Graded return to work: Using claims data for evaluating follow-up effects

Motivation: The implementation of a graded return-to-work (RTW) program to reintegrate those in long-term sickness started in Germany in 1971. The program is manifested in the Social Code Book V since 1989. Based on a return plan by the physician and insured, participants increase their working hours slowly over a specified period of time. As participants are still classified as incapable of working they still receive sick leave benefits. Literature on RTW programs shows a positive effect for those participants with longer sickness duration (approx. > 120 – 150 days) [1 – 3].

Aims: The study aims at analyzing the follow-up year of those on long-term sick leave after returning to work using claims data of the Techniker Krankenkasse (TK). Research questions focus on two aspects: First, to match program participants and non-participants and second, to assess sickness spells, demand for medical services and resulting costs one year after the return to work. In comparing both groups, we account for socio-economic factors, insurance-based characteristics and medical information such as ICD diagnoses for the initial sickness spell.

Methods: Using data on sick leaves from claims data of the Techniker Krankenkasse, we consider sick-leave spells starting from October 2010 to January 2011 with a successful return to work prior to a length of 517 days. We apply a propensity score matching [4](Greedy matching) between participants and non-participants to further analyze differences in sickness spells, medical demand and treatment costs in a follow-up year.

Results: In the considered time period, 26 761 cases of sick leave longer than 42 days who returned to work are followed. Among these cases, 6702 individuals participated in the RTW program. The most frequent diagnoses were musculoskeletal disorders, mental health problems and injuries. After matching, we identified 6 443 insured-pairs. We find only small differences in sickness spells and medical costs between treatment and control group. In detail, RTW participants show slightly lower expenditures on hospitals but higher for ambulatory services and pharmaceuticals. Moreover, differences in expenditure are related to diagnoses of the initial sickness spell. Furthermore, former RTW participants are more likely to take part in a RTW program in the follow-up year.

Discussion: Return-to-work programs are a valuable tool in the occupational health management and serve as an important instrument for sickness funds to support transition from long-term sick leave periods into regular work. The study emphasizes the need to further promote this instrument among insured, physicians and employers as occupational health management is one key for a successful and sustainable return-to-work.