Background Despite important influence of country of residence on labour force participation among patients with RA, no attempt has been made to understand the role of national policies and social security (SS) systems. We hypothesized that: 1) access to SS depends on the type of SS system; 2) wealthier countries offer more facilities to maintain work but also easier access to income compensation; 3) work retention and SS policies have an impact on sick leave (SL) and long-term work disability (WD).
Objectives To explore regulations in SS including availability of work support facilities to maintain paid employment and income substitution in relation to SL and WD.
Methods A survey was conducted among countries of the European WHO Region (n=50). One rheumatologist per country completed a questionnaire about regulations related to SS for RA patients, including efforts to support employment, criteria for eligibility as well as level and duration of income compensation. To investigate whether the regulations differed by the type of SS system (Anglo-Saxon, Bismarckian, Mediterranean, Post-Communist, and Scandinavian), country's wealth (Gross Domestic Product (GDP)) or national disability/employment rates, correlations or subgroup comparisons were done with t-test/Mann-Whitney and chi-square/Fisher's test, as appropriate.
Results Forty-four (28 EU and 16 non-EU member states) countries (88%) provided data. While all countries had arrangements to support patients with restrictions to work, large heterogeneity was observed in all specific regulations (Table). Twenty-nine (66%) and 26 (59%) countries had a requirement for employment history or social insurance contributions to be eligible for SL or WD compensation, respectively. Maximum SL length before transition to WD varied from 3 to 36 months (mean (SD) 13 (9)). Compensation for SL and WD varied from 25 to 100% and 18% to 100% of previous income, respectively. Although the majority of countries had facilities to support patients with RA in paid employment (n=33, 75%), only in a quarter of countries rehabilitation efforts were obligatory to qualify for WD. No relationship was found between any of these regulations and the type of SS system, GDP or rates of disability and employment.
The table shows the regulations related to sick leave in 44 countries of the European region.
Conclusions Three quarters of countries had facilities to support employment while all countries had income compensation schemes. Large heterogeneity was observed in most regulations including income compensation. Differences in SL and WD in RA patients seem not to be explained by differences in work retention facilities nor social by security system. Inequalities in support and income compensation call for a platform to harmonize policies for patients with RA who experience restrictions in work participation.
Disclosure of Interest None declared