Objectives To describe and explore differences in formal regulations around sick leave and work disability (WD) for patients with rheumatoid arthritis (RA), as well as perceptions by rheumatologists and patients on the system’s performance, across European countries.
Methods We conducted three cross-sectional surveys in 50 European countries: one on work (re-)integration and social security (SS) system arrangements in case of sick leave and long-term WD due to RA (one rheumatologist per country), and two among approximately 15 rheumatologists and 15 patients per country on perceptions regarding SS arrangements on work participation. Differences in regulations and perceptions were compared across categories defined by gross domestic product (GDP), type of social welfare regime, European Union (EU) membership and country RA WD rates.
Results Forty-four (88%) countries provided data on regulations, 33 (75%) on perceptions of rheumatologists (n=539) and 34 (77%) on perceptions of patients (n=719). While large variation was observed across all regulations across countries, no relationship was found between most of regulations or income compensation and GDP, type of SS system or rates of WD. Regarding perceptions, rheumatologists in high GDP and EU-member countries felt less confident in their role in the decision process towards WD (β=−0.5 (95% CI −0.9 to −0.2) and β=−0.5 (95% CI −1.0 to −0.1), respectively). The Scandinavian and Bismarckian system scored best on patients’ and rheumatologists’ perceptions of regulations and system performance.
Conclusions There is large heterogeneity in rules and regulations of SS systems across Europe in relation to WD of patients with RA, and it cannot be explained by existing welfare regimes, EU membership or country’s wealth.
- outcomes research
- rheumatoid arthritis
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Handling editor Dr David S Pisetsky
Collaborators Working group ‘Working Group Access to Social Security for Patients with RA across Europe’: Ermir Tafaj (Albania), Edi Rembeci (Albania), Saskia Decuman (Belgium), Anastasia Tushina (Belarus), Iva Miteva (Bulgaria), Šárka Forejtová (Czech Republic), Esben Toftegaard Knudsen (Denmark), Maxime Wach (France), Matthieu Mangin (France), Márta Fekete (Hungary), Antonella Celano (Italy), Grainne O’Leary (Ireland), Giedre Dereseviciene (Lithuania), Mona Thorekildsen (Norway), Leszek Roszkowski (Poland), Claudia Handra (Romania), Inessa Samko (Russia), Jenny Hubertsson (Sweden), Tapparel Ludovic (Switzerland), Zumrad Hamroeva (Tajikistan), Ilker Yagcı (Turkey), Ana Zekovic (Serbia), James Anderson (UK)
Contributors PP, SR and AB conceived the study idea. FG, MP, FSiv, TS, MdW, ADW and AZ contributed to the protocol and conceptualisation. APK advised on statistical analyses. DA, FB, IB, SB, KC, PC, RC, ED, NSD, AF, OF, GG, NG, PG, MH, IJ, JV, XJ, MKov, MKull, LCM, MM, SP, NI, ON, IFP, KP, BR, HR, FSza, GS, IS, NS, PS, RS, SSok, SShuk, AT, MT, TU, SMMV collected data. All authors read the manuscript draft and approved the final submission.
Funding This study was partially funded by Abbvie in the context of Fit for Work initiative. SMMV was supported by Versus Arthritis (grant no. 20385) and NIHR Manchester Biomedical Research Centre.
Competing interests None declared.
Ethics approval The project has been approved by Maastricht Ethical Committee. Principal investigators in each country were responsible for local ethical approvals, where necessary.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information.
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