Impact of the reform adding new sickness allowance checkpoints on rehabilitation and employment

BACKGROUND: In 2012, new sickness allowance checkpoints after 30, 60 and 90 sickness absence days were introduced in Finland to improve earlier detection of long-term work disability and to fasten return to work after illness. We examined whether the reform affected participation in rehabilitation and employment outcomes one year after the start of sickness allowance. METHODS: We conducted an interrupted time series analysis among working-age persons accumulating at least 30, 60 and 90 sickness allowance days and starting their SA during a time span covering three years before the reform and two years after the reform. Poisson regression analysis controlling for seasonal variation, gender, age, and education level was used. RESULTS: After the reform, the probability of receiving rehabilitation within one year after the start of a sickness allowance period lasting at least 30 days was increased by 5.1% (IRR 1.051, 95% CI 1.015-1.086). The increase after the reform was slightly larger regarding the 60 and 90 day checkpoints. Looking at the type of rehabilitation, vocational rehabilitation from the earnings-related pension scheme increased the most. Regarding the rehabilitation provided by the Social Insurance Institution of Finland, vocational rehabilitation, medical rehabilitation, and discretionary rehabilitation increased, but only the latter increase was statistically significant. In contrast to rehabilitation, changes in employment outcomes (employment, unemployment, sickness allowance and disability pension) after the reform were negligible. CONCLUSIONS: The introduction of new sickness allowance checkpoints increased participation in rehabilitation but did not affect employment outcomes one year later. The results indicate that the reform only partly succeeded in fulfilling its goals. Future policy changes should seek to find measures to help people enter the labor market after rehabilitation. KEY MESSAGES: • The introduction of new sickness allowance checkpoints after 30, 60 and 90 sickness absence days increased rehabilitation but did not affect employment outcomes one year later. • Future policy changes should seek to find measures to help people enter the labor market after rehabilitation.