THE EFFECTIVENESS OF OCCUPATIONAL DOCTORS AND SPECIALISTS IN THE REDUCTION OF SICKNESS ABSENTEEISM AMONG SELF-EMPLOYED

Transcription

1 STIJN BAERT BAS VAN DER KLAAUW GIJSBERT VAN LOMWEL THE EFFECTIVENESS OF OCCUPATIONAL DOCTORS AND SPECIALISTS IN THE REDUCTION OF SICKNESS ABSENTEEISM AMONG SELF-EMPLOYED Brownbag Lunch Workshop Aarhus University 03/06/2013

2 Research portfolio Dynamic discrete choice Overeducation at the start of the career: stepping stone or trap? Experimental econ. / Correspondence testing Do they find you on Facebook? The impact of revealed personality traits by CV and Facebook pictures on hiring decisions Pure Ethnic Gaps in Educational Attainment and School to Work Transitions. When Do They Arise? The labour market effects of vocationalised higher education: is there a tradeoff? Hiring discrimination against physical or psychological disabled school-leavers: the effect of wage subsidies The impact of military work experience on later civilian hiring chances. Evidence from a field experiment Track Mobility, Grade Retention, and Secondary School Completion Does homeownership lead to longer unemployment spells? The role of mortgage payments Do Employers Discriminate Less if Vacancies are Difficult to Fill? Evidence from a Field Experiment Career lesbians: getting hired for not having kids? Timing of Events / Duration models The effectiveness of occupational doctors and specialists in the reduction of sickness absenteeism among selfemployed Labour market discrimination against exoffenders: evidence from a field experiment in the youth labour market S. Baert Schoolresultaten, results, schoolbeslissingen decisions Research en and de transitie the portfolio transition van school to work: naar the werk: rolede of ethnicity rol van etniciteit 2

3 Research portfolio Dynamic discrete choice Overeducation at the start of the career: stepping stone or trap? Experimental econ. / Correspondence testing Do they find you on Facebook? The impact of revealed personality traits by CV and Facebook pictures on hiring decisions Pure Ethnic Gaps in Educational Attainment and School to Work Transitions. When Do They Arise? The labour market effects of vocationalised higher education: is there a tradeoff? Hiring discrimination against physical or psychological disabled school-leavers: the effect of wage subsidies The impact of military work experience on later civilian hiring chances. Evidence from a field experiment Track Mobility, Grade Retention, and Secondary School Completion Does homeownership lead to longer unemployment spells? The role of mortgage payments Do Employers Discriminate Less if Vacancies are Difficult to Fill? Evidence from a Field Experiment Career lesbians: getting hired for not having kids? Timing of Events / Duration models The effectiveness of occupational doctors and specialists in the reduction of sickness absenteeism among selfemployed Labour market discrimination against exoffenders: evidence from a field experiment in the youth labour market S. Baert Schoolresultaten, results, schoolbeslissingen decisions Research en and de transitie the portfolio transition van school to work: naar the werk: rolede of ethnicity rol van etniciteit 3

4 STIJN BAERT BAS VAN DER KLAAUW GIJSBERT VAN LOMWEL THE EFFECTIVENESS OF OCCUPATIONAL DOCTORS AND SPECIALISTS IN THE REDUCTION OF SICKNESS ABSENTEEISM AMONG SELF-EMPLOYED Brownbag Lunch Workshop Aarhus University 03/06/2013

5 WHY THE ANSWER MAY BE YES Moral hazard in public sickness insurance is found among employees Higher sick leave benefits lead to higher sick leave durations (Johansson & Palme, 2005) Gatekeeping by physicians is found to be important to reduce sick leave among them Postponing certificate requirement led to higher sick durations in SE (Hesselius et al., 2005) Stricter regulations for certification led to lower sick durations in NO (Markussen, 2010) ARE OCCUPATIONAL DOCTORS AND SPECIALISTS EFFECTIVE IN REDUCING SICK LEAVE DURATIONS AMONG SELF-EMPLOYED? RESEARCH QUESTION 5

6 WHY THE ANSWER MAY BE NO The evidence for employees may not be generalised to the self-employed Self-employed: financial motives to keep absence durations as short as possible Self-employed: more satisfied and involved with their jobs (Blanchflower and Oswald, 1998) Self-employed: need for achievement, love of independence, optimism (Parker, 2004) Private instead of public health cover ARE OCCUPATIONAL DOCTORS AND SPECIALISTS EFFECTIVE IN REDUCING SICK LEAVE DURATIONS AMONG SELF-EMPLOYED? RESEARCH QUESTION 6

7 Overview 1. Institutional settings and data 2. Econometric model 3. Results 4. Conclusion 7

8 1 Institutional settings and data Private insurance system In the Netherlands, sickness insurance for the self-employed is only available from private insurance companies We analyse database of major private Dutch insurance company Two importance modalities of insurance contract: Deferment period: time period between falling sick and start of benefit payment Insured income Active case management in order to enhance recovery rates Intake interview and monitoring by case workers Intervention: medical track and labour track 8

9 1 Institutional settings and data Intervention: medical track and labour track Medical track Occupational doctors (physicians) Second opinion Further medical treatment Labour track Occupational specialists (work study practitioners) Ergonomic advise Coaching 9

10 1 Institutional settings and data Data selection (1) All sickness claims (11872) between January 2009 and December Durations until (i) recovery, (ii) medical track and (iii) labour track From the start of the deferment period (daily precision) Censored if sick leave had not been terminated at 31 December For each claim: wide range of individual characteristics Exclusion of... Maternity claims (958) and claims with a missing diagnosis type (215). Claims with missing explanatory variables (31) Claims with non-positive or inconsistent durations (18) 10

11 Survival 1 Institutional settings and data Data selection (2) Distinction between 9588 physical and 1062 psychological claims Patterns of recovery differ by type of disease Figure: survival function for recovery Physical claims Psychological claims Analysis time (days) 11

12 Survival 1 Institutional settings and data Data selection (3) Distinction between 9588 physical and 1062 psychological claims Patterns of inflow into the intervention tracks differ by type of disease Figure: survival function for labour track Physical claims Psychological claims Analysis time (days) 12

13 2 Econometric model Double selection problem Problem 1: correlation between unobserved determinants of recovery and intervention Recovery and intervention may be determined by the same unobservables This may lead to a spurious relationship Problem 2: dynamic selection To evaluate the effect of intervention, the self-employed should not recover before moment of start of intervention They must therefore have relatively adverse unobserved characteristics This may bias the estimated intervention effect towards zero Solution: Timing of Events approach (Abbring & van den Berg, 2003) 13

14 2 Econometric model Timing of Events approach Treatment (1): medical track Treatment effect (1): effect of medical track on recovery rate afterwards Treatment (2): labour track Treatment effect (2): effect of labour track on recovery rate afterwards Use time variation in treatments in order to capture treatment effects 14

15 2 Econometric model Econometric framework Econometric framework r: index recovery; m: index medical track and l: index labour track θ: hazard rates t: elapsed durations since start job search λ: baseline hazards (piecewise constant) x : vector of observables; v: unobservables (discrete distribution) 15

16 3 Results Constant treatment effect model Econometric framework Constant treatment effect model Estimation results treatment effects Physical claims Psychological claims Medical track: Constant δ m,0-0.59*** (0.05) 0.13 (0.36) Labour track: Constant δ l,0-0.78*** (0.09) 0.06 (0.23) 16

17 3 Results Extended model Econometric framework Extended model Estimation results treatment effects Physical claims Psychological claims Constant -0.62*** (0.06) (0.36) Medical track: Early intervention 0.11 (0.08) 0.47** (0.20) Middle late intervention 0.08 (0.06) 0.59*** (0.18) Constant -0.76*** (0.10) 0.18 (0.27) Labour track: Early intervention 0.12 (0.23) (0.20) Middle late intervention 0.10 (0.13) 0.05 (0.15) 17

18 3 Results Sensitivity analysis 1: delay start of durations Econometric framework Extended model Estimation results treatment effects Physical claims Psychological claims Constant -0.63*** (0.06) (0.36) Medical track: Early intervention 0.09 (0.08) 0.54** (0.21) Middle late intervention 0.03 (0.06) 0.57*** (0.21) Constant -0.76*** (0.10) 0.21 (0.28) Labour track: Early intervention 0.00 (0.22) (0.18) Middle late intervention (0.12) 0.12 (0.16) 18

19 3 Results Sensitivity analysis 2: gender heterogeneity Econometric framework Other dimensions effect heterogeneity Estimation results treatment effects Physical claims Psychological claims Medical track: Constant Female -0.56*** 0.06 (0.05) (0.09) * (0.36) (0.27) Labour track: Constant Female -0.78*** 0.01 (0.09) (0.14) (0.23) (0.25) 19

20 3 Results Sensitivity analysis 3: tough occupations Econometric framework Other dimensions effect heterogeneity Estimation results treatment effects Physical claims Psychological claims Medical track: Constant Tough occupation -0.60*** 0.05 (0.08) (0.07) (0.35) (0.23) Labour track: Constant Tough occupation -0.46*** -0.48*** (0.11) (0.10) * (0.27) (0.23) 20

21 4 Conclusion Conclusion Only stable positive effect of early and middle late intervention by occupational doctors for psychological claims All other forms of intervention have a neutral or negative effect Self-employed have every interest in keeping absence durations as short as possible Occupational doctors and specialists may advise longer sick-leaves than necessary (Hesselius et al., 2005) Occupational doctors and specialists may be unable to distinguish shirkers from truly sick (Carlsen and Nyborg, 2009) 21