[The social security reform: wide-ranging effects on companies as well as occupational health services].
OBJECTIVE
To evaluate the reactions of companies and Occupational Health Services (OHSs) to the reform of the social security system by the government of the Netherlands; especially to inventory to what extent intended effects (more handicapped workers employed, more reintegration efforts) and unintended effects (exclusion handicapped workers, deteriorated quality OHSs) occurred.


METHODS
Inventory survey.


METHODS
Data on number of OHSs and their sizes and staff compositions were collected in September 1997 through a questionnaire sent to all members of the National Association of OHSs (BOA). In addition, data on efforts of enterprises in the area of working circumstances in 1996 and in 1997 were derived from the published results of enquiries by telephone among a representative random sample of 4,000 enterprises.


RESULTS
The number of employees in the care of the OHSs was twice as high in 1997 as in 1991. The number of OHS staff members had also doubled, but the proportion of physicians among the total staff had decreased. The number of employees per physician had increased by 34%. The nature of the contracts concluded with enterprises shows that the extension of the market has not led to more extensive OHS care, although it has brought about greater variation. Generally, large companies developed a policy to prevent disability and to employ more handicapped workers, while small and medium-size companies more often tried to exclude people that is at risk for disability or absenteeism.


CONCLUSIONS
Intended effects occurred to a limited extent in larger companies and unintended effects mainly in small and medium-size companies.
Vrije Universiteit, afd. Sociale Geneeskunde, Amsterdam. hn.plomp.social@med.vu.nl
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Weel
D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D004651:Employment / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D018166:Health Care Reform / Q000458:organization & administration*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D009426:Netherlands; D009786:Occupational Health Services / Q000331:legislation & jurisprudence / Q000458:organization & administration; D011050:Policy Making; D011332:Privatization / Q000458:organization & administration; D015397:Program Evaluation; D012943:Social Security / Q000331:legislation & jurisprudence* / Q000639:trends; D014942:Workers' Compensation / Q000639:trends; D000078329:Workforce
Privatisering van de Ziektewet: uiteenlopende effecten bij zowel bedrijven als Arbo-diensten.