Purpose The aim of this study was to examine the magnitude of company-level variation in vocational rehabilitation (VR) and to determine which individual- and company-level characteristics are associated with receiving VR due to mental disorders, musculoskeletal diseases, and other somatic diseases. Methods A 30% random sample of all Finnish private sector companies with more than 10 employees aged 25–62 years at the end of 2010 (5567 companies with 300,601 employees) was followed up for the receipt of VR over the next 6 years. Company size and industry, as well as gender, age, education, social class and sickness absence measured both at the individual- and company-level were used as explanatory variables in multilevel logit models. Results After controlling for the individual-level characteristics, 12% of the variance in VR was attributed to the company level. The proportion was largest in VR due to musculoskeletal diseases. Receiving VR was more common among women, older employees (except the oldest age group), those with low education (particularly due to musculoskeletal diseases), low social class, and previous sickness absence. Receiving VR was more common in larger companies, and in construction and in health and social work, and less common in professional, scientific and technical activities. Furthermore, receiving VR was more common in companies with low proportion of highly educated employees and with higher sickness absence rates. Conclusions Company-level variation in receiving VR was substantial. Adopting the practices of the companies with highest participation in VR could help to avoid work disability problems.
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Doyle Y, McKee M, Rechel B, Grundy E. Meeting the challenge of population ageing. BMJ. 2009;339:b3926.
Christensen K, Doblhammer G, Rau R, Vaupel JW. Ageing populations: the challenges ahead. Lancet. 2009;374(9696):1196–1208.
Finnish Centre for Pensions. Rehabilitation within the earnings-related pension system 2017. Helsinki: Statistics of the Finnish Center for Pensions 5/2018; 2018.
Finnish Centre for Pensions. Rehabilitation statistics. https://www.etk.fi/en/statistics-2/statistics/rehabilitation. Accessed 15 Jan 2019.
Escorpizo R, Brage S, Homa D, Stucki G, editors. Handbook of vocational rehabilitation and disability evaluation. Cham: Springer; 2015.
Waddell G, Burton AK, Kendall NAS. Vocational rehabilitation—what works, for whom, and when? Report for the Vocational Rehabilitation Task Group. London: TSO; 2008.
Knardahl S, Johannessen HA, Sterud T, Härmä M, Rugulies R, Seitsamo J, Borg V. The contribution from psychological, social, and organizational work factors to risk of disability retirement: a systematic review with meta-analyses. BMC Public Health. 2017;17(1):176.
Krokstad S, Johnsen R, Westin S. Social determinants of disability pension: a 10-year follow-up of 62000 people in a Norwegian county population. Int J Epidemiol. 2002;31(6):1183–1191.
Carlsson L, Lytsy P, Anderzén I, Hallqvist J, Wallman T, Gustavsson C. Motivation for return to work and actual return to work among people on long-term sick leave due to pain syndrome or mental health conditions. Disabil Rehabil. 2018. https://doi.org/10.1080/09638288.2018.1490462.
Härkäpää K, Järvikoski A, Gould R. Motivational orientation of people participating in vocational rehabilitation. J Occup Rehabil. 2014;24(4):658–669.
Kristman VL, Shaw WS, Boot CRL, Delclos GL, Sullivan MJ, Ehrhart MG, et al. Researching complex and multi-level workplace factors affecting disability and prolonged sickness absence. J Occup Rehabil. 2016;26(4):399–416.
Burström B, Nylen L, Clayton S, Whitehead M. How equitable is vocational rehabilitation in Sweden? A review of evidence on the implementation of a national policy framework. Disabil Rehabil. 2011;33(6):453–466.
Suoyrjö H, Hinkka K, Kivimäki M, Klaukka T, Pentti J, Vahtera J. Allocation of rehabilitation measures provided by the Social Insurance Institution in Finland: a register linkage study. J Rehabil Med. 2007;39(3):198–204.
Saltychev M, Laimi K, Oksanen T, Pentti J, Virtanen M, Kivimäki M, Vahtera J. Predictive factors of future participation in rehabilitation in the working population: the Finnish public sector study. J Rehabil Med. 2011;43(5):404–410.
Fleischmann M, Koster F, Schippers J. Nothing ventured, nothing gained! How and under which conditions employers provide employability-enhancing practices to their older workers. Int J Hum Resour Manag. 2015;26(22):2908–2925.
Fleischmann M, Koster F. Older workers and employer-provided training in the Netherlands: a vignette study. Ageing Soc. 2018;38(10):1995–2018.
Midtsundstad TI. Inclusive workplaces and older employees: an analysis of companies’ investment in retaining senior workers. Int J Hum Resour Manag. 2011;22(6):1277–1293.
Varis J, Hurmerinta S. Companies’ earnings-related pension contributions in 2016. Helsinki: Statistics of the Finnish Center for Pensions 1/2018; 2018.
Toivonen L. Statutory and occupational sickness benefits in Finland in 2011. Online Working Papers 34/12. Helsinki: Kela; 2012.
Snijders TAB, Bosker RJ. Multilevel analysis: an introduction to basic and advanced multilevel modeling. 2nd ed. London: Sage; 2012.
Marklund S, Bolin M, von Essen J. Can individual health differences be explained by workplace characteristics? A multilevel analysis. Soc Sci Med. 2008;66(3):650–662.
Laaksonen M, Rantala J, Liukko J, Polvinen A, Varis J, Kesälä M, Kuivalainen S. Company-level determinants of disability retirement: a multilevel study of Finnish private sector workplaces. Eur J Public Health. 2019;29(6):1062–1068.
Bartley EJ, Fillingim RB. Sex differences in pain: a brief review of clinical and experimental findings. Br J Anaesth. 2013;111(1):52–58.
Salk RH, Hyde JS, Abramson LY. Gender differences in depression in representative national samples: meta-analyses of diagnoses and symptoms. Psychol Bull. 2017;143(8):783–822.
Polvinen A, Laaksonen M, Gould R, Lahelma E, Martikainen P. The contribution of major diagnostic causes to socioeconomic differences in disability retirement. Scand J Work Environ Health. 2014;40(4):353–360.
Laaksonen M, Blomgren J, Tuulio-Henriksson A. Sickness allowance histories among disability retirees due to mental disorders: a retrospective case–control study. Scand J Public Health. 2016;44(3):291–299.
Pulkki JM, Rissanen P, Raitanen JA, Viitanen EA. Use and distribution of rehabilitation services: a register linkage study in one hospital district area in Finland. Int J Rehabil Res. 2011;34(2):160–166.
Aromaa A, Koskinen S. Health and functional capacity in Finland. Baseline results of the health 2000 Health Examination Survey. Helsinki: National Public Health Institute; 2004.
Leinonen T, Laaksonen M, Chandola T, Martikainen P. Health as a predictor of early retirement before and after introduction of a flexible statutory pension age in Finland. Soc Sci Med. 2016;158:149–157.
Polvinen A, Laaksonen M, Gould R, Lahelma E, Leinonen T, Martikainen P. Socioeconomic differences in cause-specific disability retirement in Finland, 1988 to 2009. J Occup Environ Med. 2016;58(8):840–845.
Leinonen T, Martikainen P, Lahelma E. Interrelationships between education, occupational social class, and income as determinants of disability retirement. Scand J Public Health. 2012;40(2):157–166.
Ahlgren A, Bergroth A, Ekholm J, Ekholm KS. Selection of clients for vocational rehabilitation at six local social insurance offices: a combined register and questionnaire study on rehabilitation measures and attitudes among social insurance officers. J Rehabil Med. 2008;40(3):178–184.
Dekkers-Sanchez PM, Wind H, Sluiter JK, Hw Frings-Dresen MH. What promotes sustained return to work of employees on long-term sick leave? Perspectives of vocational rehabilitation professionals. Scand J Work Environ Health. 2011;37(6):481–493.
Liukko J, Polvinen A, Kesälä M, Varis J. Effectiveness and incentive effects of experience rating in disability insurance: a questionnaire study on employers’ views. Helsinki: Studies of the Finnish Center for Pensions 3/2017; 2017
Kyyrä T, Paukkeri T. Does experience rating reduce sickness and disability claims? Evidence from policy kinks. J Health Econ. 2018;61:178–192.
Labriola M, Christensen KB, Lund T, Nielsen ML, Diderichsen F. Multilevel analysis of workplace and individual risk factors for long-term sickness absence. J Occup Environ Med. 2006;48(9):923–929.
Andersen LL, Fallentin N, Thorsen SV, Holtermann A. Physical workload and risk of long-term sickness absence in the general working population and among blue-collar workers: prospective cohort study with register follow-up. Occup Environ Med. 2016;73(4):246–253.
Marmot M, Feeney A, Shipley M, North F, Syme SL. Sickness absence as a measure of health status and functioning: from the UK Whitehall II study. J Epidemiol Community Health. 1995;49(2):124–130.
Kivimaki M, Head J, Ferrie JE, Shipley MJ, Vahtera J, Marmot MG. Sickness absence as a global measure of health: evidence from mortality in the Whitehall II prospective cohort study. BMJ. 2003;327(7411):364.
Leinonen T, Viikari-Juntura E, Husgafvel-Pursiainen K, Virta LJ, Laaksonen M, Autti-Rämö I, Solovieva S. Labour market segregation and gender differences in sickness absence: trends in 2005–2013 in Finland. Ann Work Expo Health. 2018;62(4):438–449.
Conflict of interest
The authors declare that they have no conflicts of interest.
The dataset consists of register data which were anonymized and not possible to trace back to individuals or companies. The Finnish Centre for Pensions obeys the Ethical Standards of The Finnish Advisory Board on Research Integrity and monitors that responsible scientific practice is followed in collecting, analysing and reporting of data.
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Laaksonen, M., Rantala, J., Liukko, J. et al. Individual- and Company-Level Predictors of Receiving Vocational Rehabilitation: A Multilevel Study of Finnish Private Sector Workplaces. J Occup Rehabil 30, 263–273 (2020). https://doi.org/10.1007/s10926-019-09869-8
- Rehabilitation, vocational
- Risk factors