Does provision of targeted health care for the unemployed enhance re-employment?

BMC Public Health Does provision of targeted health care for the unemployed enhance re-employment? Katri Romppainen 2 Antti Saloniemi 1 Ulla Kinnunen 0 Virpi Liukkonen 3 Pekka Virtanen 3 0 School of Social Sciences and Humanities, University of Tampere , Tampere , Finland 1 Department of Pori, School of Social Sciences and Humanities, University of Tampere , Pori , Finland 2 P. O Box 607, 33014 Tampere , Finland 3 School of Health Sciences, University of Tampere , Tampere , Finland Background: There is increasing pressure to develop services to enhance the health of the workforce on the periphery of the labour market. Health promotion among unemployed people may improve their health but also to increase their employability. We tested whether re-employment can be enhanced with a health care intervention targeted at the unemployed. Methods: A 3-year follow-up, controlled design was used. The data were collected among unemployed people (n = 539) participating in active labour market policy measures. The baseline survey included established habitually used health questionnaires. The intervention consisted of three health check-ups and on-demand health services. Logistic regression analyses were used to obtain the odds ratios of the intervention group versus control group for being re-employed at follow-up. Health-related differences in the re-employment effects of the intervention were assessed through the significance of the interaction in the regression analyses. Results: The intervention did not serve to improve re-employment: at follow-up 50% of both the intervention group and the control group were at work. In further analyses, the odds ratios showed that the intervention tended to improve re-employment among participants in good health, whereas an opposite tendency was seen among those with poor health. The differences, however, were statistically non-significant. Conclusion: The experimental health service did not show any beneficial effects on re-employment. Nevertheless, rather than considering any particular health care as unnecessary and ineffective, we would like to stress the complexity of providing health services to match the diversity of the unemployed. Health services; Access to health care; Unemployment - Background Unemployment is associated with poor mental and physical health independent of time and place [1,2]. It is well understood that the antithesis selection or causation is false [3]. Both selective and causal processes are therefore relevant in considering the preventive and the illness-related health services for the working aged population. Policymakers and health service researchers also consider health care for the unemployed a major challenge, but there are concerns about appropriate arrangements and the consequent effectiveness and efficiency of the service. Implementing a service always takes place in national structures and is actualised in different contexts. The * Correspondence: 1P.O Box 607, 33014 Tampere, Finland Full list of author information is available at the end of the article present study reporting a health care intervention among the unemployed was conducted in Finland, where unemployment entails a specific risk of being excluded from health care [4]. The reason for this is the structure of the primary health care service for working aged people, which largely relies on occupational health care services (OHC) [5]. OHC is provided by law for all waged and salaried employees, and has developed beyond worker protection and occupational medicine into a comprehensive system of illness-related and preventive general health care [6]. About 90% of the employed population has access to this service [7] which, however, is lost together with the job. In the other words, as a consequence of unemployment the citizen also loses part of his/her health service system and the available service is limited mainly to communal Health Centres. Therefore there is a particular pressure to develop services to cater for the workforce on the periphery of the labour market. Extensive development projects have been piloted in order to find ways to implement health services for the unemployed [8], and under the amendment to the Health Care Act of 2011 municipalities are obliged to provide health promotion and check-ups for the working aged who do not have access to OHC. Research evidence of the impacts of such a service is still lacking. Also internationally, publications tend to write about the state of affairs and recommend novel services [9-12], whereas studies concentrating on the provision and effects of the services are scarce [e.g. 13-15]. Although the ultimate and explicit aim of health care interventions is to prevent prolongation of the unemployment, to the best of our knowledge there are no studies with re-employment as the outcome of the service. The opposite phenomenon, i.e. the indirect effects [16] of employment policy interventions on health, has been studied more extensively. The evidence that the interventions are able to promote health is limited, and they seem to be relatively ineffective even with respect to work participation [17]. With these research defects as the starting point, we ask in the present study if the re-employment effect of active labour market measures could be improved by accompanying health services. The idea was to apply the existing Finnish OHC as a health service for unemployed people participating in active labour market policy (ALMP) measures. We wanted to carry over the principles and professionals of OHC to serve the unemployed in an attempt to enhance their employability. The OHC-ALMP setting was chosen in order to reduce the transfer problem of an evidencebased intervention from research settings to real contexts and populations. The aim of our trial was to investigate whether a health intervention among unemployed people enhances their re-employment prospects compared to those left without the service. In particular, we were interested in studying whether the possible effect depends on the self-perceived health of the unemployed individuals. Methods Career Health Care (CHC) was an intervention resembling Finnish OHC services, except that the clients were recruited from jobseekers participating in ALMP measures (vocational training courses, subsidized employment, and participatory training for entering the labour market). Adopting the logics of OHC, CHC aimed to tackle the problems and risks inherent in unemployment. Six occupational health nurses from established OHC providers in three localities in southern and central Finland were recruited for the client work. The CHC service consisted of three health check-ups by the nurses at the beginning and end of the ALMP measure, and when three years had elapsed since the beginning. Main focus of CHC was on health promotion and primary prevention, managed with a specific health plan adopted from OHC [6]. The activities consisted health screenings, a (...truncated)