[Development of second-line occupational health services: toward an integrated network of insurers and care providers].
OBJECTIVE
To describe the development of the second-line Occupational Health Services and the role of private insurance companies in it over the period 1994-1999.


METHODS
Descriptive cross-sectional study.


METHODS
Data were collected in 1999 from written documents and supplementary interviews with the five largest private providers of disability insurance, the National Insurance Institute, nine Occupational Health Services of different natures and 24 institutions for second-line occupational health service.


RESULTS
After the privatization of the Health Law in 1996 and parts of the Law on disability Insurance, most employers covered the risk of continued payment of wages in case of disability with private insurers. These attempted to keep claims down by active engagement in arbitration, treatment and diagnostics of disabled employees so as to counteract avoidable absenteeism. Under the influence of the insurance companies, a trend developed toward integrated nation-wide chains in which the services provided by insurers, by occupational health services and by implementing institutions are geared for one another.


CONCLUSIONS
Commercial provision of Occupational Health Service is a new, demand-active form of care provision in which the financier plays a key part. This provision of services supplied important innovating impulses for health care in its entirety because of its large scale, strong protocolling of processes and management on the basis of continuous cost-benefit analyses. A lucid and socially acceptable regulation of commercial providers of occupational health services was lacking.
Plomp
H N
HN
Vrije Universiteit, afd. Sociale Geneeskunde, Amsterdam. hn.plomp.social@med.vu.nl
D006282:Health Personnel / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007343:Insurance Carriers / Q000191:economics / Q000639:trends; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D018868:Insurance, Disability / Q000191:economics* / Q000331:legislation & jurisprudence / Q000639:trends*; D009426:Netherlands; D009786:Occupational Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data / Q000639:trends*; D012189:Retrospective Studies
Ontwikkeling van de tweedelijns-Arbo-dienstverlening: naar geïntegreerde ketens van verzekeraars en zorgaanbieders.