Promoting labour market inclusion of the chronically ill: a scoping review of Scandinavian countries' efforts.

OBJECTIVES: This article is a scoping review of efforts in labour market inclusion of the chronically ill in the Scandinavian countries, a research area that has received much political as well as research attention in recent years. The aim of the review was to identify promising strategies and the need for further research. METHODS: Six electronic databases were searched for literature published between 2015 and 2020. We included peer-reviewed articles that studied the effect of measures, aimed at the workplace or at the individual, that are intended to increase participation. Our search resulted in 2718 articles; our screening procedures resulted in 47 included articles. RESULTS: Among the included studies, musculoskeletal problems (17 articles) and mental health problems (29 articles) were the most frequent chronic conditions. Multimodal occupational rehabilitation programmes directed towards the individual employee were the most frequent interventions (30 articles). Return to work (24 articles) and sickness absence (12 articles) were the most common outcomes. About half (25 articles) of the included studies reported a positive impact of the intervention on work inclusion of the chronically ill. CONCLUSIONS: Our review found little evidence of how government programmes directed towards the supply side of the labour market succeed in including the chronically ill. Our review further indicated that multidisciplinary workplace interventions have a substantial effect. We also identified a significant lack of research on the effect of various governmental policies and programmes, including local health, work and welfare services, and limited coordination and cooperation between health and work services professions.

Health services in Nordic welfare states: Introducing a new category of providers through the Norwegian free treatment choice reform.

Aim: We contribute to the literature on private provision of health care in Nordic countries by studying developments following the 2015 Norwegian free treatment choice reform. The reform introduced new providers of publicly financed health care. These new private for-profit or not-for-profit providers are licensed by Helfo (the Norwegian Health Economics Administration) to offer pre-defined services at pre-defined prices. They treat patients referred to specialist health care given that patients choose these providers. We focus on multidisciplinary specialist substance treatment and mental health care, areas constituting 78% of reform costs in 2019. Methods and data: We discuss three sets of questions with statistics, documents, and interview data: What developments and consequences of new providers did key actors expect? What developments of Helfo-licensed providers do we see and why? How have Helfo-licensed providers influenced collaboration between public and non-public providers and recruitment? Results: Contrary to expectations, we found that most Helfo-licensed providers have not previously collaborated with public providers through tender agreements. This complicates collaboration. So far, the establishment of new providers has not undermined public providers in terms of recruitment. Conclusion: Public providers with Helfo-licensed providers in their area still experience some pressure on recruitment and express concerns for future negative reform consequences. The introduction of new private providers may influence the level of market-orientation in the Norwegian welfare state.

Defining good health and care from the perspective of persons with multimorbidity: results from a qualitative study of focus groups in eight European countries.

OBJECTIVES: The prevalence of multimorbidity is increasing in many Western countries. Persons with multimorbidity often experience a lack of alignment in the care that multiple health and social care organisations provide. As a response, integrated care programmes are appearing. It is a challenge to evaluate these and to choose appropriate outcome measures. Focus groups were held with persons with multimorbidity in eight European countries to better understand what good health and a good care process mean to them and to identify what they find most important in each. METHODS: In 2016, eight focus groups were organised with persons with multimorbidity in: Austria, Croatia, Germany, Hungary, the Netherlands, Norway, Spain and the UK (total n=58). Each focus group followed the same two-part procedure: (1) defining (A) good health and well-being and (B) a good care process, and (2) group discussion on prioritising the most important concepts derived from part one and from a list extracted from the literature. Inductive and deductive analyses were done. RESULTS: Overall, the participants in all focus groups concentrated more on the care process than on health. Persons with multimorbidity defined good health as being able to conduct and plan normal daily activities, having meaningful social relationships and accepting the current situation. Absence of shame, fear and/or stigma, being able to enjoy life and overall psychological well-being were also important facets of good health. Being approached holistically by care professionals was said to be vital to a good care process. Continuity of care and trusting professionals were also described as important. Across countries, little variation in health definitions were found, but variation in defining a good care process was seen. CONCLUSION: A variety of health outcomes that entail well-being, social and psychological facets and especially experience with care outcomes should be included when evaluating integrated care programmes for persons with multimorbidity.