Legal and policy approaches to implementing return to work ...

© 2018 Government of Singapore

A Great Workforce A Great Workplace

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Legal and policy approaches to implementing

return to work program in Singapore

International Forum on Disability Management 2018

Vancouver, Canada

October 14-17, 2018

Dr Sylvia Teo

Sr Principal Specialist(RTW Unit)

TWSH & RTW, WSHC, TAL



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Earlier return to work Subjects in intervention group RTW about 10 days earlier than control group

(Control= 48 days, Intervention= 38 days, p=.029) Potential cost savings Savings from reduced absent work days due to the RTWC intervention

Costs

Net Benefit of RTWC intervention = $1,516.43 - $672.43 = $844 per injured employee

Control Intervention Savings Savings from reduced absent work days of 10 days $0.00 $1,516.43 $1,516.43

Net Savings $1,516.43

Control Intervention Differential Costs

Medical outpatient cost $277.06 $348.87 $71.81 RTWC intervention costs (based on 6.7hrs by RTWC and 2hrs by RTW executive) $0.00 $600.62 $600.62

Net Differential Cost $672.43

Cost Benefit of RTWC Intervention



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Changes to Work Injury Compensation Act (WICA) wef from 1 Jan 16

• Higher compensation limits for medical expenses, up to $36,000 or 1 year from date of accident, whichever is earlier

• Cost of Medical Treatments includes charges relating to:

• physiotherapy, occupational and speech therapy • Cost of medicines, artificial limbs, surgical appliances • Emergency medical transport • Fees for medical reports • Case management • Psychotherapy • Functional capacity evaluation; and • Worksite assessment

Amendment

to facilitate

RTW-related

activities



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I in 4 were unemployed 7 in 10 had no change in job-scopes

Employment Status % n Base for % Calc.

Not Employed 23.8% 97 407

Employed 76.2% 310

Employed in the same company 58.7% 182 310

Employed in different company 41.3% 128

Employed with a change of job scope 26.5% 82 310

Employed with no change of job scope 73.5% 228

Employed with reduced take home pay 16.1% 50 310

Employed with no reduced take home pay 83.9% 260

Findings from the study “Social and Financial Impact of Work Injuries for Local Workers” by WSHI

2014

What are the main challenges?



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Physical and Psychological Impact

10.3%

6.4%

10.6%

24.6%

39.1%

44.2%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0%

Did not face any challenges

Felt discriminated at work

Felt a lack of support/ understanding at work

Fear that certain work activities will lead to harm/ injury

Difficult to perform work at previous stds

Felt tired easily/ other physical discomforts at work

standards

Findings from the study “Social and Financial Impact of Work Injuries for Local Workers” by WSHI

2014



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31% stated change of job

scope

24% would like to have flexi-

hours

30% stated job

redesign

Types of support needed



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Local Non-Local

Grand Total

% of Total

NATIONAL UNIVERSITY HOSPITAL (SINGAPORE) PTE LTD 463 830

1293 21.2%

TAN TOCK SENG HOSPITAL 443 968 1411 23.2%

SINGAPORE GENERAL HOSPITAL 399 396 795 13.1%

CHANGI GENERAL HOSPITAL 395 415 810 13.3%

NG TENG FONG GENERAL HOSPITAL 340 456 796 13.1%

KHOO TECK PUAT HOSPITAL 300 433 733 12.1%

ALEXANDRA HOSPITAL 9 8 17 0.3%

KK WOMEN AND CHILDREN HOSPITAL 7 1 8 0.1% RAFFLES HOSPITAL 39 50 89 1.5%

WEST POINT HOSPITAL 20 85 105 1.7%

OTHER PRIVATE HOSPITALS 16 9 25 0.4%

Total 2431 3651 6082 100.0%

96% of WIC cases are seen at 7

Public hospitals

Distribution of WIC Cases 2016

Where Do our injured Employees go?



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RTW Unit

• Drive RTW programme

• Oversee and coordinate implementation of the RTW programme

• Monitor progress and review its effectiveness

Affiliated RTW Centers

• Dedicated clinics offering RTW services

• Sited within the acute public hospitals which handle 96% of the WIC cases

National RTW programme



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Awareness gap

• Educate key stakeholders on the benefits of RTW through engagement and outreach (e.g. info-graphics, guidelines, advisories)

Capability gap

• Build a pool of certified RTW coordinators through funding formal certification programmes#

Process gap

• Set up affiliated RTW centres in public hospitals and:

• Develop RTW workflow

• Identify workers who can benefit early

• Monitor outcomes

Funding gap

• Provide seed funding to public hospitals to kick-start RTW programme

• Set up a new RTW Grant to support injured workers and employers to RTW

# Complete NIDMAR (National Institute of Disability Management and Research) course and eventually obtain either CDMP

(Certified Professionals in Disability Management)/CRTWC (Certified Return to Work Coordinators) certification

RTW unit (WSHC) to drive efforts and build capabilities

National RTW Programme seeks to address gaps



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Affiliated RTW Centers

• Seed funding for 2 years

• Development of a clinical operational workflow for RTW services

• Manpower cost of 1 RTW Co-ordinator

(Occupational therapists/Physiotherapists)

• Manpower cost for 1 RTW administration executive

• I.T. for collecting outcome indicators and for building infrastructure (equipments)

• Training of RTW Co-ordinators in NIDMAR certification

Public Hospitals -- Dedicated clinics offering RTW services



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MOM’s RTW grant

• Allows the employer to claim up to 90% of the job re-design costs (e.g. workplace modifications, purchase of equipment/tool), capped at $1,000 per RTW injured worker, and

• Allows the injured workers to claim for RTW-related interventions if his/her medical expenses exceed the Work Injury Compensation(WIC) cap of $36,000, capped at a maximum of $7000 per RTW injured worker.

• Application for the RTW Grant must be supported by the Return-To-Work Co-ordinator.

MOM’s RTW Grant



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Monitoring

Demographics • Employee’s info • Company’s info • Injury suffered • Medical

treatment

Work-related outcomes

• Time to RTW • Income prior

injury and post RTW

• RTW rate at 3,6,9 months

• Category of RTW

Health-related outcomes

• Quality of life

measure (EQ5D/5L)

• Functional ability at 3, 6 9 mths

• Self-efficacy scale

RTW Programme specific indicator

• Medical and

rehabilitation costs incurred

• Take-up rate and reasons for non-participation

• Drop-out rates, reasons for drop-out

• ROI

RTW Co-ordinators will collect and report the following indicators to MOM

Key performance Indicators in assessing effectiveness of program : a.Return to work rate (target 90%) b.RTW Participation rates (target 90%)

Monitoring



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Workplace Safety & Health Performance Awards(WSHPA)

• Lost Time Injury- Bonus criteria

• Track records of loss time injury will be taken into consideration as bonus criteria

• Definition of loss time injury

- Any work-related injury where the worker does not return to work the following workday

Workplace Safety and Health Awards



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Workplace based Model

RTW Co-ordinators are appointed by

company

e.g. Keppel Offshore and

Marine

Hospital-Based Model

RTW co-ordinators are occupational/physiotherapists

/medical social workers or nurses

First hospital to roll out RTW clinical services is TTSH in Oct

2017

Insurance-Based Model

RTW

coordinators are appointed by

insurance companies

e.g. AIA, AXA

RTW Models in Singapore: Current



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Jul-Dec 2017 Jan-Jun 2018 Jul-Dec 2018 Jan 2019

Oct 2017 – Tan Tock Seng Hospital

Feb 2018 – Singapore General Hospital May 2018 – Ng Teng Fong General Hospital Jun 2018 – Changi General Hospital, National University Hospital

Jan 2019-Sengkang General Health

RTW Clinical Services For both Singaporeans and Foreign workers 2 service delivery models of care a. OT-led b. Multidisciplinary model of care (OM/rehab physician)

Nov 2018-Khoo Teck Puat Hospital

Training of RTWCs 3 RTW Co-ordinator workshops, NIDMAR (web-based) learning, On-the-Job training

The Present : “ The Hospital Model” of RTW program



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RTW Milestones

• Engaged TTSH to conduct a RCT to showcase benefits of RTW Co-ordinator based system for rehabilitation of injured employees.

• Focus on Medical Rehabilitation with RTW services done on ad-hoc basis

1st RTW Seminar (Visiting Expert Series) 1st RTWC workshop by TTSH – 14 persons trained, from TTSH, insurers, loss-adjustors, private healthcare sector and Voluntary Welfare organizations

Minister’s Approval for Implementation of RTW Program on 14th Feb Establishment of a Return to Work Unit in WSH Council on 1st April Tan Tock Seng Hospital provides RTW clinical services by Oct 17

2010-12 2015 2017

Visit to SOCSO Rehab Centre in Malacca led by Senior govt official with a total of 17 delegates from Singapore National Employers Federation, insurers, healthcare sector and Ministry of Manpower(MOM)

2016

Conducted 3 RTWC work shops to train 40 Allied Healthcare professionals 7 Occupational and Physiotherapists successfully attained professional NIDMAR certification-CDMP/CRTWCs

2018

RTW Milestones



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Workplace based Model

RTW Co-ordinator are appointed by

company

Eg. Keppel Offshore and Marine

Insurance-Based Model

RTW Co-ordinator are appointed by

insurance companies

Eg. AIA, AXA,

Liberty Mutual

RTModels in Singapore: Longer Term

The Future:

“ The Workplace Model” of RTW program

Partnership

Collaboration

Mutual support

Embedding Injury Management in Workplace OSH Policy to complement hospital model

Identification of suitable staff to take on role of RTWC (Workplace Safety and Health officers, nurses, HR managers)

Development of competencies /capability in RTW coordination through certification

Active referral of injured worker to RTW program by

company-based RTWC (system of referral)

Effective Injury Management Program with proper disability management, including support for injured workers to limit further harm (prompt care, appropriate return to-work policies, modification of work)



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Challenges

• RTW is not legislated in Singapore- “Opt out”

• Current program is limited only to Work Injury Compensation Insurance cases

• Singapore has a significant proportion (a third of total workforce) of migrant workers

• Employer has flexibility of terminating worker

• Charges on RTW-related intervention is not controlled by the government

• Shortage of hospital-based Allied Health professionals in the acute hospitals

• Lack of policies on injury management at workplace

Legislative and Policy Challenges



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• Reports injury early and seeks treatment •Compliant to medical treatment and rehab •Adheres to RTW plan •Trust RTWC •Remains motivated and keen to RTW

Provision of a supportive environment to IW, includes • Time off for medical treatment /rehab •Provision of job accommodation •Retention of IW •Prompt payment of bills

Supported by

• Provide occupational rehab services • Hospital-based RTWCs initiates RTW process through

A. Initial Assessment, FCE B. Individualised RTW plan C. Identify barriers and challenges D. Conduct worksite assessment

• Monitoring outcome indicators • Ensure IW receive medical treatment and due compensation • Engage Tripartite partners to support RTW • Step in to facilitate RTW in specific cases

• Processing and paying WIC compensation •Step in to facilitate RTW in specific cases(complicated, delayed recovery) • Tracking of cost of rehab and case management services in insurers’ database

Affiliated RTW Centres RTW Unit and Tripartite partners

Desired RTW Framework

Legal and policy approaches to implementing return to work ...

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