14 Chapter 1 This overall aim has been broken down into three research questions: 1. What does the concept inability to work fulltime entail, and how can this be measured? 2. What is the prevalence of inability to work fulltime and what are associated socio-demographic and disease-related factors? 3. What is the association between inability to work fulltime and having paid employment one year after the work disability benefit assessment? Setting The studies for this thesis were conducted within the Dutch social security system. Because a social security system strongly affects work disability benefits, it is important to understand the context in which the assessments are conducted. In the Netherlands, long-term sick-listed workers with a limited work capacity due to chronic disease may apply for work disability benefits to compensate for income loss after two years of sickness absence. During the first two years of sickness absence, employers are obliged to continue wage payment to their workers. They also share the responsibility to help their sick-listed workers to reintegrate. These employees can apply for work disability benefits at UWV, the Dutch Social Security Institute: the Institute for Employee Benefit Schemes. They may receive work disability benefits for a disease or handicap due either to occupational or non-occupational causes. An insurance physician and a labour expert together assess the (remaining) work capacity and eligibility for work disability benefits. The work disability benefit assessment includes a medical assessment of functional limitations by an insurance physician, and an assessment of earning capacity by a labour expert. Individuals may have either a full work disability or a partial work disability [19]. Those in the latter group have residual work capacity: they are considered able to continue working after the assessment, either partially or with work adjustments. These workers are encouraged to continue in paid (part-time) employment with their current employer, or enroll in a new, more appropriate, (part-time) job with their current-, or a new, employer. The income for the original work before sick leave is compared with the income for the work they can perform according to their residual work capacity. The amount of income loss determines the amount of the work disability benefit, with a threshold of 35% loss of income. For an income loss of less than 35%, no financial compensation is provided. UWV stores data from all work disability benefit assessments, including the outcome inability to work fulltime, and data on the work status of the entire Dutch population, in separate registers. These data are thus an important source of information for research.
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