Wout de Boer, MD

TNO Work and Employment

ICF and social insurance of work disability

Köln, 14 October 2003

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Disability for work• Does this person meet the social norm of being

entitled to exclusion form work?

• Is he sick enough?

• Can anything be done about his disability

• Has he done what can be expected from him?

Köln, 14 October 2003

ICF and social insurance of work disability 3

Projects I drain from• 15 country study on criteria, daily practice,

management and control (2003)

• Working group Council of Europe on criteria and assessment (2001)

• Comparison of 7 types of evaluation for work in the Netherlands (2002)

• EUMASS (european association of medicine in assurance and social security) working group on disability evaluation and ICF

• Comparison of 7 disability scales, Barema’s

Köln, 14 October 2003

ICF and social insurance of work disability 4

Viaene: human damage• Disability represents a loss of value of human

existence: a lowering on Y axis

• Due to a specific cause: disease

• Develops in time, X axis, in relationship to Normal expectations that are hypotheses.

Köln, 14 October 2003

ICF and social insurance of work disability 5

N

Y

XTime

D B

N

C

A

Köln, 14 October 2003

ICF and social insurance of work disability 6

• Big question is what is Y?

• Second big question is what is the value of a diminution of Y?

Köln, 14 October 2003

ICF and social insurance of work disability 7

It is not the criterion itself or the concept of disability (earning or working capacity) that determines the Y-axis

Rather, it is the operationalisation that is constructed in an administrative category.

Köln, 14 October 2003

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Operationalisation• Medical: the judgment on disability is on severity of

sickness Body structure and function Listings, Barema’s

• Functional: the judgment on disability is on restrictions of activities Activities Functional scales

• Rehabilitative: the judgment on disability is on possibilities and lack of effect of rehabilitation

• Curative aspect: if treatment is possible judgment may be delayed or for a short period

• In practice decision making most often contains all, motivation of decision is limited

Köln, 14 October 2003

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ICF?• Conceptually close to practice: language

• Reveals hidden links with personal factors and notably environment: policy

• Personal factors like coping and motivation are missing, this is a pity, technically

• Gradation of severity is problematic, what does it mean to a social norm?

• Big questions (What is Y) are more concrete but not anywhere near to being solved!