Ontwikkeling van de tweedelijns-Arbo-dienstverlening: naar geïntegreerde ketens van verzekeraars en zorgaanbieders

To describe the development of the second-line Occupational Health Services and the role of private insurance companies in it over the period 1994-1999.

Design

Descriptive cross-sectional study.

Method

Data were collected in 1999 from written documents and supplementary interviews with the five largest private providers of disability insurance, the National Insurance Institute, nine Occupational Health Services of differrent natures and 24 institutions for second-line occupational health service.

Results

After the privatization of the Health Law in 1996 and parts of the Law on disability Insurance, most employers covered the risk of continued payment of wages in case of disability with private insurers. These attempted to keep claims down by active engagement in arbitration, treatment and diagnostics of disabled employees so as to counteract avoidable absenteeism. Under the influence of the insurance companies, a trend developed toward integrated nation-wide chains in which the services provided by insurers, by occupational health services and by implementing institutions are geared for one another.

Conclusion

Commercial provision of Occupational Health Service is a new, demand-active form of care provision in which the financier plays a key part. This provision of services supplied important innovating impulses for health care in its entirety because of its large scale, strong protocolling of processes and management on the basis of continuous cost-benefit analyses. A lucid and socially acceptable regulation of commercial providers of occupational health services was lacking.