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

BMC Public Health

Pekka Virtanen¹  Virpi Liukkonen¹  Ulla Kinnunen²  Antti Saloniemi³  Katri Romppainen⁴ 

[1] School of Health Sciences, University of Tampere, Tampere, Finland;School of Social Sciences and Humanities, University of Tampere, Tampere, Finland;Department of Pori, School of Social Sciences and Humanities, University of Tampere, Pori, Finland;P.O Box 607, 33014 Tampere, Finland

关键词: Unemployment;    Access to health care;    Health services;   

Others  :  1122917
DOI  :  10.1186/1471-2458-14-1200

 received in 2012-09-13, accepted in 2014-11-03,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Romppainen et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Kessler R, House J, Turner J: Unemployment and health in a community sample. J Health Soc Behav 1987, 18:51-59.
• [2]Virtanen P, Liukkonen V, Vahtera J, Kivimäki M, Koskenvuo M: Health inequalities in the work force: the labour market core-periphery structure. Int J Epidemiol 2003, 32:1015-1021.
• [3]Bartley M: Unemployment and health: selection or causation - a false antithesis? Sociol Health Illn 1988, 10:41-67.
• [4]Virtanen P, Kivimäki M, Vahtera J, Koskenvuo M: Employment status and differences in the one-year coverage of physician visits: different needs or unequal access to service? BMC Health Serv Res 2006, 6:123. BioMed Central Full Text
• [5]Kimanen A, Manninen P, Räsänen K, Rautio M, Husman P, Husman K: Factors associated with visits to occupational health physicians in Finland. Occup Med 2010, 60:29-35.
• [6]Taskinen H (Ed): Good Occupational Health Practice: A Guide for Planning and Follow-up of Occupational Health Services. Helsinki: Ministry of Social Affairs and Health and Finnish Institute of Occupational Health; 2004.
• [7]Kimanen A, Manninen P, Kankaanpää E, Räsänen K, Husman P, Rautio M, Husman K: Illness-related care in occupational health services in Finland: activities and expenses 1996–2005. Suomen Lääkärilehti 2008, 63(21):1965-1970.
• [8]Saikku P, Sinervo L: Työttömien terveyspalvelun juurrutus: valtakunnallisen PTT-hankkeen kokemuksia, arviointia ja kansallisia suosituksia. Helsinki: National Institute for Health and Welfare [952-245-398-6] Report 42 Aksidenssi Oy; 2010.
• [9]Bartley M, Ferrie J: Do we need to worry about the health effects of unemployment? J Epidemiol Community Health 2010, 64(1):5-6.
• [10]Harris E, Webster I, Harris M, Lee P: Unemployment and health: the healthcare system’s role. Med J Aust 1998, 168:291-293.
• [11]Matoba T, Ishitake T: A strategy for health promotion among unemployed people in Japan. Int Arch Occup Environ Health 1999, 72(Suppl):31-33.
• [12]Ytterdahl T: Routine health check-ups of unemployed in Norway. Int Arch Occup Environ Health 1999, 72(Suppl):38-39.
• [13]Buchanan SN, Evens A, Buckley C, Friedman L: Street corner hazard surveillance and health intervention among Chicago day laborers. Arch Environ Occup Health 2008, 63(1):9-12.
• [14]Schuring M, Burdorf A, Voorham AJ, der Weduwe K, Mackenbach JP: Effectiveness of a health promotion programme for long-term unemployed subjects with health problems: a randomized controlled trial. J Epidemiol Community Health 2009, 63(11):893-899.
• [15]Schutgens C, Schuring M, Voorham T, Burdorf A: Changes in physical health among participants in a multidisciplinary health programme for long-term unemployed persons. BMC Public Health 2009, 9:197. BioMed Central Full Text
• [16]Andersen SH: Unemployment and subjective well-being. A question of class? Work Occup 2009, 36(1):3-25.
• [17]Audhoe SS, Hoving JL, Sluiter JK, Frings-Dresen MH: Vocational interventions for unemployed: effects on work participation and mental distress. A systematic review. J Occup Rehabil 2010, 20(1):1-13.
• [18]Romppainen K, Jähi R, Saloniemi A, Virtanen P: Encounters with unemployment in occupational health care: nurses’ constructions of clients without work. Soc Sci Med 2010, 70:605-608.
• [19]Goldberg D: The Detection of Psychiatric Illness by Questionnaire. London: Oxford University Press; 1972.
• [20]Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J: An inventory for measuring depression. Arch Gen Psychiatry 1961, 4:53-63.
• [21]Antonovsky A: Unraveling the Mystery of Health. How People Manage Stress and Stay Well. San Francisco: Jossey-Bass; 1987.
• [22]Caplan RD, Vinokur AD, Price RH, van Ryn M: Job seeking, re-employment and mental health: a randomized field experiment in coping with job loss. J Appl Psychol 1989, 74(5):759-769.
• [23]Rueda S, Chambers L, Wilson M, Mustard C, Rourke SB, Bayoumi A, Raboud J, Lavis J: Association of returning to work with better health in working-aged adults: a systematic review. Am J Public Health 2012, 102(3):541-556.
• [24]Rongen A, Robroek SJ, van Lenthe FJ, Burdorf A: Workplace health promotion: a meta-analysis of effectiveness. Am J Prev Med 2013, 44(4):406-415.
• [25]Osilla KC, van Busum K, Schner C, Larkin JW, Eibner C, Mattke S: Systematic review of the impact of worksite wellness programs. Am J Manag Care 2012, 18(2):68-81.
• [26]Romppainen K, Saloniemi A, Jähi R, Virtanen P: My health and theirs: clients constructing a health service programme for unemployed people. Sociol Health Illn 2012, 34(6):809-825.
• [27]Starfield B: Pathways of influence on equity in health. Soc Sci Med 2007, 64:1355-1362.
• [28]Proudfoot J, Guest D, Carson J, Dunn G, Gray J: Effect of cognitive-behavioural training on job-finding among long-term unemployed people. Lancet 1997, 350(9071):96-100.