159 General discussion multiple diagnoses, inability to work fulltime reduced the risks of returning to paid employment after the work disability benefit assessment. Reflections on the findings The studies in this thesis shed light on the complexity of the construct ’inability to work fulltime’, and provide novel insights into the definition and operationalization of the construct, the prevalence and associated sociodemographic and disease-related factors, as well as an initial insight into how inability to work fulltime relates to having paid employment one year after a work disability benefit assessment. The novelty of this topic was illustrated at the start of our study by the discovery that no suitable word was available in English for the Dutch word ‘urenbeperking’, and that scientific literature on the subject was lacking. We first decided to use the term ‘work endurance’, as endurance is related to the ability to perform work over an extended period of time. However, we soon learned that from the perspective of the assessor (the professional assessing the work disability benefit), ‘work endurance’ may not completely cover the construct, as it may more commonly apply to physical endurance. Based on our findings from the qualitative interview study and the international survey, incorporating professionals’ perspectives as well as the help of researchers in Canada and the USA with expertise in the field of insurance medicine, we decided to replace ‘work endurance’ with ‘(in)ability to work fulltime’. This term better renders the sense of the Dutch word ‘urenbeperking’ (related mainly to the “restricted number of hours per day or week an applicant is able to work due to a disabling health condition”), and explains its use by insurance physicians to describe the total number of hours someone is able to work per day and per week. In the Dutch social security setting, being able to work eight or more hours per day is considered normal ability to work fulltime, and being able to work fewer than eight hours per day is considered an inability to work fulltime. Based on this definition, register data of a year cohort of applicants with residual work capacity indicated that almost 40% had been assessed with an inability to work fulltime. This means that almost half of applicants with residual work capacity are not able to work fulltime. Interestingly, in this group 79% were able to work about 4 hours per day. The other side of the coin is that more than half of the applicants were assessed as having the ability to work fulltime. This does not necessarily mean that they were denied a work disability benefit; many of these applicants had other limitations restricting their work capacity, which entitled them to a partial or full work disability benefit. An interesting finding in the international comparison study (Chapter 3) was the varying definitions of fulltime work across countries. In the Netherlands, fulltime means 40 hours (8 hours, 5 days/week) or more, whereas in other countries the definition of fulltime ranged from 35 hours 8
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