Vabljeni predavatelji

Prof.dr. Geert Van Hove, PhD - Ghent University, Belgium/ VU Amsterdam, University Medical Center, Nizozemska

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Prof. dr. Geert van Hove has been professor in Disability Studies and ‘Inclusief Onderwijs’ at the University of Ghent, department of Special Education since 1993. In the 80’s he started several projects, as one of the first researchers in Belgium, for people with intellectual disabilities.

Prof. dr. Geert van Hove Professor by Special Appointment in Disability Studies Starting the first of December 2013, prof. dr. Geert van Hove is appointed as professor by special appointment in Disability Studies, at the VUmc Department of Medical Humanities and within the EMGO+ Institute.

What can we learn from narratives about work ? Voices of persons with disabilities/chronic illnesses.

This lecture takes a Disability Studies perspective. Disability Studies is an academic discipline that grew out of grassroots, rights-based politics in the 70ies and since then focused upon ways historical, social, cultural, political and economic framings of disability simultaneous came into play with other discourses of disability – impacting the degree of access and participation persons with disabilities have to all aspects of society. Following the Disability Studies slogan (of the disabled people’s movement) ‘Nothing about us without us’ (Charlton, 2002) in recent years narrative forms of inquiry became increasingly visible within Disability Studies.

In this lecture we will present narratives of persons with disabilities/chronic illnesses living in different countries about work. The analysis of these stories follows a cooperative research strategy.

    While analysing the narratives we will make use of different frameworks:

  1. E.g. the critical stance base on the question ‘why many people with disabilities identify with the ‘liberal individualism’ upon which participation in the capitalist labour market is largely based
  2. E.g. the rights based perspective that states that participation in the regular labour market has to be seen as a basic human right for all citizens
  3. E.g. the comparative perspective where we try to link the different stories with the different contexts narrators live in.
  4. E.g. a phenomenological perspective through Interpretive Phenomenological Analysis. Within IPA researchers look for a balance between phenomenological description and interpretations that are based in the narratives as presented.

prof. Kristina Alexanderson, PhD - Professor and Head of the Division of Insurance Medicine at the Karolinska Institutet, Stockholm, Švedska

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Kristina Alexanderson is a professor of social insurance and head of the Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet in Stockholm Sweden. She is a leading researcher within the field of insurance Medicine.

She leads the interdisciplinary research group ’Sickness Absence, Health, and Living Conditions’, where some 20 different research projects are run and about 35 people work. She has since 25 years conducted research mainly on different aspects of sickness certification, sickness absence, and disability pension (in general and with specific diagnoses, such as cancer, MS, mental disorders, or in occupational groups). Focus is on 1) risk factors for sick leave or disability pension; 2) consequences of being sickness absent or disability pensioned; 3) factors that hinder and promote return to work; 4) sickness certification practises; and 5) methods and theories within this research area.

She has published about 225 peer reviewed articles, 40 book chapters, and 80 scientific reports. The research is interdisciplinary, using both epidemiological and qualitative methods with extensive international research collaborations.

She has several commissions including being the president of the European network for sickness absence researchers – the Section for Social Security, Work and Health within the European Public Health Association (EUPHA) and member of the Executive Council of EUPHA, member of the Scientific Committee of EUMASS, and the Board of Cochrane Insurance Medicine. She also runs academic courses in insurance medicine.

Are there ‘side effects’ of being sickness absent?

To sickness certify a patient is a common procedure in healthcare. Regarding other healthcare procedures we want to base them on scientific knowledge regarding pros and cons and discuss those with the patient, especially regarding possible side effects. What such knowledge do we have regarding being sickness absent, for different diagnoses, occupations and for different duration?

So far, most studies on sickness absence concern risk factors for becoming sickness absent. There are also some studies in physicians’ sickness certification practices and on factors affecting return to work. However, the number of studies on future situation among sickness absentees is very limited, but increasing. Aspects studied are e.g., consequences for health, morbidity, premature death, social isolation, life style factors, economy, and career. Scientifically, the challenge is to differentiate the consequences of the disease from being sickness absent due to that disease. Different types of studies as well as results from such studies will be presented.

prof. Haije Wind, PhD - University of Amsterdam, Nizozemska

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Haije Wind is an insurance physician and professor in insurance medicine at the University of Amsterdam. He is a member of the Council Board of the Research Center for Insurance Medicine in the Netherlands, which has succeeded in building a solid infrastructure for the scientific development of insurance medicine in the Netherlands in the last ten years. The topic of his PhD thesis was the utility of Functional Capacity Evaluation (FCE) information for insurance physicians in performing disability assessments. He is a practising insurance physician and performs research at the Coronel Institute of Occupational Health, University of Amsterdam. His main areas of research are improving the quality of disability assessments in the Netherlands and developing guidelines for insurance and occupational physicians. He is particularly involved in developing guidelines on Acquired Brain Injury, Depression and Chronic Disorders, all in relation to work participation. He has a special interest in the work participation of young disabled. Additionally, he is involved in the education programme for medical students in their bachelor and master degrees as well as postgraduate physicians training to become insurance physicians.

More young disabled persons working: that is what it is all about!

In the Netherlands claims for disability benefit among young handicapped persons have increased and still increase. Under current legislation many young handicapped persons receive a disability benefit and get support to find work that fits with their capacities. However, the labelling as disabled appeared to be an obstacle towards participation in work for young handicapped persons. To overcome this obstacle, there have been a number of adjustments in the legislation, leading to more emphasis on activation and work participation. Up till now these measures were not very effective.

The maxim nowadays is that ‘who can work, should work’ and we are on the threshold of again a radical change in legislation for this group of young handicapped persons. For those young handicapped persons that do not have any abilities to participate in work, the new legislation has no impact. They keep their right to a disability benefit. For all others the medical focus shifts from assessing earning capacity towards assessing work abilities. This has consequences for the assessment procedure that shifts from the right to benefit towards the right to work. This puts emphasis on other relevant work-related aspects, such as person characteristics and environmental context. This is where the ICF (International Classification of Functioning, Disability and Health) comes in. The change in assessment of functional abilities of young handicapped persons in the Netherlands is supported by the application of the ICF in the disability assessment procedure. This is in line with the bio-psycho-social model that is nowadays leading in the world of disability assessment. Insurance physicians should be able to describe impairments in terms of limitations in activities. This requires new competencies and skills of insurance physicians and therefore has consequences for the training of insurance physicians. It could even be discussed whether or not it would be better to involve other disciplines than IP’s in these assessments. Already labour experts have an important role in the new procedure of disability assessments of young handicapped persons. Another important aspect of the new procedure is the reliability of assessments on which the disability benefit is based. However, the big question is: what does this change of legislation mean for the young handicapped persons? Will they benefit from this change in assessment procedure? Will this change lead to more young handicapped persons finding the way to work participation? Will this change lead to better ‘health’ for young handicapped persons? These are the key questions that need to be asked when evaluating this new assessment procedure, because that is what it is all about: more young handicapped persons working!

prof. Helena Burger, PhD - URI Soča, University of Ljubljana, Faculty of Medicine, Slovenija

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Dr. Helena Burger is a specialist of Physical and Rehabilitation Medicine (PRM) at the University Rehabilitation Institute, Republic of Slovenia (URI) and Professor of Physical and Rehabilitation Medicine at University of Ljubljana, Ljubljana, Slovenia. Dr. Burger is Medical Director of the URI, the board member of the European Federation for Research in Rehabilitation and member of the European Academy of Rehabilitation Medicine. She is also a board member of the Prosthetics Orthotics International and of the International Journal for Rehabilitation Research.

Dr. Burger has been active, both nationally and internationally, in PRM, specially in Prosthetics and Orthotics and Rehabilitation of people following amputations, including war victims, victims of unexploded objects and implementing ICF into clinical practice. She established the ITF programme for Land Mine Victims Rehabilitation at the URI and leads it for five years and programme for Rehabilitation of Children following Amputations. For Land Mine Victims Rehabilitation programme URI got the award of the World Veterans Federation.

She published over 40 articles in International Journals on Rehabilitation, specially Rehabilitation following amputations and Outcome measurement. She also participated at several European and national research projects and has been coordinator of several national projects.

Vocational Considerations after Amputations

Amputation itself is a change in body structure. It has a huge influence on many activities, participation (including the ability to work), and also on quality of life. The ultimate objective of rehabilitation is to allow persons after amputation to integrate in the community as independent and productive members, which also means to allow them to work. Rehabilitation outcome is successful when a person returns to active employment, but may have to change jobs. The percentages of persons who successfully returned to work (RTW) differ from study to study and whereas persons have lower or upper limb amputation. There are several factors that influence return to work. According to the International Classification of Functioning, Disability and Health they can be divided into health condition, body functions and structures, activities, environmental and personal factors.

For health condition most authors agree that co-morbidities, level of disability, reason for amputation (injury, specially work related injury versus other reasons), other major injuries during the accident that causes amputation, problems with residual and contralateral limb, phantom and stump pain are negative predictors for RTW.

There are no studies on influence of body functions, such as muscle strength, range of motion (ROM), balance and other on problems at work or RTW. Factors from body structure part are amputation level, stump and skin condition.

None of the authors really studied the influence of activities and participation on RTW. Activities such as walking, climbing stairs, using public transportation and driving are important for going to/from work and also for several working tasks, and can therefore – when impeded – be a reason for reduced productivity.

Environmental factors influencing return to work are prosthesis, climate, geography, type of work, support, transportation services, legal and social security services and health services, systems and policies.

Personal factors influencing return to work are gender, age, education, motivation, person’s attitude about RTW, being white, being a non-smoker, higher self-efficacy, no litigation, and unemployment in the general population.

Persons after amputation, both of lower and upper limbs, have problems with RTW and at work. Several factors, not all independent, influence RTW after amputation. However, RTW may increase and problems at work decrease if the affected persons are included into comprehensive interdisciplinary rehabilitation that includes vocational counselling.

prof. Regina Kunz, MSc - Basel University, Švica

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Prof. Regina Kunz is an internist and clinical epidemiologist. Since 2010, she is director of asim, the Swiss Academy of Insurance Medicine at Basel University Hospital. asim runs a unit for independent medical evaluations (IMEs), a research department and a postgraduate Master’s program in insurance medicine. Prof Kunz is an expert in evidence-based medicine and guideline development with a focus on gearing insurance medicine towards increased transparency and reliability. In 2015, together with partners from the Netherlands, Sweden, and Canada she founded Cochrane Insurance Medicine, a Field within the famous Cochrane collaboration. Her research concentrates on exploring and improving the consistency of IMEs, especially for work capacity evaluations, and thereby improve their quality. Her research also looks at getting patients who have suffered accidents or chronic illnesses back into working life promoting interventions with proven effectivenes. asim has launched a number of postgraduate programmes to promote professionalism and quality standards in insurance medicine.

Return to work: where do we stand with the evidence?

Promoting return to work of people with impaired health is a core task in insurance medicine and in social insurance in general. Very many ideas on how to do it best have been developed which inspired interventions that are now in place. In modern times, one would expect that return to work promotion would be based on solid evidence. Indeed, much research has been carried out to determine the best ways to promote return to work. Nevertheless, the best approaches have not yet been established. What are the challenges in practice and in research? What difficulties prevent researchers to produce scientific results that everyone seems to be waiting for? Strategies in practice and research emphasise the individual, the work situation and the process and the institutional environment. In this presentation, I will focus on the scientific results and scientific difficulties at the level of the interventions and the indication for the interventions: the assessments of work capacity. I will sketch ways to improve the evidence in this important area.

doc. Breda Jesenšek Papež, PhD - Institute of Physical and Rehabilitation Medicine, UKC Maribor, Slovenija

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Breda Jesenšek Papež graduated from Medical Faculty of the University of Ljubljana, Slovenia in 1986. In 1994 she completed her specialization in physical medicine and rehabilitation at the Medical Faculty in Ljubljana. In 1997, she finished post-graduate studies in neuroscience at the Medical Faculty of Zagreb University, Croatia, where she also received her Master of Science degree in 2002. She obtained her PhD in 2009 at the Medical Faculty of University of Maribor, where she currently teaches as an assistant professor. Breda Jesenšek Papež has headed the Institute of Physical and Rehabilitation Medicine at the University Clinical Centre Maribor since 2009. As of 2015 she is head of Department of Physical and Rehabilitation Medicine at the Medical Faculty of Maribor University.

Possibilities of returning to work in patients with neurological impairments - reality or illusion? A viewpoint of a rehabilitation medicine physician

Rehabilitation is a line of profession which, by definition, treats a patient as a whole, comprising also their work capacity and return to work. The rehabilitation of patients with neurological impairments is a dynamic process, which may last a few weeks, months, years or even their entire life. Its goal is to restore patients’ independent functioning and social reintegration, all within the limits set by the degree of their impairment. Neurological rehabilitation spans a wide range, comprising patients with various neurological impairments. The impairment score ranges from mild impairments to severe impairments of central and peripheral nervous system and target organs. There is a wide variation in clinical features, the outcome of rehabilitation, however, depends on the cause of impairment, the extent of impairment, timely treatment, complications, accompanying diseases and a patient’s age.

Comorbidity has a decisive effect on the planning and outcome of rehabilitation. A rehabilitation team includes various experts, depending on the specific needs of a patient. The basis of the rehabilitation of patients with neurological impairments is represented by the complexity of treatment and team work. In the past early rehabilitation was primarily aimed at physical and psychological effects of neurological impairment. A modern approach primarily focuses on one’s functioning and a biopsychosocial concept of impairments, which also takes into consideration environmental and personal factors (ICF classification). Within the framework of interdisciplinary treatment, occupational rehabilitation and early intervention of therapy programs towardsthe returning of a patient to work are thus becoming increasingly relevant.

The presentation is going to contain organisational levels, staff benchmarks and clinical practice in the implementation of the rehabilitation in patients with neurological impairments in Slovenia. We are going to point out the specificity in neurorehabilitation as well as objective and subjective obstacles regarding patients’ return to work. The problems regarding the planning and implementation of programs, including accountability for achieving rehabilitation goals, are going to be pointed out, on an individual as well as social level. We are going to stress the significance of collaboration with funding institutions and a general practitioner. The lecture is going to be supported by practical examples and the current situation compared with evidence based models and good practice examples.

assist. prof. Corina Oancea, PhD - Lecturer at the Discipline of Medical Assessment and Work Capacity Rehabilitation of the Carol Davila University of Medicine and Pharmacy Bucharest, Romunija

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Corina Oancea is an internist and social insurance physician. Since 2015 she is assistant professor at "Carol Davila" University of Medicine and Pharmacy Bucharest. She is author/co-author of 29 articles published in extenso (3 published in ISI journals), first author of a monograph and author/co-author of 76 papers presented at scientific meetings (12 presented at international congresses). She has been member of research teams in national/international projects focused on different aspects of social insurance medicine. She is the Secretary General of the Romanian Society of Medical Assessment and Work Capacity Rehabilitation and member of the Scientific Committee of EUMASS.

The role of the (social) insurance physician in vocational rehabilitation; An international survey

Return to work of people with health conditions is an item of major interest in many European countries, considering the positive implications both on social security schemes and on the health and wellbeing of the workers. In different countries many different procedures are in place, involving different types of professionals and much research is going on about what interventions for return to work are effective in which cases. One group of professionals involved in sick leave and return to work, are physicians who work for, or in, social security or private insurance. Their role is typically to certify sick leave and assess work capacity but some are also active in promotion of return to work. It is unknown what their involvement is and how far it goes, beyond the assessment of capacity for work.

It is relevant to know this as it helps us understand the process of promotion of return to work, to identify the best practices, to understand the qualifications that physicians need and to support the identity of insurance physicians as not only judging but also caring.

This presentation aims to operationalize the concept of promoting return to work into professional activities, as they are carried out in the context of the great diversity of the socio-economic and legal environments across European countries. We drafted and piloted a questionnaire based on these functions. We carry out a survey with this questionnaire and interview respondents in countries where the roles of the physicians are well developed. The data will be collected and analysed to illustrate the extent of the insurance physicians’ efforts to promote return-to-work.

The degree to which the findings can be used to draw up valuable recommendations, based on the opinion of international experts, reflecting the physicians’ perspective, beyond the organization and the tradition of different social security systems, will be discussed.

prof. Dr. Oskar Mittag, Institute for Quality Management and Social Medicine, University Medical Center of Freiburg, Nemčija

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Education

  1. 1972 – 1978: Studies in psychology (University of Cologne, University of Trier)
  2. 1985: Doctor of Science (University of Trier)
  3. 1999: Licensed psychotherapist
  4. 2005: Postdoctoral lecture qualification (University of Luebeck)

Employment Record

  1. 1978 – 1982: Scientific assistant / lecturer (University of Trier)
  2. 1983 – 1984: Scientific assistant / lecturer (University of Cologne)
  3. 1984 – 1986 Head of psychology department of a cardiac hospital center in Schleswig-Holstein
  4. 1986 – 2001: Head of psychology department of the Federal German Statutory Pension Insurance Schleswig-Holstein
  5. 2001 – 2007: Senior researcher (Institute of Social Medicine, University of Luebeck)
  6. 2007 – Senior researcher / lecturer (Institute for Quality Management and Social Medicine, University Medical Center of Freiburg), Associate professor (Institute of Psychology, University of Freiburg)

Main areas of interest

Social medicine, rehabilitation psychology, evidence based medicine

Social Security and Return to Work Efforts in Four European Countries

Oskar Mittag; Hanna Kampling; Tomaž Tomažič; Christina Reese; Felix Welti

Over the past 20 years most European countries have taken measures in order to reduce inflow rates into disability benefit schemes, and foster return to work (RTW). We study the social security systems of 4 countries (Finland, Germany, Netherlands and Slovenia), and compare them as to disability benefits and vocational reintegration efforts (e.g. rehabilitation). The Netherlands have successfully reduced the formerly high percentage of people receiving disability benefits by a number of legislative reforms. Essential part of these reforms is a clearly defined sequence of actions during the first two years of disability as well as strong incentives for vocational reintegration. In comparison, employers as well as employees in Germany face fewer (financial) incentives for RTW. In the Netherlands, occupational and insurance physicians play an important role in the assessment of incapacity for work. In Finland, occupational health care and (vocational) rehabilitation are considered very important.

prof. Angela de Boer - University of Amsterdam, Nizozemska

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Angela de Boer is a researcher and lecturer at the Coronel Institute of Occupational Health of the Academic Medical Center in Amsterdam. The focus of her research is on cancer and work. Her research programme aims to provide high-quality, evidence- based contributions to: 1) identify prognostic factors for return-to-work and work maintenance of cancer survivors; 2) explore cancer survivors’ views on return to work and to continue working; 3) assess the impact of cancer on return-to-work and to work continuation; 4) assess quality of working life of cancer survivors; 5) improve psychosocial oncological care regarding work-related issues by designing and evaluating interventions for cancer patients; and 6) assess cost-effectiveness of work-related oncological interventions.

She chairs the EU-funded COST network on cancer and work CANWON of 80 members.

Cancer and work

In Europe, 3.2 million new cases of cancer are diagnosed each year with every 1 in 4 people ever diagnosed with cancer. The prevalence of cancer survivors of working age is expected to grow in European countries because of an ageing population, higher retirement age and continued improvements in treatment of many forms of cancer.

Almost half of all cancer survivors are younger than 65 years. Most cancer survivors want to resume work after treatment but not all survivors succeed to do so and their unemployment is 40% higher than in people who never had cancer.

For this reason, innovative interventions that mitigate the economic impact of surviving cancer and improve the quality of life of survivors are urgently required. In the past two decades, several interventions have been developed with approaches that were either psychological (e.g. counselling), physical (e.g. physical exercise, clinical interventions), vocational (e.g. job placement services, vocational rehabilitation), occupational (e.g. educating employers, implementation of work adjustments), and/or legislative (e.g. anti-discrimination acts) in their emphasis.

Multidisciplinary interventions have been proved to be most effective in return to work and work retention of cancer survivors. However, research has also shown that collaboration between clinical specialists in the curative centres and professionals working in insurance or occupational medicine, can be challenging. Positive results can nevertheless be achieved when barriers for collaboration are removed.

There is a growing international awareness of the work situation of cancer survivors. International networks uniting professionals, researchers, employers and stakeholders concentrate on disseminating research knowledge and best practice. Collaboration between countries on the development of evidence-based, validated interventions for work participation of cancer survivors to prevent unemployment will highly benefit the lives of millions of cancer patients in Europe and beyond.

prof. Anne-Claude Crémieux, PhD, Francija

Mobile teledermoscopy for skin cancer screening targeting agricultural population : an experience in France on 289 patients

Introduction: The incidence of melanoma and non-melanoma skin cancer has reached epidemic proportions in white population. With 80 000 new cases per year, skin cancer is the most frequent localization of cancer in France and the trend is still rising. Between 1980 and 2005, the incidence of melanoma, has tripled. In 2012, 11 176 new cases were diagnosed and melanoma was responsible of 1672 deaths. Agricultural populations are exposed to ultraviolet radiation during their professional activities. Incidence of non-melanoma and melanoma skin cancer is significantly increased in this population compared to the general population.

In 2014 the organization in charge of health insurance for agriculture (Mutualité Sociale Agricole, MSA) offered to its customers living in rural area with reduced access to dermatologist, to participate to a one-day teledermoscopy screening event, organized jointly with the Union of dermatologists (Syndicat national des dermato-vénérologues, SNDV) for the « national skin cancer screening day ».

The aim of this work was to assess the feasibility of a mobile teledermoscopy triage of a large number of agricultural workers by occupational physicians and medical officers.

Methods: Fifteen teledermoscopic screening centers were located in different area in France. Those areas were selected for their low density of dermatologists. Patients were attended by appointment by an occupational physician or a medical officer working for the MSA, previously trained by a oneday course on skin tumors by dermatologists of the SNDV. Those volunteers’ physicians were also taught how to acquire both clinical and dermoscopic images. Individuals older than 18 years, affiliated to the MSA, working in agriculture and living in rural area near a teledermoscopic screening centers were invited by e-mail or letter to participate to this skin cancer screening.

Skin lesions were screened through the examination of the entire body. In case of suspicious skin lesions, digital images of these lesions were performed with a mobile cellular phone and dermoscopic pictures were obtained. Images correlated by age sex and location of the lesion (clinical history was optional) were then transferred for teleconsultation to the dermatologist platform located in the central institution in Paris. Three dermatologists with high experience in dermoscopic were simultaneously present at the platform all the day for diagnosis and decision-making.

Images were reviewed by one or two of them, then the lesions were grouped into four management categories: (i) No further treatment or follow up required (ii) Follow up at 12 months interval (iii) Patient was advice to take an appointment with dermatologist of his choice with no emergency (iiii) Referral to a local dermatologist for rapid face to face examination or excision. In that case the appointment was organized by the MSA physician.

Results: On the 289 patients (67% men) who underwent skin cancer screening, 56% were farm owners, 24% agricultural workers and 16% retired; the median age was 54 years-old.

For 199 patients (69%), one or more suspicious lesions were identified and generated 412 pictures. Management recommendations by dermatologists present on the platform were as followed:

  1. 105 patients (53%): no follow up required
  2. 16 patients (8%) with one or more lesions need to be followed at 12 months interval
  3. 61 patients (31%) referred to a dermatologist without emergency
  4. 17 patients referred by the MSA physician to a local dermatologist for a rapid examination including 12 suspicion of melanoma

On these 12 patients, 11 were examined by the local dermatologist within 10 days and biopsy was performed in 9. Melanoma was confirmed by histopathology in one patient. For the 8 other lesions, atypical nevi or actinic keratosis were the main final diagnoses.

Conclusion: Mobile teledermoscopy cancer screening targeting agricultural population and performed by occupational physicians and medical officers was feasible and has potential clinical and economic benefits as it diagnosed within 10 days 1/289 patient with melanoma (versus 10 per 100 000 inhabitants in the general French population) and allowed to avoid a face to face examination by a dermatologist in in 53% of cases.

Prof. Dr. iur. Kurt Pärli, Professor for Private Social Law at the University of Basel, Švica

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Enforced cooperation for patients – implications for Social Rights

In this presentation it is argued that the shift from Welfare to Workfare and the overall trend to social policies and work place activities with a focus on activation and integration in the labour market should be in line with major constitutional values. Reform of Sickness Benefit Acts and legal practice towards a more active role for the sick employee leads to much tighter control leaving less room for autonomy. One could prove this thesis with the Swiss case law of the Federal Court regarding somatoform disorder and other diseases that are not accepted as relevant causes for social benefits. On the other hand, more and more treatments as for example psychiatric therapy or even surgical interventions are demanded from patients as part of their cooperation under Social Security Laws all over Europe. If behaviour control and sanctions are rising, it is not a surprise that employees tend to avoid sick leave and even more, go to work despite sickness. This relatively new phenomenon is labelled as “presenteeism”. Offensive and repressive activation of sick employees leads to crucial human rights questions like the right to privacy, the Right for freedom of choice and the nondiscrimination rule. Policies for the activation of sick employees should be reconstructed under a Human Rights perspective. Constitutional constraints should hamper the enactment of too repressive activation for sick employees and other sick persons.

prof. Luc Barret, PhD - CnamTS, Francija

PRADO- a home-based-program for patients hospitalized with hearth failure.

Cardiac failure leads to frequent hospitalisations, being the nr 1 cause of hospitalisation of people over 65. The personal and financial loss of this is considerable, representing 1 to 2 % of cost of health care in industrialised countries. With patient education, coaching and home surveillance many hospitalisations can be avoided. Based on these principles, programs have realised a reduction of rehospitalisations of 25 to 30%.

Therefore, the French health care insurance (CNAMTS) cooperated with the French cardiology society (Société française de cardiologie) to create a programme to support the return to home for patients hospitalized for heart failure, (PRogramme d’Accompagnement du retour à DOmicile des patients hospitalisés, PRADO). This programme aims at reducing the number of rehospitalisations by organising the return to home, optimising the medical care and organising home surveillance by a specialised nurse.

This programme was started by mid- 2013 in 10 pilot hospitals. It is being rolled out to all French hospitals until 2017. On January 1st of 2015 some 1000 patients were included, in 27 hospitals.

Evaluation is foreseen on the process and on results (mortality, rehospitalisations, medico-economic evaluation). By the end of 2015 the first results will be available.

Health care insurance strives to enrich its services with this programme, which fits in France’s national health strategy.