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In the Netherlands, return-to-work after sickness absence is a shared responsibility of employers and employees, supported by an occupational physician. In case of uncertainties in medical diagnosis or capabilities to return to labor, the occupational physician may be unable to provide adequate support. A medical and occupational second opinion could provide clarity and improve return to work of employees with longer than expected sickness absence.
To describe the employees that received a medical and occupational second opinion between 2011 and 2014 in terms of diagnosis, return to work and health costs.
Using pseudo-anonymized data matching by a trusted third party, we combined different data sources for our analysis The dataset includes client data from a company providing second opinions (N=2595), a questionnaire for employees (N=1800), a questionnaire for referrers (occupational physicians, employer case managers) (N=400), recovery data from one case management company (N=564) and claims data from a health insurance company (N=725).
49% of second opinions concerned musculoskeletal problems, compared to 23% mental problems, 14% combined problems, and 16% other problems. The majority of second opinions occurred between 6 and 12 months after the first sickness day. In 51% of the cases, physicians of the second opinion company recommended changes in treatment, either because treatment is inadequate or treatment is insufficiently geared toward return to work. In 29% disabilities were considered too restrictive to allow for return to work. In the subgroup of the case management company, recovery occurred in 83% of the cases, on average nine months after the second opinion. 53% of the referrers respond that the second opinion usually leads to a change in treatment Employees were negative about the results of the second opinion in 31% of the cases. Average annual health costs of longer-than-expected sickness absence were €7800 per year, compared to €2800 before sickness absence.
A second opinion for employees with longer-than-expected sickness absence could identify suboptimal treatments and clarify prognosis. In the majority of cases (partial) return to work is an option, although availability of suited employment might be insufficient. A substantial part of all employees were unsatisfied about the results of the second opinion. In contrast, most referrers were very satisfied with the results.