Use of Health Services and Rehabilitation before and after the Beginning of Long-Term Sickness Absence-Comparing the Use by Employment and Disability Pension Transition after the Sickness Absence in Finland

Abstract

The objective of the study was to follow the health care and rehabilitation use before, during and after long-term sickness absence (LTSA), and to compare the use by post-LTSA labour market situation in terms of disability pension and employment. Individuals aged 18-58 with a ≥30-day LTSA spell in 2015 (N = 2427) were included from the total population of the city of Oulu, Finland. Register data included LTSA spells, outpatient health care visits, inpatient care spells and rehabilitation spells, disability pensions (DP), employment dates, and demographic, socioeconomic and disability-related covariates. The study population was followed for one year before, and three years after the start of LTSA. Negative binomial regression models were utilized to examine covariate-adjusted use of the three service types and group differences. The use of outpatient health care peaked at the start of the LTSA spell, and adjusted for covariates, the height of the peak was similar regardless of post-LTSA labour market situation. Adjusted for covariates, those who transferred to permanent DP after an LTSA used more outpatient (predicted mean 4.87 for attendance days quarterly, 95% CI 4.36-5.38) and inpatient (predicted mean 84 days quarterly, 95% CI 0.62-1.06) health care than others during three years after the start of LTSA. Individuals not employed after an LTSA showed the highest and increasing level of rehabilitation use. The results indicate that Individuals returning to employment after an LTSA are provided with relatively high amount of early outpatient care, possibly aiding the return. For individuals not employed after an LTSA, rehabilitation is used quite frequently but rather late in the disability process. The frequent use of health care among future disability pensioners is consistent with their increasing health problems leading to retirement.

Keywords: disability pension; employment; health care; labour market status; long-term sickness absence; longitudinal; rehabilitation; socioeconomic determinants; trajectories.

Figure 1

The use of three service types in the four LTSA groups. (a) Number of outpatient health care visits; (b) number of days in inpatient care; (c) number of days in rehabilitation.

Figure 2

Covariate-adjusted * use of three service types in the four LTSA groups (predicted means and 95% confidence intervals). (a) Number of outpatient health care visits; (b) number of days in inpatient care; (c) number of days in rehabilitation. Note: * Sex, age group, marital status, occupational class, labour market status at the start of LTSA, chronic or severe diseases, LTSA length, and LTSA diagnosis group.