reached. Part-time employment is negotiated between the corporation's case manager
and the employer, as part of the general early intervention strategy, and there is no automatic job
protection.
Private sickness and short-term disability benefit programmes (as well as the 'long-term
disability' programmes which follow on) in the USA are increasingly providing for partial
benefits. Newer, more progressive plans provide a return to work benefit during the first year
as an incentive to return to work during the critical initial periods. These provide full disability
benefits, regardless of partial disability earnings, as long as they do not exceed the pre-disability
level of earning. Private plans are not comprehensive, and are more common among white-
collar workers in medium and large enterprises.
Some statutory sick pay and sickness benefit schemes in the study countries also offer
opportunities to return to the job part-time.
In Sweden, where partial benefits combined with income from work are commonplace in the
social insurance system, the sickness benefit scheme is designed to allow for partial payment of
employer-paid sick pay as well as the sickness benefit, in parallel with a job. The Swedish
arrangement allows for three degrees of partial benefit (quarter, half and three-quarters). The
sickness benefit scheme in New Zealand allows for assessment as partially fit for work, and
income from work is seen as a way of supplementing this flat-rate means-tested benefit.
25 A position expressed in the Canada report.
34
5.6 Return to work from long-term disability benefits
In most systems, the critical work resumption threshold has passed once the disabled worker
exhausts the term of sickness or short-term disability benefit, or otherwise meets the criteria for
a long-term disability benefit.
In the Anglophone countries, waiting periods mean that several months may have elapsed since
first absence from work. In the USA, the waiting period for the social security disability
insurance benefit is five months, in the UK normally six months have elapsed, although in
Canada the waiting period is only three months. In these countries and New Zealand, although
definitions vary, generally speaking beneficiaries are regarded as incapable of gainful
employment, although there are limited opportunities to undertake paid work up to an hours or
earnings ceilings and to engage in voluntary work.
The work disincentive effects of the design and regulations of these 'all or nothing' benefit
systems are widely acknowledged: the loss of disability income by undertaking rehabilitation,
training or education; the lack of extra financial support during job search for ex-beneficiaries
who are found capable of work; cessation of benefit and loss of benefits in kind on return to
work; and the risk of losing eligibility if the return to the job does not work out.
Study countries report some attempts to reduce these disincentives, such as retention of benefits
during rehabilitation or training, 'linking rules' which enable the person with disabilities to return
to the previous benefit level if the job does not work out, and arrangements to retain the benefit
during the first four months of trial work.
In the USA, a battery of work incentives for SSI recipients is designed to enable them to test
ability to work and gradually become self-supporting, including full cash payments during the
first 12 months, although no information is available about their effectiveness. In all countries,
however, the proportion leaving the disability rolls for employment remains extremely low; in
Canada, less than one per cent annually returns to work. The fundamental problem, as articulated
in the report from Canada, is that the benefit system is premised on an unsustainable concept of
unemployability.
In the systems of mainland Europe, on the other hand, the disability benefit system is designed
to allow for partial as well as full benefits. In the Netherlands, for example, where the concept
of partial capacity is integral to the disability benefit system, there are seven categories of partial
disability. The advantage in these systems is that the partial benefit can be held both in and out
of work.
5.7 Supplementing income with benefits
As well as reduced capacity to work full time, for workers with disabilities, return to employment
may imply a lowering of the wage. In many cases a change of occupation due to a disability
means a wage loss, especially if a change of employer is involved. This increases the employee's
incentives to opt for early exit with compensation related to the pre-disability job and earnings.
One way of countering this tendency is to provide compensation in addition to the wage. In the
35
Netherlands, it is possible to get a supplementary benefit when accepting a job with lower
earnings than those on which the benefit was based.
The United Kingdom reports a means-tested disability benefit which can be claimed only by low
paid disabled workers in employment.² It was designed both to increase the incentive to take
up work and to support in work those individuals whose disability put them at a disadvantage in
terms of earning power of hours they were able to work. Unlike the other in-work benefits
discussed here, eligibility is not restricted to disabled individuals with a work history. In
practice, the benefit was taken up mostly by disabled workers who were already in employment,
although it is not known how far the benefit was used to support employment after the onset of
disability.
There are many forms of subsidy programme which are similar in that they boost the disabled
worker's wage but by subsidising the employer rather than the employee.
In France, for example, there is an arrangement to supplement the wage, up to the minimum wage
level, of a disabled worker with reduced productivity. Job subsidy programmes appear to be used
very rarely to help with the retention of a worker who becomes disabled, however.
An interesting arrangement reported in Sweden is to combine employment with a wage subsidy
with a partial benefit such as sickness benefit.
5.8 Benefits for rehabilitation and training
Benefits and rehabilitation are inseparable in Germany, where there are many benefits in kind and
it is misleading to concentrate on monetary aspects alone. The statutory occupational accident
insurance gives primacy to rehabilitation services in line with the principle of 'rehabilitation
before pension', starting with medical treatment as required followed by occupational
rehabilitation. A very wide range of benefits is provided during the rehabilitation process,
including support for training, aids, psychosocial counselling, rehabilitative sport, modifications
to the home and to transport, financial assistance for job search.
Incentives to participate in and complete rehabilitation may be useful in motivating workers with
disabilities. It is reported that in Ontario, workers with partial disabilities may receive total
benefits if they co-operate with rehabilitative efforts.
In Sweden, a special rehabilitation benefit is payable in place of sickness benefit.
In France, compensation paid during vocational training is boosted to equal the minimum wage
of the relevant profession. Disabled workers may apply for a retraining completion bonus.
26 Disability Working Allowance is to abolished and replaced by a disability tax credit scheme.
36
5.9 Trial return to the job
One of the obstacles to work resumption is uncertainty over ability to cope. An arrangement
reported in Sweden involves the recipient retaining sickness benefit while trying out their
strength and capacity in the previous job, or one that is better suited, in an unpressured way,
without any formal time limit.
In Germany, there is an interesting arrangement for gradual return to the job, sometimes known
as 'step-wise' rehabilitation. The statutory health insurance provides sickness benefits (for up
to six months) which can be used as a full wage substitute while the employee gradually increases
the working hours as health improves. When the employer re-starts wage payment and to what
extent, has to be settled by agreement between the employer and the works council.
5.10 Key issues in benefits and compensation programmes
Looking across the study countries, there is considerable variation in access to
benefits to support job retention. Opportunities for partial benefits to support
part-time return to the job apply in some compensation schemes but not in
others. Some schemes require minimum periods of employment while others
do not. The number of waiting days required before benefits can be paid varies
from one programme to another. If accident or workers' compensation
programmes, statutory sickness benefits or private schemes operate side by
side, there can be major inequalities in treatment of workers who become
disabled, both in the generousity of the benefit and coverage.
The incentives and disincentives to employers and employees, and the
interactions between them, require more detailed study. In particular, more
research-based information is required on the part that the benefit level and
associated benefits in kind plays in the disabled worker's decision to return to
the original employer.
Insurance-based incentives to employers, such as experience rating, appear to
be used increasingly to influence employers to retain workers who become
disabled, both in mandatory and private systems. The effects of the different
types of incentive need to be explored, as well as their adverse consequences
for employees and people with health limitations seeking employment.
37
There is varying evidence of activity to support the return to the job during the
period of receipt of sickness benefit. In some systems, employers still have no
responsibilities to take action and the benefits authority has no mandate to
intervene to support the employer or the employee. Accordingly opportunities
are lost for early intervention. Within privately-insured programmes,
innovative examples of augmented return to work benefits appear useful.
It appears that greater co-ordination between the various agencies providing
benefits at the different stages of the 'disability career' might be beneficial to
'track' the disabled worker and prevent them falling through cracks in the
system, particularly in the transition from short-term and to long-term insurers.
Return to work part-time with a partial benefit is a feature of several
programmes which appears to offer opportunities for earlier work-resumption
and which ties with changes in the labour market. Those schemes which allow
income from work to be gradually increased while benefit reduces are worth
further exploration.
38
6.
REHABILITATION AND EMPLOYMENT SUPPORT SERVICES
Rehabilitation and employment support services' is the omnibus term used here to encompass
the broad range of personal support services to prevent ill health developing into a disability at
work, help recover working capacities and skills, and support re-adjustment to work. 27 Adapting
the working environment to the needs of the individual is a different, and complementary,
approach.
6.1 The policy picture
In most countries there is a wide range of policies to enable people with disabilities to prepare
for their return to work and to re-establish themselves in the workplace. In any one country an
array of programmes serve different groups, funded from different sources, and within different
institutional regimes. Persons with disabilities may receive personal support services via a range
of public services (labour market authorities, health authorities, social insurance agencies,
veterans affairs departments, social affairs departments, and so on). Services may be restricted
to those meeting a definition of disability, or depend on assessed need. Eligibility may depend
on receipt of social security benefits, workers' or accident compensation, or unemployment
benefits. Services may be directly provided by public bodies or subcontracted to specialist
agencies. In parallel to the public system, private and not-for-profit organisations may be direct
providers.
It is apparent that policies are often fragmented, not co-ordinated and sometimes even
contradictory. In most countries there is little co-ordination across isolated policy areas to create
greater consistency in rehabilitation and employment support policies. Each funding institution
acts within its own policy framework and its own budget, making it difficult to maximise
effectiveness and cost-efficiency.
6.1.1 Policy developments
On-going public policy changes impact on this already complex situation: cost-cutting to reduce
financial obligations of public bodies; re-orientation to active labour market policies from
passive benefits; rearrangement of responsibilities between social security systems and labour
market authorities; and introduction of market principles into publicly-funded services, with
separation of purchaser and provider functions.
Developments relating to rehabilitation, job retention and return to work in some study countries
reflect these broad policy changes:
increased employers' responsibilities to improve working conditions, minimise sickness
absence and support return to the job, as part of wider strategies to reduce the costs to the
state of sickness and disability benefits
27 The terms 'occupational rehabilitation', 'vocational rehabilitation' and 're-integration' are used if customary
in national systems.
39
a new emphasis on rehabilitation and re-employment within workers' and accident
compensation programmes, in response in part to rising claims costs
affirmative actions for disabled workers within labour market programmes
withdrawal of state agencies from direct service provision and contracting-out to specialist
service providers for return to work.
It is remarkable that most reforms to the structure, organisational framework and provision of
services primarily have been driven by financial cut-backs. Cost-cutting and cost-shifting
tendencies, and reduced state involvement in cost-sharing arrangements, limit the adoption of an
integrated policy approach. Changes are often incremental, programmes and services in different
parts of the system are in a constant state of flux; and quite often new programmes are put in
place before it is possible to assess the effects of the last. The need for co-ordination at the policy
level is recognised but obstructed by multi-tiered responsibilities, departmental rivalries and
competing philosophies.
Reforms are rarely guided by re-evaluation of the relevant concepts and content of rehabilitation
or by any coherent set of principles. The corner stones for an integrated and coherent policy
approach have still to be identified.
6.1.2 New players
The possibilities for coherent public policy approaches are constrained by the entry of new
players to the stage who, as yet, have no integral role in policy development. Increasingly
enterprises are developing their own support services for their employees, either in-house or
purchased in the market-place. Companies buy private insurance to cover risks of sickness or
disability, and insurers are becoming important independent providers of rehabilitation and
supports for job retention. In the USA the responsibility for funding and providing job retention
services falls almost entirely on the private sector.
Private insurers, already well-established purchasers and providers of employment support and
rehabilitation services in the USA, are discovering new markets in systems where employers bear
the costs of sickness absence. 28 The Canadian report notes that automobile accident insurers are
leading players, funding rehabilitation services for claimants employed at the time of the accident
and employing private rehabilitation consulting companies.
The reduced involvement of public bodies in direct service provision and growing reliance on
the market have stimulated the growth of private service providers from whom services are
purchased as required. Contracting is also increasing the role of voluntary organisations as
providers. While these tendencies increase flexibility and can promote more individualised
assistance, they can also stand in the way of a more coherent and principled approach. The
28 By Spring 1997, 80 per cent of Dutch employers had insured against the risk of paying wages in the first year
of sickness absence.
40
competitive tendering process and conflicting service philosophies make it difficult to develop
inter-agency co-operation.
The proliferation of independent providers also presents problems for disabled persons, and those
who advise them, in first finding out about services and then assessing their relative merits, in
an increasingly diffuse and complex system.
6.2
The balance of provision
It is difficult to generalise about the balance of provision over eight complex systems. It is clear
that public policy for rehabilitation of persons with disabilities in some systems favours
individuals with (severe) disabilities who have little or no work experience (as in the federal-state
vocational rehabilitation programme in the USA). In many systems, employment support
services concentrate on short-term interventions for those who are almost 'job ready', and health
services provide medical rehabilitation, with little to connect the two. In Germany, however,
there is a relatively smooth transition from medical to vocational rehabilitation, but a
comparatively lengthy process which tends to lead in the direction of retraining for a different
occupation rather than a return to the original job.
It seems that, overall, the thrust of public policy is to support disabled people who are out of
work rather than those in work or who have a job to return to. Quite frequently, however,
programmes do not differentiate between disabled people seeking work and those already in
work. The methods of data collection and analysis used to monitor programmes often make it
hard to gauge the respective levels of activity devoted to job retention and return to work and the
outcomes of measures.
6.3
Policies for job retention
In most countries, the main rehabilitation provision for those who become injured or disabled in
employment is built into either the workers' or accident compensation programmes (USA²⁹,
Canada, New Zealand and France³⁰) or the social insurance programme (Sweden, the Netherlands
and Germany³¹). Responsibilities for initiating the process, planning rehabilitation, and putting
in place services to support work resumption are distributed across employers and insurance
agencies. There appear to be three main models:
i)
the enterprise is responsible for monitoring sickness absence, planning for rehabilitation
and putting necessary workplace supports in place, while the (social) insurance agency
purchases external rehabilitation
29
In the USA, while workers who become seriously ill or injured are eligible for vocational rehabilitation
services (participation is mandatory in 15 States), less severely disabled workers are often ineligible and tend to
be covered by the private services which many private insurance providers and employers now provide or
purchase.
31 30 The work-injury compensation programme in France provides for a right to vocational retraining.
In Germany responsibilities are split among pension funds: the statutory accident insurance fund and the other
pension funds are responsible for the medical and occupational rehabilitation of the majority of workers, while the
federal employment office takes care of those, mainly younger, workers who have not yet qualified for pension fund
coverage.
41
ii)
the enterprise takes the initial steps to identify a need for rehabilitation and contacts the
insurance agency's or compensation authority's case manager who takes responsibility
for care planning and service co-ordination
iii)
the enterprise notifies the compensation authority of the absence; the latter contacts the
absent worker to assess need for vocational rehabilitation and provides or co-ordinates
services.
In these different approaches to co-ordinating work resumption, the balance of advantage to the
employer and to the worker with disabilities appears to vary. If the enterprise has total
responsibility for managing the return to work and also bears the costs of claims, rehabilitation
of the employee may take second place to minimising the costs of sickness absence or its effects
on productivity. Pressure on the injured worker to return to the job too soon is thought to occur
in some workers' compensation schemes.
Selecting out employees for rehabilitation interventions is also a possible consequence. It is
reported that USA employers and insurers tend to calculate the costs and benefits in deciding
whether to invest in rehabilitating an employee, favouring younger and more productive workers.
In regulated systems, external monitoring inhibits discretion. In the Netherlands, the employer
has to report the absence to the social security agency, along with a plan setting out action already
taken to promote job retention and details of how work resumption will be facilitated. The agency
checks whether the employer did everything reasonable to make resumption of work possible.
But fines for not reporting or reporting late seem to be rarely applied.
In Sweden, where employers now have responsibilities for payment of sickness benefit for two
weeks only, there are no sanctions on employers who do not complete rehabilitation
investigations or submit them to the social insurance agency, or who fail to meet their
responsibilities to finance rehabilitation support in the workplace. Responsibility then falls by
default to the social insurance agency. It is argued in Sweden that the lack of clarity in the rules,
along with the absence of either 'sticks' or 'carrots', limits efficiency and delays provision of
rehabilitation.
The advantage of the second model, as it operates in New Zealand, is that liaison between the
case manager and the company can begin at an early stage and co-operation can be won. Return
to the job appears to be easier if the enterprise has a rehabilitation unit in place.
The third model, where responsibility is taken out of the hands of the enterprise, may relieve the
enterprise of the burden and costs of planning for rehabilitation, which Swedish employers, for
example, have found onerous. However, in the absence of strong incentives to the insurance
agency delays in starting rehabilitation can occur. Lack of clarity about which fund takes
responsibility has been a continuing problem in Germany, leading to considerable delays which
interfere with the principle of return to the original employer.
42
Within these three approaches rehabilitation is variously a right, a requirement or an option. The
right to rehabilitation or the requirement to participate does not necessarily lead to equality of
access to services, however, as agencies can have considerable discretion in deciding which
measures to offer.
6.4
Prevention and early identification
Little information is available about the part played by enterprises in preventing ill health or
injury from deteriorating into a more serious condition which leads to sickness absence or
disability. Many larger USA companies have well-developed services to educate employees on
life-styles detrimental to health and offer private counselling services, in addition to workplace
health checks. But cultural differences will inhibit transference of this approach; the Dutch
report comments that life-style problems (such as alcohol dependence or obesity) are viewed as
essentially private matters about which the employer should not enquire.
In general there is still a reliance on the medical model of rehabilitation, where the physician has
prime control. Some UK initiatives aim to educate general practitioners (family doctors) about
the therapeutic value of work and the types of workplace support available. Often there is no
communication between the employer, the employee with a disability and the treating physician.
Private insurance companies, as well as compensation boards, have introduced case managers
to link the three parties.
The occupational physician is a powerful player in many systems, acting as gatekeeper to
workplace remedies. Dutch employers are legally obliged to engage an occupational health and
safety service. Its physician assesses whether the employee is unable to work, sets an expected
date of work resumption, and supervises the process.
Confidentiality of medical information, and restrictions on the physician informing the employer
about the medical condition of an absent employee without the latter's consent, can inhibit
planning of support within the workplace. Solutions then depend on the skills and knowledge
of the occupational health service. Raising awareness of job retention options among
occupational health physicians has been identified as a priority in some systems.
6.5
Services in the workplace
In comparison with support services for (re)entry to work which might well be used by disabled
people in work there are rather few publicly-provided personal support services specifically for
workers who become disabled. In general, employers' awareness of external services is low.
The Swedish social insurance agency has a particularly well-developed, although time-limited,
grant scheme for work assistants to aid job retention. Personal readers, signers and support
workers are variously available to disabled people in work, or their employers, through national
programmes. There are advantages to workers with disabilities if personal support services are
available via bodies which also arrange aids and adaptations in the workplace.
43
Negotiating the maze of providers and bureaucratic procedures to obtain the required support can
be problematic for employers. The 'one-stop shop' is one way forward. In Sweden, the largest
of more than 400 rehabilitation providers, Working Life Services, is the contract services arm of
the Labour Market Board. It operates at county level as a resource (similar to a job centre) to
public and private employers, as well as to social insurance offices, fully funded by means of
charges. Its services, which include support to the organisation as well as the individual, are used
by large employing organisations primarily to support retention.
Co-workers, supervisors and managers also need services, both to support the disabled worker
in the job and to help them adjust to working with a disabled person. In Germany, the authorities
which specialise in providing support for disabled people (the Hauptfürsorgestellen) may contract
'social and psychological care' services from independent non-profit-making bodies. These
providers and the Hauptfürsorgestellen themselves work with disabled employees on managing
the demands of the job and to promote self-help, with co-workers to enlist their active co-
operation, and with family members if required to solve work-related problems. External
providers in general have an important, as yet under-developed, role to play in encouraging and
backing the natural supports in the workplace provided by co-workers and supervisors.
Most public provision to support disabled people in work depends on bringing external services
to the workplace. A different approach is reported from Germany. In Bavaria the
Hauptfürsorgestellen can pay all or part of the salaries of internal working assistants hired
specially by the company or appointed from existing staff, and provide training if needed. Their
role is to support disabled workers in coping with the demands of working life, handling conflicts
and in performing the job. They also aim to raise co-workers' and line-managers' knowledge of
the disability and understanding of the disabled employee's situation. To reduce possible stigma
attached to their users, most of whom have psychological support needs, these assistants offer
their services to the entire workforce. For larger firms the opportunity to demonstrate (and
advertise) social commitment is an incentive to participate. An evaluation of the Bavarian
experiment found reduced absenteeism among workers receiving support, a consensus that the
atmosphere at work had improved, and relief of immediate line-managers and decrease in internal
conflicts through early interventions by the working assistants.
6.6
Maintaining employment
A strategy for job retention must also maintain in employment those workers who were already
disabled on taking up work. Incentives and support services to facilitate entry to employment
should not lead only to short-term gains, with individuals with disabilities exiting the labour
market once subsidy schemes expire or initial support on the job is terminated. The obligations
and commitment of employers who take advantage of such schemes need to be considered. A
maintenance strategy may mean appropriate phasing-out of job coaching or wage subsidies, and
should direct attention to the quality of employment and opportunities for promotion and
advancement. Maintenance might be particularly important for those with psychiatric disabilities
or individuals with learning disabilities who may wish for ongoing support after short-term
measures have ceased. The question remains of who should provide and finance continuing
support in the workplace.
44
6.7
Meeting employers' needs
Some employers' organisations notably the Employers' Forum on Disability (EFD) in the UK
argue that employers are also customers of employment services and that the way forward is not
to persuade and cajole them into employing disabled people but to recognise their own
requirements. In their view, the answer lies with action to make it easier for employers to take
on or retain people with disabilities who have the skills that companies need. This would include
service providers who understand how businesses work and who can assist in promoting change;
the approach taken by Workbridge in New Zealand (the employment agency specialising in
persons with disabilities) to learn about the business ethos and understand company operations.
The EFD proposes that employers have a contribution to make in providing work experience for
the staff of employment support and rehabilitation agencies, and in shaping the development of
services in general.
6.8
Interventions for return to work
Everywhere there are significant medical and legal obstacles to early interventions. Assessment
for rehabilitation is still dominated by medical issues and clinicians' lack of knowledge of
vocational rehabilitation. Commonly, the waiting period for assessment is long. Quite often
there are different kinds of assessment and people are often unnecessarily reassessed. The
average interval from application to acceptance for service provision takes several months. As
a result, interventions for vocational rehabilitation frequently start too late, when the contacts to
the former employer are already broken.
Little is reported about interventions at the critical point of taking up an unemployment benefit
once employment has been lost. In New Zealand people with disabilities who register as
unemployed are automatically referred to the specialist employment agency for people with
disabilities.
In the Anglophone countries, with their 'all or nothing' disability benefits systems, interventions
to support the return to work of recipients of disability benefits have not been the norm, but new
mechanisms are now being developed. A five-year controlled experiment into the efficacy of
four case-management models, for new applicants as well as existing beneficiaries, has been
completed by the social security administration in the USA. A national vocational rehabilitation
programme for recipients of disability insurance benefits was piloted in Canada. Selected
recipients who voluntarily agreed were referred to external rehabilitation consultants, and
vocational rehabilitation services were delivered through an outside contractor. The pilot was
judged successful and a vocational rehabilitation programme is being integrated into the Canada
Pension Plan.
There are many examples of innovative projects and programmes in the public and not-for-profit
sectors to support disabled people to take up work for the first time, or to help longer-term
unemployed disabled people back to work. It appears that return to work success rates may be
higher in specific projects where services are 'custom-made', depending on the type of clients
and intensity of the service, although the Netherlands report notes that this is less the case for
persons with mental disorders. There is scope to orient these projects to the needs of people
45
leaving employment and entering the disability or unemployment benefit system, possibly with
funding from social security and employment authorities.
6.8.1 Co-ordinating return to work
Workers who become injured or disabled meet different service providers and benefits agencies.
Mechanisms for co-ordination between service providers are required. In several countries the
solution for better co-operation and more tailor-made measures is seen in flexible ad hoc
mechanisms at local level, where decisions are made according to local conditions and
requirements. A project aimed at improving return to work outcomes for clients simultaneously
involved with some combination of insurers is being piloted and evaluated in British Columbia
(Canada) in partnership with the disability community. This partnership approach aims to
identify barriers in the process of return to work and potential systemic solutions.
6.8.2 Training and return to work
Special arrangements to enable unemployed disabled people to access mainstream training or
work-preparation programmes, or special programmes to give short-term opportunities to persons
with disabilities, are reported in the study countries. However, transition from these schemes to
work is often a weak point.
The role of vocational retraining in a strategy for return to work depends in part on the
importance in the national system of vocational qualifications as a foundation for employment.
In Germany and France crucial questions are when and how the worker who becomes disabled
can achieve new or extra qualifications, and how this process relates to workplace requirements.
The fit between employer demand and the skills of disabled workers is an issue of broader
concern, although in some systems outside mainland Europe the emphasis lies with preparing the
worker to be 'job-ready' rather than with the acquisition of occupational skills.
Training on the job for disabled workers is a part of active labour market programmes in some
countries but opportunities for workplace-based training appear to be less available to more
severely disabled workers, especially for those still undergoing medical treatment. Vocational
training in the workplace needs to be organised to minimise the imposition on the employer of
onerous responsibilities, costs and disruption of enterprise activity.
6.9
Equity issues
Rehabilitation which relies on residential programmes tends to exclude women who have family
commitments; innovations to locate services close to home are reported in Germany. Services
appear to be biased towards rehabilitation of those who work full time, although examples are
given of arrangements to return to work part time in the first instance. If there is discretion in
selecting whom to rehabilitate, older, more severely disabled and less productive workers miss
out.
46
6.10 User choice, accountability and quality of services
Programmes which give real choice to users appear rare to be rare. There are tendencies for more
individualised provision with 'service packages' tailored to the disabled individual's needs but
whether the user has a choice among elements which make up the package is questionable. 'Case
management' is an increasingly popular concept, especially in North America, although in the
insurance world it can be more of a device to control costs than a vehicle for extending choice
among rehabilitation options. As the range of service options grows, the individual with
disabilities will increasingly require information and guidance to make appropriate choices. Yet
in some systems there is a contrary trend towards self-service, through 'data-banks' and other
computerised sources.
Typically, the provider is accountable to the funder rather than the user. 'Vouchers' and 'tickets'
have been proposed to give users quasi-purchasing power, the aim being to stimulate the market
and raise quality of rehabilitation services through competition to serve the customer. The
underlying purpose of the proposed ticket system in the USA is to increase the very low number
of disability insurance beneficiaries leaving the rolls. As originally proposed, the idea was to
stimulate quality of service provision by ensuring that providers were rewarded for on-going
results, measured by permanency of employment, rather than for intermediate outcomes.
The difficulties of outcome-related allocation of resources, performance measurement and
incentives, and 'creaming' effects (selecting those with the greatest prospects of returning to
work) are reported in several countries but few answers have been found. Causal links between
quality in rehabilitation and in employment are contestable, and additional performance
indicators need to be developed.
With increasing privatisation, the need for accreditation in arrangements becomes more urgent.
In some systems, contracts are let on the basis of established reputation and standards for quality
are not transparent. Public services can lack the expertise to evaluate quality. More needs to be
done to gather information on developments by providers to work to external standards and to
apply 'total quality management' type systems to achieve internal improvements. In particular,
user evaluations of quality need to be developed.
6.11 Monitoring and evaluation
Monitoring of service users and reporting their destinations in terms of job retention or return to
work appear to be limited. 'File closure' as a measure of rehabilitation interventions tells us little
about whether employment has been achieved. If outcome data do exist, the kind of information
which is available normally gives no indication if the employment achieved is due to support
through certain programmes or not. Information is held by insurers who develop and evaluate
services for return to work and monitor outcomes. But this information is proprietorial and
lessons are difficult to learn. The possibility of monitoring the longer-term outcomes, the
duration of the employment kept or found, depends on the legislative requirements imposed on
the employer, for example the requirement to retain the returning worker for a defined period.
47
Good outcome-related evaluations, which clearly identify the relevance of rehabilitation and
employment support services through counterfactual research designs, are important. But these
need to be complemented by process-oriented, qualitative evaluations to understand how
rehabilitation interventions interact with personal histories to achieve successful job retention.
6.12 Key issues in rehabilitation and employment support services
Developing a strategy for rehabilitation to support job retention and return to
work is possibly the most challenging aim of this Project. At the policy level,
achievement of a coherent and co-ordinated approach is thwarted in many
countries by withdrawal of the state, fragmented budgetary responsibilities,
competing policy aims, multiple providers and, sometimes, strong attachments
to radically different philosophies. A forum to bring together players to
identify and agree upon the corner-stones of a coherent strategy may be a step
forwards, but only if there is a genuine policy-level commitment to work
towards implementation.
Ways need to be developed to bring into the policy process the emerging
players, including independent providers, insurers, employers and enterprise
representatives, and disabled workers themselves.
In some systems, rehabilitation policies are designed specifically to promote
job retention. Many have dual aims of benefiting the injured, sick or disabled
worker through restoring capacity for valued work and of reducing costs to the
employer or insurer. Without adequate checks in the system, the latter aim may
take precedence, rehabilitation may become a lower priority, or even denied to
the worker with disabilities.
Linking rehabilitation and employment support services to measures to keep
the job open for the returning worker is an important development in many
systems. Mandatory or negotiated re-employment and rehabilitation are
explicitly connected in many social insurance and compensation programmes.
48
The locus of rehabilitative support is shifting overall to the workplace and
public agencies are taking on new roles to enable, rather than substitute for,
enterprise-based activity. There are models of funding and training for
enterprise staff to facilitate support for disabled workers, and in particular
workers with mental health needs, which could be developed in other systems.
Similarly, 'one-stop shops' which allow easy access to employers to purchase
services for rehabitative support in the workplace appear to be a promising
development. Within such models there may be scope to include support
services for adaptations of work and workplace, to counterbalance any over-
emphasis on changing the individual to fit with pre-existing demands and
constraints.
The structure of statutory sickness and disability benefits in Anglophone
systems inhibits opportunities to combine benefit receipt and paid work, and
to enable therapeutic employment. Rules are being relaxed in some systems,
however.
The worker with disabilities commonly has to rely on many agencies for
different aspects of the return to work process, either simultaneously or
sequentially, and co-ordination between them is a growing priority. Multi-
agency and multi-disciplinary co-ordination initiatives at local levels may offer
transferable lessons, as will evaluations of the efficacy of case management.
Arrangements for streamlining assessment procedures and initiatives which
bring the physician into a less medically-oriented process need to be explored.
Within these processes it is important to examine the opportunities to the
disabled worker for informed choice and for influence over the quality of
rehabilitation services.
The issue of quality of service provided is pre-eminent. Providers' own efforts
to develop standards and to implement quality systems, as well as new
mechanisms to stimulate the market, will provide criteria for allocation of
resources as well as for user choice. Employers also have perspectives on the
quality of services provided to them and a role to play in ensuring that
providers understand businesses and business interests.
49
7.
ADAPTATION OF WORK AND WORKPLACE
Disability is increasingly seen as resulting from the interaction between impairment and the
social and physical environment. In this view, the environment has to be adjusted, as far as is
reasonable, to meet the needs of the individual, rather than the person rehabilitated to live and
work in a 'normal' environment. Adapting to disability, through removing barriers in the social
and physical environment as well as in the workplace, has become the hallmark of disability
policy in many Western countries over the last decade.
7.1 Measures to reduce social and environmental barriers
Policy measures which remove barriers in the built and social environment also influence the
climate for job retention and return to work. Following the ADA - which requires removal of
barriers in public offices, hotels, restaurants, shops, health care facilities, schools and so on - the
environment has become more 'disability friendly'. An environment which facilitates travelling,
shopping and access to health or social amenities may make staying in work a more viable
option. Most importantly, measures which improve access to facilities benefit those who work
in them. The ADA was backed by a publicly-funded programme of technical assistance, with
materials distributed to businesses and libraries and a toll-free ADA telephone information line.
The Department of Justice has also funded organisations to provide technical assistance to design
professionals, inspectors, contractors and others involved in removing barriers.
A more incremental approach is to adjust national building standards. In New Zealand, for
instance, the Buildings Act requires that 'reasonable' and adequate provision is made for people
with disabilities to enter and carry out normal activities within new and reconstructed buildings,
including where there is a change of use. A non-statutory organisation, the Barrier Free Trust,
trains auditors who issue certificates of compliance with the Building Act, has an advocacy role
and contracts to some large employers to provide audits.
Legislating to change the way in which services are provided - avoiding discrimination against
people with mental illness or learning disabilities, for example - may affect business attitudes to
retaining employees with disabilities. The DDA in the UK has stimulated 'disability awareness'
and 'disability equality' materials and training.
Typically businesses bear the costs of removing wider environmental barriers. The USA enables
businesses to recoup some of the costs of removal of barriers for customers. A disabled access
tax credit can be claimed towards the costs of making small businesses accessible to customers
and employees with disabilities (as defined by the ADA); it covers sign language interpreters,
readers, adaptive equipment and removal of architectural barriers in vehicles or older buildings
(the maximum annual benefit is $5,000). A tax deduction is available to all businesses for
making a facility or public transportation vehicle usable by individuals with disabilities (the
maximum deduction was reduced to $15,000 on the introduction of the ADA). Although
publicity is improving, these modest provisions have been under-used, in part because of
difficulties navigating the claiming procedures, as well as antipathy to dealing with tax
50
authorities. Entrepreneurs have created new businesses out of administering credit processes in
return for a portion of the credit obtained.
Persons with sensory and physical impairments employed by service-providing organisations
(especially in recently constructed or redesigned premises) stand to benefit most from these
measures. Disabled workers in traditional manufacturing and industrial sectors, with no
customer contact, miss out. There appears to be inadequate encouragement and support for
businesses outside the service sector to remove social and environmental barriers.
7.2 Measures to reduce barriers in the workplace
Apart from the requirements relating to public facilities already described, few measures require
that disabling barriers are removed within places of employment. Health and safety legislation
is the obvious exception. Otherwise, a battery of policy measures can encourage voluntary
change.
7.2.1 Work environment requirements
Some laws place general obligations on employers to improve working conditions for disabled
employees. These are 'laws of good-will' setting out broad expectations.³²
A recent development in the Netherlands is part and parcel of the policy drive to reduce the costs
of disability benefits. Employers must draw up working conditions policies based on an
inventory of occupational hazards by the obligatory occupational health and safety service, under
contract to the employer. Dutch enterprises have been found to direct these policies towards the
individual employee, rather than evaluation of workplace risks and improvement of working
conditions.
The Swedish Work Environment Act (which stipulates that the enterprise has suitable
arrangements for work adaptation and rehabilitation, studies to identify what is needed,
competent personnel and annual follow-up) is an interesting approach but effectiveness will
depend on incentives, sanctions or external advice. 33 In Sweden, a labour union is entitled to call
for negotiations with the employer on adaptation of the work environment.
Regulatory bodies typically have limited resources to advise on workplace adjustments. In
Sweden, where work environment policy is strong, the labour inspectorate is found to have
discussed rehabilitation and work adjustment in only seven per cent of workplace visits. Most
bodies concerned with workplace safety focus on compliance with standards, investigation of
accidents and prosecution of persistent violators. The USA Occupational Health and Safety
Administration (OSHA) has recently moved to a more co-operative relationship with employers.
32
For example, the German Severely Disabled Persons Act obliges employers to establish and provide for disabled
employees adequate workplaces according to their skills and capabilities so that permanent employment can be
assured. A 1985 study found almost no differences between disabled and non-disabled employees.
33
A 1997 survey found that only just over half of the functionally disabled employees in need of aids or workplace
adaptations stated that their employer had taken measures to adapt the workplace.
51
It now offers free consultation assistance which includes an appraisal of work practices and
hazards in the workplace, and assistance in developing, implementing or improving the
employer's workplace safety and health programme. Employers who correct hazards and
implement an effective programme may be exempted from OSHA random enforcement
inspections for one year.
Occupational health and safety (OH&S) authorities have an increasingly important part to play,
both in removal of disabling barriers and in the prevention of 'new' disabilities. In many
countries, they are fettered by out-dated, injury-reporting requirements which focus on
'traditional' workplace injuries and diseases, and their resources are concentrated on more
hazardous working environments rather than on the emerging service sectors. OSHA (USA) has
recently targeted ergonomics as a safety issue to prevent cumulative trauma disorders,
complementing enterprise initiatives driven by workers' compensation claims.
7.2.2 Requirements to accommodate
Non-discrimination laws which require accommodations for individuals with disabilities may
encourage broad workplace adaptations, if laws are appropriately framed. It is possible that
effects will be reduced if there is little evidence of disabled people exercising their rights and if
there is no obligation on employers to remedy practices which give rise to discrimination. Larger
employers, with experience of disability, may be pro-active in arranging work and workplace to
minimise the need for individual adaptations. In the USA, there has been considerable public
investment in technical assistance programmes and materials established under the employment
provisions of the ADA, and a range of other design or technology related programmes. In
general, however, accommodations are individualised.
7.2.3 Business incentives
The Canadian and German reports note that some large organisations have turned to ergonomic
assessment and technology in an effort to increase productivity and that this can have a secondary
effect in terms of retention of employees who become disabled. Occupational health and safety
departments in large Canadian organisations reportedly take an interest in promoting adaptations
for preventive purposes, particularly where injury compensation claims costs are high. However,
evidence from the USA suggests that most interventions are directed at sensitising the individual
to adopt non-disabling working practices (such as proper use of equipment) rather than at general
and more costly modifications of the working environment. It will be interesting to observe how
recently introduced experience rating of insurance premiums in the Netherlands interacts with
requirements to formulate working conditions policies aimed at preventing sickness absence.
The 'business case' argues that a diverse workforce gives companies a competitive advantage by
enabling them to meet better the needs of their customers. The Canadian report notes, however,
that workers with disabilities compete with other 'diverse' groups and may lose out if there is a
perception of costly accommodation requirements. Diversity policies favour workers in service-
34 The term 'adjustment' is used in the UK.
52
providing organisations with visible and acknowledged impairments, and may lead to removal
of physical and communication barriers.
7.2.4 Promotion of good employment practices
Equal employment opportunity (EEO) policies in New Zealand expect public service departments
to introduce measures to address disadvantages faced by groups of staff, including people with
disabilities. The most frequently cited current EEO practices for disability are those that centre
on improving physical access to buildings. The business case for employing people with
disabilities may bolster interest in EEO and so encourage workplace adaptation which, in turn,
may benefit workers who become disabled.
Under employment equity laws and similar voluntary arrangements in Canada, employers should
identify possible barriers limiting the employment opportunity of designated groups, and develop
and implement a plan aimed at promoting a fully representative workforce, including measures
to remove barriers. The law is unclear about practical measures, however. Most attention is
given to increasing the representation of women and it seems unlikely that employers would
invest in removing physical barriers. This type of approach may be more effective if dedicated
to disabled workers and if incentives are attached; contract compliance is one possible method.
7.2.5 External assistance to remove barriers in the workplace
The technical assistance programmes for US businesses are exceptional. Sources of advice and
assistance to make changes to the work and workplace appear to be limited in most countries.
At federal level. in Canada an industrial research assistance programme provides technology
development research and services, including ergonomic advice, to support economic
productivity and competitiveness. Notably, in Sweden and the USA, several national institutes
focus on technical support to people with disabilities, some with a remit for promoting accessible
environments; these do not specialise in workplace adaptation, however. Generally, sources of
external assistance are unco-ordinated and assistance is not linked to funding. Although several
countries have national funds to help with adaptations for individuals, they are seldom used to
improve the general working environment.
An innovative five-year programme began in Sweden in 1990. The Work Life Fund was
financed through a short-term mandatory tax on employers (1.5 per cent of the company's total
wage bill over fifteen months) raising 11 billion kronor (approximately 1.4 billion US$) for a
programme of grants to supplement employers' own investment. It aimed in part to reduce
sickness absence. Apart from rehabilitation measures for employees with long-term impaired
health, the main thrust of the Fund was to change the organisation of work, as well as to improve
the physical environment. More than 50 per cent of employees in the country were estimated to
be affected by its workplace programmes. Evaluations found several positive effects, including
substantial reductions in absenteeism and concomitant savings to employers who invested in
work environment improvements. The work environment improved for women. An important
effect of the programme was increased awareness of the importance of the work environment for
the company and a realisation that it is economically profitable to invest in better work
environments and better work organisation.
53
7.3
Adaptations for individual need
Adaptation means more than 'a product, instrument, technical system or equipment used by
persons with a disability, specially produced or freely available, to prevent, to compensate, to
reduce or neutralise the impairment or disability³³⁵. This narrow, 'material' interpretation covers
adaptations to the workplace and the work station but not changes to the content of a person's
job or the way that tasks are allocated, that is, 'non-material' adaptations to the work itself.
An illustration from the Netherlands distinguishes types of material and non-material adaptations
(and their reported occurrence or usage) made for disabled workers returning to work. 36 These
findings apply for both white- and blue-collar workers, in both industrial and service sectors.
- Change in tasks and work content (70 per cent) (including change in work activities,
variation in tasks, a move to another job with the same or another employer)
-
Change in duration and distribution of working hours (48 per cent) (including reduction or
elimination of night working, more regular working hours, reduction in the working day or
week, shift changes and rest periods)
- Reducing tempo/speed of work (41 per cent) (including reductions in productivity targets or
customer contacts, help by colleagues, self-organised work patterns)
- Purchase of special or new devices (ten per cent) (including mobility within the workplace
such as wheelchairs, and transport to and from the workplace)
- Training (seven per cent) (including vocational training, on the job training, and job-
coaching)
- Adapting tools/equipment/workplace (four per cent) (adapting worksite, workstation,
machines, buildings, accommodations, lighting, internal climate, chairs etc.)
- Other types (14 per cent) (including help in the home to get to work and changing the culture
on the shopfloor).
This shows clearly that most adaptations are non-material changes to tasks or routines. Provision
of adaptations by external or co-funding agencies will show a different pattern. They seem to
concentrate more on funding special and new devices, adapting equipment and workplace,
transport facilities and so on, with a focus on permanent, often structural adaptations.
In most countries adaptations have been developed to support entry to employment: a job is
chosen and aids (usually permanent) are provided to facilitate it. Modification of an existing
position will require different solutions. The limited data available on disabilities of people who
become disabled in work indicate that a majority will require non-material changes to the nature
and content of the work. In practice, many adaptations of this kind result from negotiations
between the employer, the employee and co-workers and are less amenable to external assistance.
35 World Health Organisation.
36 Nijboer, I.D., Grünemann, R.W.M. and Andries, F. (1993) Werkhervatting na arbeidsongeschiktheid (Work
resumption after disability), Den Haag: VUGA Uitgeverij B.V.
54
7.4 Policies to promote adaptations for individuals
Adaptations to meet individual needs can be promoted from many directions: laws relating to the
work environment, health and safety, employment security, workers' and accident compensation,
compensation, social insurance, human rights and disability discrimination, and other laws
promoting employment of disabled people.³⁷ Accommodation of returning workers may be
written into collective agreements, as occurs in Canada. Grants, subsidies and tax credits
reinforce some of these public policy approaches. In combination, these policy initiatives
increase awareness of accommodation as an appropriate response to the occurrence of disability.
But policies are rarely co-ordinated, not surprisingly, given the wide spread of responsibility
across departments and agencies. The Canadian report comments on one achievement when the
Ontario Workers' Compensation Act adopted the definitions of accommodation in the Human
Rights Code.
At the enterprise level, policies can be complementary, as the USA report suggests.
Workers' compensation and occupational health and safety laws have affected employer,
union and employee expectations and provided standards for enterprise disability
management practices in modifying job-sites and accommodating returning workers with
occupational disabilities. Practices were thus in place to deal with the accommodation
requirements of the ADA. The Family and Medical Leave Act (1993) in turn
complements the ADA: if workers returning to their jobs after short-term sickness need
accommodations, then the ADA swings into action.
The various policy instruments for promoting adaptations have unequal coverage. Rights-based
legislation depends on workers taking the initiative and on their meeting the legal definition of
disability. The concept of 'reasonable' accommodation based on costs to the employer may
disadvantage disabled workers who happen to work in premises which are exceptionally difficult
to alter. Because of rising costs, the types of disabilities covered by workers' compensation have
been restricted. Other equity issues arise in systems where coverage relates to cause of
disability. For example, in New Zealand only individuals injured by accident will receive case-
managed services, including adaptations if necessary; the employment service, although it has
a grants scheme directed at employers taking on a person with disabilities (and a sub-contracted
specialist placement agency provides individually tailored funding for support on the job), has
no provision for adaptations for those already in work.
37
Work environment and Occupational health and safety legislation may require employers to survey the workplace
and act on any needs for adaptation identified within the workforce and avoid aggravating the condition of an ill
or injured worker. The Swedish Employment Security Act requires employers to explore needs for adaptation
before any attempts at dismissal. Some workers' compensation laws have built-in requirements to accommodate
returning workers (as in Ontario). Employers may be required to co-operate with agencies charged with
rehabilitation of injured individuals, who may recommend adaptations as part of the rehabilitation package. Social
insurance legislation which increases employers' responsibilities for employees who go absent on sick leave (in
Sweden and the Netherlands) involves identifying necessary accommodations to enable rapid work resumption of
employees. Reasonable accommodation/adjustment are duties under the Americans with Disabilities Act and the
UK Disability Discrimination Act and accommodation is a requirement under Canadian human rights law.
55
7.4.1 Financial incentives for individual adaptations
It is reported that USA employers attempt to accommodate workers who become disabled mostly
to reduce costs. Experience rating of premiums for workers' compensation provides incentives
to return employees to work with appropriate adaptations. However, the litigious nature of
workers' compensation means that employers can be reluctant to make accommodations if doing
so is seen as indicating liability. It may be more beneficial to the employer to allow workers who
are more costly to retain to pursue compensation claims and leave their employment; it is clear
that decisions on whether to offer support are often determined by a case manager provided by
the insurance carrier. This option may be reduced if experience rating is combined with
protection against dismissal (as in the Netherlands), or with obligations to co-operate in returning
disabled workers to their original job.
7.5 Voluntary action
Enterprises will voluntarily make individual adaptations, regardless of any legal obligations or
public programmes, because of loyalty to the worker, the value of the individual to the company,
out of 'good corporate citizenship' or other cultural assumptions about employers'
responsibilities towards employees. In the Netherlands over 80 per cent of adaptations are
arranged and paid for by employers. Dutch case studies have shown that adaptation of work is
more easily provided by the employer, and accepted by staff and co-workers, when the worker
was injured during work time. The German report notes that industries where work-related
disabilities are more common tend to provide for their employees. Public policies in the UK
which promote good recruitment and retention practices (such as the 'Disability Symbol') have
been effective in increasing employers' willingness to consider making adaptations for a disabled
employee.
Larger employing organisations in many countries have developed their own resources for
adaptation. For material adaptations many employers (or their insurance carriers) deal directly
with suppliers in the commercial market. Even where publicly-funded services exist, employers
may not be aware of them, are deterred by the costs and delays of dealing with bureaucracies, or
sometimes are reluctant to attract the attention of bodies whose main role is to monitor
compliance.
7.6 Raising awareness
While in many countries there has been a tradition of providing light work, particularly for older
workers, the idea that accommodation should be the first response to enable a worker to stay in
the job is comparatively recent. Employers and employees who are more accustomed to
traditional compensatory or rehabilitative responses to the occurrence of disability, where
responsibility is passed to the state or pension funds, may need to be made aware of the
possibility and its implications for them. The concept of a right to workplace accommodation
may be difficult to accept if responding to disability still has connotations of 'good deeds'.
New legislative requirements can have significant effects on awareness. In the USA, for
example, the concern initially created by the ADA caused it to receive a great deal of attention,
leading to greater employer and public awareness of disability; employer awareness of
56
accommodation requirements now appears to be high but small firms with no experience of
employees with disabilities remain unsure about possible courses of action.
Employers' organisations, which have inside knowledge of employers' needs and concerns, are
well placed to promote awareness amongst their members, reduce any fears and to promulgate
attitudinal change. In the UK, employers' networks on disability encourage members to learn
from one another so that they voluntarily might adopt good practices in workplace adjustment
and other aspects of employing disabled people. In France, employers' organisations have set
up teams to inform and raise awareness among employers, including advice on modifications in
the workplace.
A number of countries report initiatives within the workplace. In France, AGEFIPH funds
awareness-raising programmes for management and for occupational health and personnel
departments, as well as internal training programmes targeted at union representatives. In
Germany, training events for workplace representatives, financed by the authorities, can include
topics such as adaptation of workplaces or needs of special groups.
7.7 Sources of information and advice for individual adaptations
Rights-based requirements to accommodate have been supported by programmes specifically to
advise employers on implementing accommodations in the workplace. Possible accommodations
("adjustments' in the UK) are described in a technical assistance manual (a code of practice in
the UK) rather than finely detailed in the law. In the USA, the Equal Employment Opportunities
Commission (EEOC) funds technical assistance grants and direct assistance, including education,
training, and written materials. US employers and persons with disabilities may also access a
large number of technical assistance programmes, databases and services providing advice on
assistive technologies for independent living. Other countries also report innovative information
sources on technical adaptations, such as the REHADAT database developed in Germany and
adopted in British Columbia (Canada).
In the USA and Canada, the Job Accommodation Network (JAN) provides a toll-free telephone
consulting service. The vast majority of calls requested information on accommodations for
current employees and a large proportion of calls concern material accommodations, mainly for
people with motor impairments. Follow-up surveys of action taken subsequent to calling JAN
have been cited in the UK and at European Union level to show the low costs of most
adaptations. The UK Department for Education and Employment has published case-studies to
demonstrate possible adjustments and their costs.
Despite a burgeoning of information provision, it is commonly fragmented and unco-ordinated.
As the report from the USA notes, despite huge publicity efforts, many employers (particularly
small employers) remain unaware. Because they have no need to know about the ADA and
accommodation requirements until they are confronted with a disabled employee or applicant,
employers lack expertise in accessing information and, when they start searching, they are likely
to be overwhelmed by too much complex, confusing and sometimes contradictory information.
57
The report from Canada comments on the profusion of often partisan information, the limited
value of computerised data banks and the need for more information clearing houses.
Information is of limited use if employers do not know how to apply it. As the Canadian report
comments, many employers cannot identify that they have a problem that could be resolved,
much less the type of problem it is, whether to call someone for office ergonomics advice or for
systems advice.
7.7.1 Bringing information to the enterprise
Programmes which rely on employers seeking out information appear to have limited potential.
The key question is how to bring the right information to a receptive employer at the time that
it is needed. Bringing advice, service development and funding under one umbrella organisation
is one possible way forward. The French fund (AGEFIPH) is exceptional in having sole
responsibility for funding modifications to the workplace, and in combining technical assistance
and funding. AGEFIPH has brought into its network of partnerships a national consultancy
organisation which provides appraisals of working conditions and ergonomic studies.
Particularly in Europe, employers rely on intermediaries to bring them advice. Information to
support retention can be accessed via agencies whose prime business is placement. Recruitment
incentives, heavily used in France, encourage enterprise interest in other AGEFIPH provision.
The general trend towards contracting out of placement and employment support activities to
specialist organisations limits information sharing, however. If agencies develop a reputation as
worthwhile organisations to deal with, employers are more receptive to their advice on
accommodating disabled employees.
Agencies which police compliance with regulations may be viewed by employers as
interventionist and burdensome, rather than as agents of change. There is some evidence of
regulatory authorities now taking a more conciliatory approach to promote acceptance of advice.
In Germany, for example, the authorities who intervene when dismissal is threatened can show
how disabled employees could be retained, by using technical aids, reorganising the workplace
or taking up subsidies, and there is evidence that employers are willing to drop dismissal
proceedings if a solution to the underlying problem is offered.
Shortfalls in staffing, budget ceilings and targets oriented towards entry to work may inhibit
dissemination of information about adaptations for job retention. Agencies may concentrate on
co-operative enterprises and neglect emerging sectors which require more effort to penetrate.
Some country reports comment on the difficulties facing staff in these agencies in keeping abreast
of technological developments, limited opportunities for training and lack of specialist staff.
7.8 Timely intervention
In France, employees are obliged to undergo regular checks by an occupational physician, and
in this way needs for work adaptations are identified. Some UK large employers have introduced
surveys through which employees are free to express outstanding work adaptation needs. Many
larger employers in the USA, and a smaller number in the UK, provide in-house programmes
58
which help employees who participate voluntarily to identify needs which might be
accommodated in the workplace. The effectiveness of internal surveillance mechanisms may be
limited by assumptions about who deserves intervention and by perceptions of disability. A need
for self-disclosure by the disabled worker is an obstacle, particularly for workers with invisible
disabilities such as mental illness. Restrictions on sharing confidential medical records are
further constraints.
The USA report describes the 'Stop the Pain' programme sponsored by the American Federation
of Labor and Congress of Industrial Organisations. Building on successful campaigns in
unionised establishments, it calls on workers to draw attention to work environments and
practices which lead to cumulative trauma disorders (repetitive strain injuries). It provides
practical guidance to workers in determining the scope of the problem, and methods to gain co-
operation from employers in making corrections.
A device has been developed in France to overcome the problem of delays in the procedure to
qualify as a disabled person eligible for assistance. AGEFIPH gives enterprises who request it
a job retention grant which helps to cover adaptation costs for workers who become disabled -
for assessment and training, ergonomic advice in advance of technical modifications, as well as
the disabled person's wage costs.
7.9
Paying for adaptations
Whether employers should be offered public funds towards meeting legal obligations is a matter
of continuing debate. The assumption that employers are responsible for employment-related
costs and the concept of 'reasonable accommodation' underpinning rights-based disability
employment legislation both argue against public funding. In the USA, where the costs of
disability are seen as a company responsibility and accommodation a civil right, it is up to
employers to arrange, procure and pay for reasonable accommodations under the ADA. 38 Canada
has a limited tax credit scheme, and a case has been made for its expansion to assist employers
to pay for adaptations. There is no funding tied to DDA reasonable adjustments in the UK,
although the publicly-funded scheme for adaptations may be accessed.
Under work-injury programmes, employers and insurers are responsible for paying for
accommodations. However, assistance towards job-site modification is possible in seven US
state workers' compensation programmes; in three states there are new requirements that insurers
must subsidise worker accommodation as necessary.
The argument that incentives are needed to reinforce legal obligations is advocated by some
disabled people's organisations. The Netherlands has introduced a number of subsidies as
38 Under the tax credit schemes noted in 7.1, USA businesses may recoup some of the costs of general adaptations;
publicity suggests that this may be used for individual employees but the bias is towards accommodating new
employees.
59
incentives for workplace adaptations but take-up is extremely low³⁹; adaptation of the working
environment remains fundamentally the employer's responsibility. In France and Germany,
funding for employers is part and parcel of the quota-levy system, based on the concept of
collective responsibility and redistribution.
The general trend appears to be moving towards recognising the difficulties which employers
may experience in meeting the costs of more expensive adaptations.
7.9.1 Public funding arrangements
In the systems in the mainland European countries and in the UK, employers and disabled
employees can receive funding of certain, mainly material, adaptations from a public agency.
Separate funding for job retention is unsure, although in Sweden the social insurance agency
funds occupational aids for employees and their employers, and the labour market authority funds
adaptations for previously unemployed disabled people. While this arrangement allows a
protected budget for job retention, the employer must deal with two separate agencies. The
French quota-levy fund (AGEFIPH) has developed special measures both for adaptation and for
job retention, many sub-contracted to specialist providers.
Co-funding is a usual approach in Europe. Arrangements vary considerably. There may be limits
on the total amount the employer is asked to pay towards a given adaptation, or across a defined
time period. More expensive adaptations may be funded from the public budget or costs may be
shared. The economic climate, not surprisingly, affects employers' willingness to contribute
towards the costs of adaptations, and in Germany this has been found to translate into reduced
demand.
Quite often budgets are designed to cover a restricted range of adaptations. The Access to Work
(ATW) in the UK is a good example of a more integrated approach. ATW, an Employment
Service programme, was introduced in 1994 and replaced five separate programmes. It provides
a wide variety of help, in the form of either a one-off payment, for example to purchase
equipment or convert premises, or by providing continuous support, for example by providing
help with travel to work costs, personal readers or support workers. The programme is open to
people who are disabled, within the meaning of the DDA and need extra help because of their
disability. For employed disabled people, financial help is provided towards costs of £300 and
over (approximately 480 US$); all costs above a £10,000 (16,000 US$) threshold are met, and
up to 80 per cent of the costs between £300 and £10,000, over three years.
New Zealand health authorities can fund technical aids for individuals with disabilities in work
or seeking to be placed in work, although this is not a priority within budgetary limits. Generally,
budgets for support for independent living do not seem to be geared to meeting employment
needs. A disability tax credit system, such as that in Canada which allows severely disabled
39
A representative sample survey of 4,000 employers in the Netherlands found that the formal provision for
reimbursement of adaptations to the workplace had been used only for 0.06 per cent of their employees.
60
individuals to set some of the costs of attendant support against income tax, might avoid some
of the difficulties in funding supports which can be used both at home and in the workplace.
Constraints on the effect of external funding arrangements reported variously from Sweden,
Germany, the Netherlands and the UK include:
limited co-funding for very expensive adaptations
bureaucratic procedures and lack of resources to negotiate with external agencies
restrictions that the adaptation must only benefit the disabled individual and should not bring
business advantages
wrangles over cost-sharing
disputes over whether responsibility lies with the employer or the social insurance agency and
consequent uncertainty over whether an application will be granted
funding tied to a given job, limiting the disabled worker's opportunity to change employer
requirements on agencies to 'shop around' for best value, leading to delays in provision
agencies' limited expertise in finding the right solution for the individual and knowledge of
new technology
employers' negative attitudes towards external agencies and lack of positive experience of
co-operative working.
7.10 The balance of provision
Public programmes to advise on, provide, or support the costs of adaptations generally
complement rather than substitute for enterprise activity. The Netherlands report provides a neat
illustration of the complexity of adaptation and the difficulty of recording how the needs of
workers with disabilities are being accommodated.
An employee is able to perform only some of his former tasks and in order to have a full-
time job, a new task has to be added. This task is available but needs some extra vocational
training. To perform both parts of the job the employee needs a new chair to use when he
wants to and help from co-workers in lifting heavy packages. In this example, only the
vocational retraining will be recorded although the restructuring of the work process, the
new equipment and informal support are essential to successful job retention.
Schemes where the employer or employee has to apply for a grant for a specific adaptation seem
to have limited take-up compared with the case-managed approach, where the right combination
of adaptations is funded to suit the needs of the individual. New technologies appear to favour
the retention and return to work of people with visual impairment. People with multiple
disabilities tend to miss out.
Some publicly-funded schemes appear to offer only a limited range of solutions, focussing on
one-off expenditure on equipment and alterations to premises. Human support services (personal
assistants and readers) which require on-going expenditure are rarely major items, although in
Sweden personal assistants account for a third of the budget. External services for adaptation
have a limited role in advising on and financially supporting job-restructuring. However,
initiatives introduced to support entry to work, such as job coaches, are beginning to be taken up
to support job retention, notably of people with mental health problems.
61
Public programmes do not usually offer preventive adaptations (such as ergonomically designed
equipment) and employers have to rely on the market and on knowing what is available. Early
intervention to support a progressive condition can be problematic.
7.11 Key issues in adaptation of work and workplace
Policies for the removal of barriers in the living and working environment
which raise awareness and change attitudes to disability, stimulate the market
in technical assistance and adaptations, and set common standards for
accessibility will reinforce statutory requirements to appraise and remedy risks
in the workplace, duties to accommodate workers with disabilities and
voluntary good employment practices.
It appears that publicly-funded support for individual adaptations is not geared
to the changing pattern of employment - part-time working, limited-term
employment contracts and agency working. When provision is tied to a
particular employment situation, the disabled worker can find it difficult to
change job or employer, or to hold more than one part-time job. Legislating to
reduce barriers in the built environment, and providing technical assistance and
funding, should facilitate flexible working for some persons with disabilities.
Overall, policies which promote removal of disabling barriers appear to support
employment of individuals with physical and sensory disabilities in service
sectors. Occupational health and safety authorities and public providers of
individual adaptations have found these sectors difficult to cover, however.
Response to the new occupational diseases will remain limited unless policy
and provision for prevention and for adaptations are targeted at the emerging
service sectors.
Provision for workplace adaptations and rehabilitative support may be better
co-ordinated if brought within the scope of a single agency and a single budget;
there appears to be growing potential within insurance-related strategies for job
retention. Combining employer responsibilities for adapting the working
environment and for rehabilitation in the workplace appears to be a promising
strategy.
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In the absence of enforced legislative requirements, it can be difficult to
combine employers' endeavours for rational and cost-effective activity with
work adaptation measures which may not be seen as profitable and generating
a financial return. National programmes, such as the Swedish Work Life Fund,
can increase the realisation that it is economically profitable to invest in better
work environments and work organisation.
There may be a case for encouraging employers' interest in ergonomic
assessments and new technologies to increase productivity, if there are checks
in the system to support the continued employment of workers whose
disabilities need to be accommodated by other means.
There is a burgeoning market in information, advice, technical services and
equipment which employers and workers with disabilities find difficult to
access, comprehend and apply when a need emerges. Employers, occupational
health professionals and disabled employees need timely help in the workplace
to spot difficulties and identify and try out possible individual solutions.
How staff working in public and private agencies might keep abreast of
technological developments and improve the quality of service to employers
and workers with disabilities is a question commonly raised. Agency resources
are often limited and links to fragmented training sources difficult to establish.
How the right kind of training can be provided and funded is a question for
research and development institutes and not just manufacturers and suppliers.
Whether, and how far, employers should bear the costs of barrier removal and
individual adaptations relates to the issue of what it is reasonable to expect
them to pay for. There appears to be a special case for supporting small
employers who are deterred by the costs of arranging adaptations; and different
cost-sharing arrangements could be explored. The costs of bureaucratic
procedures, and delays in assessment and supply, are not compatible with
running an efficient business, however.
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8.
ENTERPRISE STRATEGIES
The fifth main theme of the study concerns enterprise policies, programmes and practices
supportive of work retention for persons with disabilities. The focus is on those activities within
the workplace over which the enterprise assumes control and responsibility. In line with the
premise underlying the study, our interest extends beyond those policies and practices where job
retention is the specified aim. Company initiatives to provide confidential counselling or policies
to reduce sickness absence, for example, can support retention as well as interventions to support
return to the job. In developing an enterprise strategy for job retention and return to work we
need to look beyond specific initiatives, however, and consider how these might be integrated
into enterprise management systems.
8.1 The knowledge base
In comparison with public policies and programmes, policies and practices within the enterprise
are not well documented or researched. The orientation of much public policy research towards
assessing the impact of measures on employers has tended to deny the role of the enterprise as
an independent player and creator of policy in the management of disability.
Enterprise practices are idiosyncratic and will vary according to industrial sector, size, union
presence and so on. Information is often restricted to isolated practice examples. Approaches
to job retention are difficult to characterise and their prevalence hard to gauge. Surveys in some
countries have tended to monitor policy statements of intent rather than actual practice. Many
companies have developed informal customs and practices to support the employment of workers
who become ill or disabled, and their investigation requires unusual research efforts. Research
in Germany, for example, identified a pattern of ad hoc activities to retain newly disabled
workers which were not subject to any internal regulations but dependent on goodwill and co-
operative internal relationships.
8.2 Growth of enterprise activity
Companies assuming responsibility for the continued employment of their disabled workers is
by no means new. In their hey-day, iron and steel, coal and ship-building industries commonly
ran in-house disability programmes, including sheltered workshops and redeployment of injured
workers in jobs with rehabilitative value. In the German coal and steel industries, special status
is given to long-term employees in heavy or environmentally demanding work who can then be
redeployed in light work, and in Germany company-run sheltered workshops are still used. It is
not unusual for socially responsible firms to respond to modern risks, such as those associated
with use of new technologies, by providing in-house equipment and adaptation units.
In some countries, the scope of independent enterprise activity has greatly expanded, to the extent
that companies have taken on health-related, personal support and rehabilitative services once
provided exclusively by external bodies in the community, as well as injury prevention,
accommodation of disabilities and managed programmes for work resumption. This trend is
most pronounced among larger firms in the USA, and to a lesser extent in Canada, who have
64
adopted a variety of such programmes in the workplace, stimulated by the separate work injury
schemes in these countries and encouraged by financial and legal incentives.
In contrast to growing voluntary action on the part of enterprises, legal responsibilities for quite
similar activities have been imposed on employers by governments, notably in the Netherlands
and Sweden where enterprise responsibilities for work adaptation, rehabilitation and work
resumption are overseen by the authorities.
8.3 Motivations to promote work retention
Enterprise employment and retention practices must be reviewed in the context of workplace
culture, legislation and economics.
First and foremost, it is the legislative and
constitutional framework which defines the extent to which costs - financial, economic and
social - are borne by employers, workers and government for both occupational and non-
occupational injury and illness. It is the statutory framework which largely defines roles,
responsibilities and actions on the part of employers, workers and insurers in relation to
integration and re-integration of injured, ill and disabled workers.
The impetus and opportunity for the enterprise to develop and implement strategies for job
retention varies from one country to another. But it is a common theme among the study
countries that the primary motivations for work retention among enterprises have been
economic and legal. The motivations to reduce the costs of lost time, to increase productivity,
and to reduce injury compensation costs, interact with legislative requirements. Although
some evidence exists to support the 'goodwill' theory of motivation among enterprises for
retention activities - which may also bring indirect financial advantages - financial and
legislated motivations dominate the study.
8.3.1 Business incentives
The most obvious single influence affecting the development of voluntary enterprise activity
in North America has been the need to control costs of workers' compensation, including
medical costs in the USA. In addition to reducing the direct costs of claims, insurance
premiums which are set according to claims records (experience rated) are an incentive to
prevention and early work resumption. If compensation claims are financed and handled by
employers, claims handling can be integrated with support for job retention, although this is
inhibited by the growing use of external claims administrators. The effects of insurance-
related incentives, which now also exist for non-work injury claims in North America, on the
prevention and management of disability will be interesting to compare with developments
emerging in other systems.
In New Zealand, a pilot 'accredited employers programme' allows approved employers, with
all necessary health and safety and rehabilitation systems in place, to carry out duties normally
undertaken by the accident insurance corporation: managing and paying claims for the first
year; and paying medical and rehabilitation expenses.
The employer is paid an amount
estimated to be the costs associated with the first 12 months of the claim.
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Controlling the costs of disability benefits is the central aim of Dutch labour and income
strategy. The costs now fall to employers for up to five years and a system of differentiated
insurance premiums has been introduced. The preventive and controlling roles of the recently
established obligatory occupational health services are set to expand further into supporting
work resumption.
The need to control the productivity costs of time lost through sickness absence has been an
incentive to introduce workplace programmes. It is noted in the USA report that the costs of
time lost through chronic illnesses, rather than traumatic illnesses, have led to a growth in
enterprise prevention programmes, health promotion, and industrial ergonomics, with a
particular focus on early intervention.
8.3.2 Internal agreements
In Canada, trade unions have been significant in requesting rehabilitation and return to work
clauses in collective agreements. There is evidence among larger German enterprises, with
strong employee representation, of pressure to achieve internal agreements on the employment
of severely disabled persons and of persons with health limitations in general. Such
agreements reflect the implementation guidelines of the Severely Disabled Persons Act.
In France, job retention among enterprises is included in state contract policy. Based on the
1987 law, covered employers can sign an enterprise agreement that exonerates them from
paying levies if it is approved by the authorities. Enterprises are required to take action in two
out of four plans relating to disabled workers: recruitment, rehabilitation and training,
adaptation to technological changes, and retention if dismissal would otherwise occur. By the
end of 1995, almost ten per cent of private sector firms subject to the employment obligation
had job retention plans.
8.3.3 Legislative requirements
The most significant legal requirements which encourage and support job retention activity
within larger North American enterprises appear to be the workers' compensation laws, with
requirements to re-employ and accommodate disabled workers found in some workers'
compensation laws in Canada. The accommodation requirements in the ADA and recent
rulings under the Canadian human rights code, which obligate labour and management to act
jointly on the duty to accommodate, appear to be influential in promoting support for workers
with disabilities who are not covered by workers' compensation.
8.3.4 Reputation of the enterprise
Over and above legislative influences, the reputation of the company as a good employer of
disabled people can be important for business success, especially among firms which are
exposed to the public or compete for well-qualified workers who are concerned about the
treatment they will receive. Public image is an important consideration for large firms in
Germany who seek to demonstrate their social responsibility to severely disabled workers and
to others with health limitations by making internal accommodations (and so avoid the
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embarrassment of paying large levies for not meeting the employment obligation). Public
image is often the extension of the 'corporate culture' to the outside world.
8.3.5 Corporate culture
A common theme is that 'corporate culture' is a significant factor in the emergence of policies
and activities supportive of job retention. Programmes appear to succeed in organisations
which are receptive to change and take an inclusive approach to decision making, with the
support of top management, as well as of workers and supervisors. In small firms the personal
commitment of the owner or manager, sometimes arising out of personal experience of
disability, can be critical.
8.3.6 Interactions
The interactions are complex and it is misleading to isolate single motivating elements. The
USA report notes that while much of the initial development of disability management grew
out of workers' compensation and occupational health and safety laws, the benefits of reduced
costs, increased competitiveness and increased employee morale - 'good corporate citizenship'
- encouraged its extension. The requirements of the ADA and FMLA had further effects and
fostered the realisation that disability management practices make good economic sense.
8.4
Strategic approaches
8.4.1 Disability management at the workplace
The term 'disability management at the workplace' has increasing currency in the English-
speaking countries. As articulated in North America, this process ideally involves the pro-
active enterprise in assuming control and responsibility for prevention, early intervention and
re-integration of injured and disabled workers, and in developing internal systems for planning
and co-ordinating workplace-based services.
In the USA, where the concept is most advanced, "disability management' is still developing.
In its most complete form in large enterprises, a disability management system will address
disabilities incurred either on or off the job, include headquarters staff as well as field
supervisors and employees, and cover mental as well as physical disabilities. The most
comprehensive models include employee safety programmes, ergonomic assistance, work-site
health clinics, 'wellness' programmes, employee assistance (confidential counselling)
programmes, disability claims co-ordination, case-management and modified or gradual work
resumption programmes. Also included are ancillary activities such as maintaining an
appropriate data system, and the education of supervisors and other personnel in disability
prevention and management. Success is thought to depend on responsibility for disability
management resting with the entire organisation, with support and commitment from all levels
of labour and management, rather than being confined to the human resources department or
any other unit.
The ideal is an integrated system rather than unco-ordinated activities. A common approach
is to form an interdisciplinary disability management team. Internal co-ordination between
67
departments (medical, occupational safety and health, human resources, managerial divisions
and union representation) can be facilitated by a qualified 'disability manager', by a trained
member of the human resource department, a member of the occupational health staff, or
possibly by a safety representative or workers' representative. Where such a person is best
located will depend in part on opportunities for input into enterprise policy development at the
strategic level.
8.4.2 Reducing absence related to ill health
In Europe, enterprise policy is typically framed in terms of preventing and reducing workplace
absenteeism. The greatest emphasis appears to be placed on monitoring and controlling
absence; prevention activities at the workplace, such as improving working environments and
promoting health and well-being, and personal support to resume work are less common.
Enterprises rarely combine these elements into an overarching strategy or integrate them into
organizational policy and practice.
European research suggests that a strategic approach, integrated into management systems, is
possible and is to be recommended to employers. The recommended good practice elements
bear a remarkable resemblance to disability management ideals. Common elements include:
a systematic approach; a co-ordinating project team; active support from senior and line
management; active involvement of human resource management and the occupational health
service; involvement of works councils, health and safety committees and trade unions; active
worker participation; good information and communication; and integration.40
A strategy based on reducing costs of absence may appeal in those systems where the costs
of work-injury compensation or sickness and disability benefits are not all borne directly by
the enterprise. As the European study points out, the package of measures must be balanced
to include preventive measures focused on both the person and the work and interventions to
reduce the barriers to work resumption. Several country reports in our study drew attention
to the probable ill effects on health of devices to reward workers for good attendance records
or, conversely, to penalise them or their co-workers for absence.
8.5
Supporting enterprise strategies
Enterprise job retention strategies (whether framed as disability management or prevention of
absence) operate on a modest scale in most study countries apart from the USA. Enterprises
generally lack information about their potential value and the knowledge base to implement
programmes in the workplace. In the USA and Canada, external bodies such as the
Washington Business Group on Health and the Canadian National Institute of Disability
Management and Research, as well as other employer organisations, human resource
organisations and research institutes funded by workers' compensation boards, along with
provider organisations, have been active facilitators.
40
Gründemann, R.W.M. and Vuuren, C.V. van (1997) Preventing Absenteeism at the Workplace: European
research report, Dublin: European Foundation for the Improvement of Working and Living Conditions.
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Several major French groups and enterprises work with AGEFIPH (the body which administers
the quota-levy fund) to implement active job retention programmes; for example, a major
group of industrial establishments signed a 'framework convention' with the aim of retaining
newly disabled workers in production jobs. This model of collaboration between the enterprise
and an external public body may contain transferable lessons.
In general, there seems to be a role for governments, insurance funds and other national
funding bodies to institute national action programmes to encourage and support enterprise
endeavours.
8.5.1 Supporting small enterprises
Generally, it is the largest employers that have, initially, provided the most comprehensive
responses to the needs of persons with disabilities. This has been reflected historically in the
growth of employee assistance programmes and disability management programmes. Once
economic outcomes are demonstrated among the larger enterprises, smaller employers are
expected to replicate the most salient features of effective programmes. While it is universally
acknowledged that many employment opportunities exist among smaller enterprises, they are
less well equipped to respond to the job retention needs of workers with disabilities.
Programmes developed in large firms need to be adapted to meet the needs of small and
medium-sized enterprises. They need to be supported by information on good practice models
and helped with implementation.
8.5.2 Developing standards
Disability management is idiosyncratic and practices vary from company to company. In the
USA there are no formal best practice standards at the official government level. Rather, good
practice standards are continually evolving in the private sector through groups of employers,
insurers and labour unions; most appear to be of relevance to human resource managers in
large firms. External recommendations and standards have not been elaborated in those
systems where employers have legal responsibilities to improve working conditions and to plan
and implement work resumption programmes. More research is required to explore enterprise
practices as a first step towards a code of practice.
8.6
Obstacles to effective enterprise strategies
8.6.1 Obstacles within the system
In some countries it is observed that loosening of employment security law, combined with
labour surpluses, means that employers attach no priority to retention of workers who become
disabled. Employers can avoid responsibilities by placing disabled workers on short-term
contracts.
In some systems many employers assume that only social programs have responsibility to care
for persons with disabilities once they become unable to perform work activities at their
enterprise. As a consequence, the responsibility to accommodate or retain injured, ill or
disabled workers is not built into the enterprise's operations. This is most obvious where there
69
is no separate work injury benefit system, where the costs of medical treatment are
automatically met by the state, and where there is relatively easy progression to social
insurance or employee benefits.
Experience rating among many workers' compensation schemes may lead to claims avoidance
practices by employers which, in turn, lead to adversarial relationships between worker and
employer, delays of rehabilitation intervention, and other barriers to work resumption and
retention. Some compensation schemes encourage injured workers to extend their absence to
achieve the best rates of compensation and similarly create obstacles to early interventions.
On the other hand, there are suggestions that financial incentives to employers can lead to the
worker being returned too soon and without long-term support.
A recurrent issue in this study, although unique to the USA, Canada and New Zealand, is
differential treatment of individuals insured under workers' or accident compensation schemes
and those privately insured, or not insured at all. This is an obstacle to a comprehensive
approach to management of workplace disability, as it necessitates separate claims management
procedures and as enterprises have considerably more discretion in how they respond to non-
work-related injuries; advances in integrating the two are reported in the USA, however. Non-
discrimination legislation and other accommodation requirements are important countervailing
forces in the USA and Canada, as is pressure by labour unions for more equitable treatment.
8.6.2 Definition and assessment of disability
A lack of uniformity in the categorisation of disability means that enterprises may have to
respond in different ways, depending on whether the individual has work-related or non-
occupational injuries, illnesses and disabilities, or falls within the coverage of non-
discrimination or other employment protection legislation. Definitions and assessments of
disability vary and sometimes conflict. Different insurance schemes reflect differing
operational definitions of disability, the amount of wage replacement benefit, the duration of
those benefits, and the circumstances under which benefits and associated services will be
terminated.
Most countries have laws and statutes that fail to provide equal protection in employment for
persons with non-visible disabilities, such as drug and alcohol addiction, mental illness, or
chronic pain syndromes, and enterprise response is contradictory and often adversarial
Clearly, a universal problem among most nations surveyed is the role of medical doctors as
gatekeepers of return-to-work decisions. Physicians are often unable to determine an
individual's functional abilities objectively and validly, and have little experience in the
workplace. Most employers, as well as public and private insurers, demand medical
certification for entitlement, yet the most successful initiatives are those able to focus more on
physical demands of the workplace and do not assume that workplace disability is a function
of a person's medical condition or impairment.
Most rehabilitation interventions are
focused on the individual, and exclude consideration of changes to the work environment and
70
work retention technology. Models of work retention which define disability in terms of the
person-environment-technology interaction need to be tested.
8.6.3 Obstacles within the enterprise
Enterprises do not necessarily have in place the relevant expertise for disability management
activities, although specialist disability management courses are now emerging outside the
USA, notably in Canada and the UK. Mandatory occupational health services are unusual and
occupational health professionals can have limited knowledge of workplace solutions. Limited
training for safety representatives, trade unionists and disabled persons' representatives is
reported in some countries. In France, however, AGEFIPH funds major awareness-raising and
training programmes in aspects of job retention for works council and union representatives.
Work resumption can be seen as an end in itself with no mechanisms in place to support
workers with long-term disabilities. Early intervention strategies, which often bring workers
back to work before they have fully recovered, can require medical surveillance to prevent
further risk of harm.
Co-worker resistance to the returning worker needs to be addressed by pro-active disability
awareness training that challenges underlying attitudes. Some countries report interventions
at too late a stage, once discriminatory incidents have occurred. In some systems,
opportunities to accommodate the returning worker in a different job are constrained by labour
agreements. Job coaches may be viewed as giving the worker with disabilities an unfair
advantage, and limited duty assignments may be resented.
The supervisor is commonly identified as a critical player in the implementation of a job
retention strategy. Yet reported practices, such as adding hours lost through absenteeism to
the workload of remaining workers, reduce the supervisor's interest in retaining a potentially
less productive worker. The supervisor needs to be motivated to develop and implement
workplace accommodations and support systems, and to promote them amongst the workers
for whom he or she is accountable. Mechanisms could be developed to hold supervisors
accountable (through performance evaluations or departmental charge-back systems) for the
consequences of not supporting job retention activities.
The attribution of costs of reduced productivity to the disabled worker's department can inhibit
return to the original unit. An example is given of a German company which established a
special cost centre to which newly disabled workers were assigned; the costs were assigned to
company overheads rather than the individual's unit. In the USA and Canada the contrary
argument is put that the general lack of departmental accountability for the cost of not retaining
an injured worker means that managers have little incentive to accommodate and retain the
worker.
71
8.8
Assessing outcomes
There is little research into the outcomes of enterprise programmes. The question of the
benefits to persons with disabilities has been inadequately addressed. The major focus has
been on quantitative variables - notably reduction of lost time, reduction of workers'
compensation insurance premiums and increased productivity - rather than qualitative variables
that reflect on quality of life improvements for persons with disabilities. The perspectives of
disabled workers participating in programmes are rarely integrated into research. The limited
research which is available appears to support the economic and social benefits derived from
participation in disability management programmes.
Although it has been widely documented that early intervention or early involvement with a
disabled person can be an important factor in reduced recovery time and more timely work
resumption, there is evidence that to be effective in maintaining long-term employability, early
intervention needs to followed by continued support on the job. Successes occur among those
cases where the worker returns with continued enterprise and insurer accommodations and
support. More research attention needs to be paid to longer-term outcomes and their
workplace-related determinants.
8.9
Key issues in enterprise strategies
Enterprises have developed informal practices as well as formalised policies
in response to the occurrence of disability. Before embarking on a strategy to
support enterprises in the development of good practices, we need to look
from inside the enterprise at the barriers and facilitating factors and
comprehend enterprise needs and priorities. This requires the active
participation of the range of enterprise actors and an investigatory approach
which delivers benefits to the participants as well as to the wider community.
Across the study countries enterprises are developing new ways of managing
the occurrence of disability, both for business reasons and in response to
requirements imposed upon them by national policies. The result is not only
an increase in services provided within the company which previously fell
within the remit of external agencies but also a growth of new forms of
provision tailored to the prevention of disability and the management of its
occurrence. There is a need for mechanisms to promote the transference of
proven good practices across systems, as well as within the country.
72
There is a growing interest in disability management approaches to the co-
ordination of enterprise activity which bring together the range of actors with
disparate roles in prevention, early intervention and reintegration of workers
with disabilities. The different models of co-ordination need to be elaborated
and their effectiveness in different contexts explored. Models need to be
tailored to the needs of small enterprises.
Enterprises need information about the potential value to them of approaches
to the management of disability. External bodies which can offer funding and
expertise and can work in partnership with enterprises, such as the French
fund AGEFIPH, appear to have potential.
Disability management is idiosyncratic and although good practice standards
are evolving, notably in the USA, external recommendations and standards
have not been created at the official government level. Employers, insurers
and labour unions, as well as disabled workers' organizations, will have
essential roles in the development of codes of practice.
The incentives to enterprises to develop strategies for job retention depend, in
part, on the need to control the costs of absence and the consequences for
productivity. A strategy based on reducing the costs of absence may appeal
in those systems where the costs of work injury compensation or sickness and
disability benefits are not borne directly by the enterprise.
In some systems, enterprise interventions to support retention are targeted at
those workers who are perceived as being of more value to the company.
Labour unions within the enterprise, injured workers' organizations and
external requirements to prevent discriminatory treatment are important
countervailing forces.
The outcomes for the disabled worker of enterprise programmes have been
inadequately addressed, and research has focused on quantitative outcomes.
There is some evidence that if early intervention is to be effective, it needs to
be followed by continued support on the job. More attention needs to be paid
to longer-term outcomes and to their workplace-related determinants.
73
9. DEVELOPING STRATEGIES
So far, the key issues in relation to the five themes of the study have been identified. In this
concluding section we highlight some of the most significant cross-cutting issues relevant to the
study countries.
Part-time working
Part-time working is growing overall and in some countries is actively promoted in national
policy. There are signs of benefits and compensation arrangements increasingly responsive to
the particular needs of persons with disabilities for part-time opportunities. Outside the
enterprise, employment support services and provision for adaptations of the work and workplace
need to be oriented for supporting part-time work in general, and to opportunities for combining
work with benefit in particular.
The small enterprise
Small firms have a marginal position in most of the policies and programmes which support job
retention and return to work. Although some noteworthy successes have been reported in
reaching out to small enterprises (such as the French fund AGEFIPH's programme) they have
less capacity to bear the costs of a worker who becomes disabled, few structured incentives to
do so, and limited resources to find out about and use external sources. Strategies for job
retention may need to be tailored specially to the needs of small enterprises, for example by
offering more generous funding towards making accommodations for workers with disabilities.
Equitable support for job retention
As job retention increasingly becomes an enterprise concern, and direct provision by statutory
agencies takes a less prominent role, there is more discretion for the employer. Particularly
where enterprise retention activity is driven by the need to contain costs to the business,
employees who are more valued can be selected for support and rehabilitation to the
disadvantage, it seems, of less qualified and easier to replace workers. Inequities might be
reduced in part by adjusting the employer incentive structures. Advocacy in the workplace and
legislation to prevent discrimination in employment appear to be important mechanisms to
counter any tendency towards selectivity.
Disincentives to recruitment of disabled workers
Risk selection is a commonly reported effect of policies which protect the employment of
disabled workers and of policies which encourage or require enterprises to retain workers who
become disabled. Employers are more likely to screen job applicants to avoid hiring someone
who might become sick and so impose costs on the enterprise. This tendency could be inhibited
by disability discrimination legislation, although discriminatory recruitment practices cannot be
entirely overcome, or by mechanisms to support the costs to the employer of employees with
abnormally high levels of sickness absence.
74
Long-term support for workers with disabilities
Policies for early intervention and work resumption may not always be in the best interests of
disabled workers and need to be supplemented by medical surveillance and longer-term support
on the job. Equally, a strategy for job retention should not exclude the maintenance in
employment of individuals who were disabled before entering employment.
Supporting enterprise-based activity
External services will need to be oriented towards bringing support to the enterprise at the time
that it is needed and enabling the enterprise to deploy its own resources to support disabled
workers. Access to advice and services for adaptation of work and workplace needs to be
simplified and resources need to be better co-ordinated to facilitate direct use by employers.
Ergonomic assistance needs to be promoted and more attention paid to the person-technology-
work interface.
Identifying excluded groups
A coherent strategy for job retention and return to work needs to consider who is intended to
benefit. The focus on early intervention and work resumption tends to leave out of the picture
workers who are more severely disabled and who encounter barriers in re-entering the labour
market, for example after a disabling accident or long-term illness. A focus on short-term
absence also ignores the situation of workers whose continued employment is at risk because of
unreported illnesses which do not manifest themselves in sickness absence.
Co-ordinating the players
The need for improved co-ordination between multiple players emerges as a key issue across the
thematic areas of the study. Achieving co-ordinated programmes is increasingly problematic as
new players, with quite different objectives and philosophies, enter the arena.
Keeping the job open
As the emphasis shifts to early intervention and rehabilitation, ensuring that the worker with
disabilities has a job to return to is critical. The effectiveness-of the different approaches to
linking employment protection to receipt of sickness benefit or injury compensation could be
explored, as could the roles of benefits and compensation bodies in facilitating work resumption.
The costs to enterprises of keeping jobs open for returning workers need to be identified and
mechanisms found to ensure that it is worthwhile for the employer to do so.
Accommodating disability
Requirements to accommodate - to adapt the work and workplace so that the individual with
disabilities is not disadvantaged - are a key element in a coherent job retention strategy.
Compensation systems which prioritise job retention appear to be strengthened by the inclusion
of accommodation requirements. Including accommodation requirements in compensation
systems as well as in disability-discriminate legislation reduces inequities in treatment between
those who are covered by compensation programmes and those who are not. In the absence of
enforced requirements, employers need to be convinced that it is economically worthwhile to
75
invest in adaptations. Where responsibility should lie for the funding of individual adaptations
is an issue for debate.
Learning from enterprise strategies
Fundamental to the Project is the intervention between enterprise policies and practices and
national policy and regulation. Across the study countries, enterprises are developing new ways
of managing the occurrence and consequences of disability. Partnerships between enterprise
actors and policy makers need to be developed to facilitate the exchange of good practice
between public and private sectors. The International Research Project on Job Retention and
Return to Work Strategies for Disabled Workers seeks to stimulate and develop such an
exchange through the active participation of enterprise actors, disabled people's organisations
and policy makers in phase two of the Project.
76
APPENDIX
Table 1: Public expenditures and participant inflows in labour market programmes
Programme categories
Canada
France
Germany
N'lands
NZ
Sweden
UK"
USA
Australia
96-97
1995
1996
1996
95-96
95-96
95-96
95-96
95-96
Exp
PI
Exp
PI
Exp
PI
Exp
PI
Exp
PI
Exp
PI
Exp
PI
Exp
PI
Exp
PI
1. Public employment
0.20
0.15
02.4
0.36
0.13
0.25
0.20
0.07
0.24
services and administration
2. Labour market training
0.21
1.9
0.38
3.5
0.45
1.6
0.12
0.4
0.33
..
0.51
3.4
0.10
1.0
0.04
0.7
0.15
4.8
a) Training for unemployed
0.21
1.9
0.34
2.8
0.45
1.6
0.12
0.4
0.33
0.50
2.8
0.09
0.9
0.04
0.7
0.14
4.2
..
adults and those at risk
b) Training for employed adults
-
-
0.04
0.7
-
-
-
-
-
-
0.02
0.6
0.01
-
-
-
0.01
0.6
3. Youth Measures
0.03
0.5
0.25
2.8
0.07
0.7
0.09
0.8
0.09
..
0.11
2.5
0.12
1.0
0.03
..
0.06
1.3
a) Measures for unemployed
0.01
0.2
0.09
1.0
0.06
0.4
0.07
0.3
0.02
1.3
0.11
2.5
-
-
0.03
0.4
0.03
0.4
and disadvantaged youth
b) Support for apprenticeship
0.02
0.3
0.17
1.9
0.01
0.3
0.03
0.5
0.08
-
-
0.12
1.0
-
0.03
0.9
..
..
and related forms of general
youth training
4. Subsidized employment
0.08
0.3
0.42
4.4
0.40
1.4
0.26
0.13
0.67
5.5
0.02
0.1
0.01
0.31
2.5
..
**
..
a) Subsidies to regular
0.02
-
0.16
2.3
0.07
0.2
0.13
0.09
1.3
0.17
1.5
-
-
-
0.06
1.2
--
..
employment in the private
sector
b) Support of unemployed
0.04
0.1
0.04
0.3
0.03
0.2
-
-
0.01
0.07
0.4
0.01
-
-
-
0.03
0.1
..
persons starting enterprises
c) Direct job creation (public or
0.03
0.2
0.22
1.8
0.30
1.0
0.13
0.03
0.9
0.43
3.6
0.01
0.1
-
0.1
0.22
1.2
..
non-profit)
5. Measures for the disabled
0.03
**
0.09
0.4
0.27
0.3
0.54
0.1
0.03
1.7
0.71
0.9
0.03
0.2
0.04
"
0.07
0.7
a) Vocational rehabilitation
0.03
0.03
0.4
0.14
0.3
-
-
0.01
0.7
0.08
0.6
-
0.1
0.04
0.03
0.3
b) Work for the disabled
-
0.06
0.14
-
0.54
0.1
0.02
1.1
0.62
0.3
0.02
0.1
-
-
0.04
0.4
**
6. Unemployment
1.31
1.43
2.37
3.41
1.16
2.27
1.33
0.34
1.29
compensation
7. Early retirement for
0.01
0.36
-
-
-
-
-
-
-
labour market reasons
Total
1.87
3.09
3.80
4.78
1.87
4.52
1.79
0.54
2.14
Passive measures (6&7)
1.31
1.79
2.37
3.41
1.16
2.27
1.33
0.34
1.29
Active measures (1-5)
0.56
2.7
1.30
11.2
1.43
3.9
1.37
0.71
2.25
12.2
0.46
2.3
0.19
0.84
9.2
Notes: Exp - Public expenditure as a per cent of GDP. PI Participant inflows as a per cent of the labour force.
# Excluding Northern Ireland
.. Data not available
- nil or less than half of the last digit used.
Source: OECD (1997) Employment Outlook 1997, Table K.
Table 2: Labour force structure and trends
Labour force'
Labour force participation rate (%)'
Civilian sectoral distribution (%)²
1994
Total
Annual
Total
Male
Female
Agri-
Industry
Services
(1000s)
growth
culture
1996
(%)
Forestry
1980-
1980
1996
and
1980
1996
1980
1996
1996
Fishing
Canada
15796
1.6
49.6
53.8
60.1
59.0
39.1
47.6
4.1
22.6
73.3
France
26046
0.6
44.2
45.4
54.2
51.0
34.7
38.7
4.9
26.7
68.4
Germany
a
40935
0.6
47.8
49.8
60.2
59.4
36.6
41.1
3.3
37.6
59.1
Netherlands
7250
1.6
39.9
46.5
55.1
56.5
24.9
36.8
4.0
23.0
73.0
NZ
1780
1.9
42.5
50.1
56.1
55.8
29.1
43.2
10.4
24.9
64.6
Sweden
4769
2.4
50.6
54.1
57.4
57.0
44.0
51.3
3.4
25.0
71.6
UK
28967
1.3
47.8
50.1
60.0
57.6
36.3
42.4
2.1
27.7
70.2
USA
136884
1.4
48.5
51.4
58.2
56.4
39.1
45.4
2.9
24.0
73.1
Australia
9144
2.0
45.9
51.0
58.1
58.0
33.7
43.3
5.1
23.5
71.4
Notes:
The economically active population is defined as all persons of either sex who furnished the supply of labour for the production of goods
or services. National practice varies in the treatment of such groups as the armed forces, members of religious groups, persons seeking their
first job, seasonal and part-time economic activities. The labour force participation rate is defined as the percentage of economically active
adults in each gender group (ages 15-64).
a In this appendix, data from 1992 onwards refer to the whole of Germany unless otherwise noted.
Sources: 'ILO (1997) World Labour Report 1997-98, ; 2 OECD (1996) Labour Force Statistics 1974-1994.
Table 3: Population and labour force participation
Population 1995 I
Labour force participation rates 1996 2a
Elderly
dependency
total
Age structure of population
men
women
ratio
(1000's)
% of total population
under
15-64
65 and
15-24
25-
55-64
16-
25-54
55-
estimated
15
over
54
24
64
for 2000
Canada
29,606
20.2
67.7
12.0
63.5
91.0
59.3
59.5
76.4
36.9
18.2
France
58,141
19.5
65.4
15.1
32.4
95.2
42.3
25.9
77.8
31.3
23.6
Germany
81,662
15.9°
68.1°
16.0°
58.5°
92.5°
52.7°
52.7d
72.1°
28.1°
23.8
Netherlands
15,457
18.4°
67.4°
13.4°
61.3
92.7
42.2
60.9
67.5
20.5
20.8
New Zealand
3,580
23.3°
65.1°
11.7°
70.9
92.0
69.0
64.0
73.2
42.8
17.1
Sweden
8,827
18.8°
63.7°
17.5°
48.9
90.0
72.2
46.7
85.5
65.0
26.9
United Kingdom c
58,613
19.5°
64.8°
15.7°
75.3
91.9
62.9
65.8
74.5
40.2
24.4
USA
263,057
21.9
65.3
12.7
70.2
91.6
67.0
62.2
76.1
49.6
19.0
Australia
18,054
21.6°
66.6°
11.8
72.9
91.5
60.3
67.6
69.2
28.6
16.7
Notes:
a The labour force participation rate is defined as the percentage of economically active adults in each age group.
h
Population aged 65 and over as a per cent of the working age population.
c 1994 data.
d 1995 data.
c Age group 15-24 refers to 16-24.
/ Age group 55 to 64 refers to 55 and over.
Sources: I Labour Force Statistics 1975-1995, OECD, Paris 1997 20ECD (1997) Employment Outlook 1997, Table C.
3 Ageing in OECD Countries, Social Policy Studies No. 20 1996; Table A.3.
Table 4: Unemployment 1996-97
Standardised
Unemployment rates 1996 2
Incidence of long-term unemployment from
unemployment
survey-based data' 1996 2
rates
men
women
men as a per cent of
women as a per cent of
Dec'97 1
male unemployment
female unemployment
15-
25-54
55-64
15-24
25-54
55-64
6 months
12 months
6 months
12 months
24
and over
and over
and over
and over
Canada
8.6
17.5
8.7
7.8
14.6
8.5
7.6
28.5
15.3
26.7
12.1
France
12.3
22.1
9.3
8.6
31.9
13.0
8.6
58.6
37.1
64.0
41.6
Germany b
10.0
8.4
7.0
15.2
7.5
9.3
23.0
62.9
45.6
68.0
51.0
Netherlands
4.7°
11.3
4.3
3.5
11.6
7.5
5.1
81.2
53.5
81.5
45.0
NZ
6.8d
12.3
4.7
4.3
11.0
5.1
2.7
40.2
23.8
36.5
20.7
Sweden
9.1
16.7
7.4
8.6
14.5
6.7
6.5
40.3
18.5
36.0
15.5
UK
6.6
17.8
8.0
9.5
11.1
5.6
3.4
63.5
45.9
47.7
28.0
USA
4.7
12.6
4.2
3.3
11.3
4.4
3.4
18.5
10.4
16.2
8.4
Australia
8.1
15.4
7.2
9.8
14.1
6.4
4.5
50.8
30.9
45.4
24.8
Notes:
"While data from Labour Force Surveys make international comparisons easier they are not perfect. Difference in questionnaire wording
and design, survey timing and age group definition mean that care is required in interpretation.
h Long-term rates for Germany are 1995 data.
C For age group 55-64 refers to 55 and over.
Source: 'OECD (1997) Quarterly Labour Force Statistics, 1997 No 2; 20ECD (1997) Employment Outlook 1997, Tables C and I.
Table 5: Part-time employment
Part-time employment as % of total employment
Female part-time
Average annual
employment % of
hours actually
women and men
total part-time
worked per person
women
men
employment
in employment
1994
1996
1994
1996
1994
1996
1994
1996
1994
1996
Canada
18.8
18.9
28.6
28.9
10.7
10.7
68.8
69.1
1737
1732
France
14.9
16.0
27.8
29.5
4.6
5.3
82.7
81.7
1635
1645
Germany"
15.8
16.3
33.1
33.8
3.2
3.6
88.1
87.4
1602
1583
Netherlands
36.4
36.5
66.0
66.1
16.1
16.1
73.8
73.8
..
New Zealand
21.6
22.4
36.6
37.3
9.7
10.4
75.0
74.3
1851
1838
Sweden
24.9
23.6
41.0
39.0
9.7
9.3
80.1
79.5
1532
1554
United Kingdom
23.8
22.1
44.3
42.7
7.1
5.6
83.6
86.0
1728
1732
USA
18.9
18.3
27.7
26.9
11.5
10.9
67.3
67.9
1947
1951
Australia
24.4
25.0
42.6
42.6
10.9
11.7
63.2
62.6
1879
1867
Notes:
National definitions of part-time work. See OECD Labour Market and Social Policy Occasional Papers No. 21 The Definitions of Part-
time Work for the Purpose of International Comparisons forthcoming).
-- not in series
B 1996 data are for 1995.
Source: OECD (1997) Employment Outlook 1997, Tables F and G.
Table 6: Employer tenure and job security
Average employer tenure¹
Perceptions of job security
(years)
percentage not
percentage satisfied
worried about the
with their job
future of their
security
company
total
men
women
age
age
age
1992
1996
1992
1996
15-24
25-44
45 or
%
%
%
%
years
years
more
Canada
7.9
8.8
6.9
1.6
6.5
13.8
74
61
49
45
France
10.7
11.0
10.3
1.6
9.0
17.5
72
58
56
41
Germany
9.7
10.6
8.5
2.4
7.7
16.2
73
64
62
48
Netherlands
8.7
9.9
6.9
1.8
7.6
16.0
71
66
74
61
Sweden h
10.5
10.7
10.4
2.2
8.2
15.9
66
60
49
49
United Kingdom b
7.8
8.9
6.7
2.2
7.0
12.2
52
47
52
43
USA
7.4
7.9
6.8
1.6
6.2
12.4
60
52
57
47
Australia a
6.4
7.1
5.5
1.9
5.9
11.1
69
67
78
67
Notes:
"Tenure refers to the amount of time a worker has been continuously employed by the same employer in waged or salaried employment.
Data drawn from national household surveys with differing question wording. New Zealand is not in this series.
a
1996
h Data in 1992 columns refer to 1993.
Source: OECD (1997) Employment Outlook 1997, Tables 5.3 and 5.6.
Table 7: Industrial relations
Trade union
Trade Union Density
Change in trade
Collective
Dominant
membership
Union membershipᵇ
union density :
-
bargaining coverage
bargaining levels
as a percentage of:
Union membership
ratesd
over past 10 years
as a percentage of:
year
Union
period
wage
period
wage
year
proportion
member-
and
and
(%) of
ship
salary
salary
employees
(1000's)
earners
earners
covered by
agreements
Canada
1993
4128
1993
37.4
85-93
-0.7
1996
37.0
Company / plant level
France
1995
1758
1995
9.1
85-95
-37.2
1995
90.0
National/ Sectoral
Germany
1995
9300
1995
28.9
91-95
-17.6
1996
90.0
National/ Sectoral
Netherlands
1995
1540
1995
25.6
85-95
-11.0
1996
80.0
National/ Sectoral
New Zealand
1995
362
1995
24.3
86-95
-55.1
1995
23.1
Company / plant level
Sweden
1994
3180
1994
91.1
85-94
8.7
1995
85.0
National/ Sectoral
UK
1995
7280
1995
32.9
85-95
-27.7
1994
25.6
Company / plant level
USA
1995
16360
1995
14.2
85-95
-21.1
1995
11.2
Company / plant level
Australia
1995
2440
1995
35.2
85-95
-29.6
1995
65.0
Company / plant level
Notes:
"The database applies a comprehensive definition of a trade union which recognises that a union's central purpose is the
representation of the employment and wage interests of workers. General, industrial, craft, occupational, enterprise unions or
professional employee associations whose role-includes collective bargaining, pressure on legislators or public authorities, strikes,
working-to-rule, petitioning, demonstrations or legal action are all included in the database. Where possible, self-employed
members, unemployed and retired members are excluded from the ILO report.
h Union density expresses union membership as a proportion of the eligible workforce. This denominator includes all people who
earn their living on wages or salaries including those who are employed in the public sector and in government service.
C Change in density over the period describes relative change, e.g. density rates for NZ fell by just over half during the period.
d Collective bargaining coverage rate is the proportion of employees covered by collective agreements in the formal sector. The
formal sector excludes employers, self-employed, unpaid family workers, farm workers and domestic workers.
c In 1996 an estimated 37 per cent of all employees were covered (in Great Britain only) according to Labour Market Trends, June
1997.
Source: ILO(1997) World Labour Report 1997-98, Tables1.1 1.2, 1. 3 and 3.1.
Table 8: Real earnings growth for different groups of workers over the past five and
ten yearsᵃ (percentage changes) - earnings of full-time workers
Total
Men
Women
Youth ( 20-24)
Prime-age (25-54)
Past 5
Past 10
Past 5
Past 10
Past 5
Past 10
Past 5
Past 10
Past 5
Past 10
years
years
years
years
years
years
years
years
years
years
Canada (1995)
0.7
3.8
-1.4
1.5
6.5
14.1
-2.0
-1.5
-0.4
1.6
France (1994)
2.6
7.2
2.1
6.7
4.4
10.0
1.1
1.1
1.1
1.7
Germany ¹(1994)
9.9
21.0
7.6
19.7
15.7
26.1
9.6
19.5
3.0
10.9
Netherlands 2 (1994)
3.3
9.3
2.7
8.4
7.7
17.1
..
..
..
..
NZ 3 (1994)
-0.6
-2.8
-1.3
-4.0
5.8
6.0
..
--
..
..
Sweden (1994)
-2.3
9.3
-2.0
10.8
-0.2
10.0
-9.6
4.2
-3.3
6.5
UK (1996)
8.5
23.2
7.8
21.9
11.7
33.4
1.6
13.4
6.0
18.9
USA (1995)
-0.9
-3.1
-4.8
-6.3
0.2
3.7
-8.2
-11.0
-2.8
-4.8
Australia (1995)
5.5
1.8
5.8
2.7
6.6
3.9
2.3
-4.8
7.9
1.6
Notes:
a All nominal wage series have been deflated by each country's consumer price index.
.. Data not available
I All data refer to West Germany only.
2 Data for the past ten years refer to the past eight years.
3 Data for the past five years refer to the last six years.
Source: OECD (1997) Employment Outlook 1997, Table 1.5.
Table 9: Occupational injuries
National reporting criteria for occupational injuries,
Persons injured
Rate of fatal injuries by
disease etc as applied by the ILO Yearbook
(thousands)
economic activity
total per 100,000° persons
employed
year
year
Canada
compensated injuries, includes occupational diseases
1995
411.214
1995
6.55
France
compensated injuries
1991
787.111
1991
7.4
Germany
reported injuries, relates to the territory of FRG before
1993
2199.356
1993
8.0
3.10.1990, includes commuting accidents,
Netherlands
reported injuries
1992
64.657
..
..
NZ
compensated injuries, year ending March of year
1994
37.817
1993
5.3
indicated, including commuting accidents and
occupational diseases.
Sweden
reported injuries, includes persons with dental injuries.
1995
33.587
1995
2.3
UK
reported injuries, year beginning April of year indicated,
1995
150.299
1995
1.1
excludes road accidents
USA
reported injuries, establishments with 11 or more
1991
2963.40
1991
2.1h
employees, including occupational diseases
Australia
compensated injuries, includes occupational diseases
1994
135.729
1995
6
Notes:
1 Data taken from the ILO Yearbook is collated according to the latest versions of the International Standard Industrial Classification
of all Economic Activities; the International Standard Classification of Occupation and the International Standard Classification of
Status of Employment.
.. not in series
a The original figure in the ILO report is per 1000 persons employed.
h Per 1,000,000 hours worked.
C Under-reporting makes comparison problematic.
Source: ILO (1997) Yearbook of Labour Statistics 1997, Tables 8A, 8B and 8C.
ISBN 92-2-111137-7