12 Chapter 1 work fulltime, being assessed with an inability to work fulltime and thus no longer obliged to pursue fulltime work participation, may also have a positive impact. It may release workers from the pressure of (looking for) a job with more working hours than they can cope with. Moreover, employers suffer less economic damage if workers are sick-listed for fewer than fulltime working hours, especially in a situation where there are many part-time positions available in the labour market and part-time employment is generally accepted as in the Netherlands [10]. A reduction of working hours may be helpful for people returning to or staying in the labour market. A Dutch study indicated that people unable to work fulltime nevertheless often have favorable work characteristics, such as a higher education and experience in previous employment [11]. These advantages make it easier for them to get a part-time job. In addition, a recent review described that changes in work times (and flexibility in time scheduling as work accommodation), had strong positive associations with return to work among workers on long-term sick leave and assessed with residual work capacity [12]. This may indicate that confirming sick-listed employees’ inability to work fulltime could positively affect their return to work. It could also allow them to continue to work part-time, while protected from income loss by disability benefits. However, research on this topic is lacking. Assessment of Inability to Work Fulltime In the Netherlands, the work disability benefit assessment is performed by insurance physicians from the Dutch Social Security Institute: the Institute for Employee Benefits Schemes (UWV) under the Work and Income Act (WIA) [13]. To assess the work disability benefit, these physicians use a (semi- ) structured interview to gather information on the applicant’s medical-, work-, and social situation, as well as his/her functioning. They also use other sources, such as treating- and occupational health physicians. In 2013, for example, 57.811 first assessments took place. Of these, 15.6% resulted in partial disability and 41.9% in full disability; 42.6% of the applications were rejected [14]. Assessment includes a ruling about an applicant’s (in)ability to work fulltime, reported as the number of hours he/she can work per day, graded in steps of 2 hours. In 2000 the professional guideline (in Dutch: ‘Standaard verminderde arbeidsduur’) was designed to support and guide insurance physicians when assessing inability to work fulltime and to improve the reliability and validity of these assessments [15]. However, due to a lack of scientific evidence, the professional guideline is based only on the expertise of these physicians. A group of insurance and occupational health physicians supervised the development of the guideline and reached consensus on three specific indications of inability to work fulltime: 1. a lack of energy consistent with
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