The consequences of the further "privatisation" of the Netherlands' Sickness Benefits Act in 1996 have been closely scrutinised. Research published in March 1998 has demonstrated that more than 90% of company and insurance doctors are aware of negative consequences of privatisation. Additionally, on the basis of employee experience, the Dutch Trade Union Federation (FNV) has come to the conclusion that amendments are necessary. This view is shared by other organisations involved.
The Sickness Benefits Act (Ziektewet, ZW) has undergone a process of "privatisation" in recent years, with a new allocation of responsibilities and risks between the Government, employers and employees, and the transfer of the Act's financing and administration from the public to the private sector. The most recent stage in this privatisation came in 1996, as a result of which employers must now pay the salaries of members of staff who are ill for an entire year, as opposed to the previous two- or six-week period (NL9710138F). This forces employers to accept more responsibility (financial and otherwise) for the health of their employees. The expectation was that extended financial responsibility would lead to a reduction of absence due to illness, based on greater attention being paid to prevention and improved working conditions. However, the majority of company and insurance doctors now report that the opposite has occurred.
Frustrated company doctors
To date, privatisation has not led to a reduction of "absenteeism". This is the first conclusion reached in a new study on the consequences of privatisation, which was conducted by two research institutions - NIA and TNO- and published in March 1998 ("Privatisering van de Ziektewet. Het medisch draagvlak wordt kleiner", JHBM Willems, in Medisch Contact 53/13, 27 March 1998). Furthermore, 40% of the company and insurance doctors questioned in the research believe that employers have become more selective in the recruitment process when it comes to the expected health of potential employees. To prevent this, in January 1998 legislation came into force prohibiting medical examinations for new employees. Now it appears that increasing numbers of people are working under temporary employment contracts; employers can take the sick leave record of employees into account when deciding whether or not to hire them for a permanent position.
The NIA TNO research also shows that more than 90% of the doctors are aware of negative consequences resulting from the ZW privatisation. The study contains the responses of almost 1,000 company and insurance doctors. These doctors reported that less attention is now being paid to prevention, that their independence is at risk and that disputes between employers and employees are on the rise. The doctors feel that they have been given the role of "absenteeism fighter", while they should be counselling sick employees and advising companies on working conditions and work pressure. Of the doctors, 15% state that they feel they "are being made accountable for the rate of absenteeism due to illness". Furthermore, more than 15% indicate that underlying relationships with general practitioners (GPs), for example, are deteriorating, and that they encounter increasing difficulty in receiving information about patients. One company doctor explains: "Some companies deserve a red card. One company undergoing reorganisation asked me to chart the risk cases. The game is being played more harshly."
Employees off sick
In response to employee complaints and in cooperation with the Dutch Trade Union Federation (Federatie Nederlandse Vakbeweging, FNV) and the occupational health and safety services (ARBO), the Secretary of State for Social Affairs has proposed a number of measures. Some serious complaints have been made to FNV (see "Eerste tussenrapportage. Resultaten februari 1998", FNV-meldlijn Arbodiensten, March 1998), although it is arguable whether these negative experiences were exclusively the result of the privatisation of the ZW. The complaints focus on the way in which company doctors handle patients' medical records. Employees are not allowed to see their own records, but they do end up on the desks of personnel officers. Furthermore, GPs and company doctors often give conflicting advice: while the patient's GP might advises more rest, the company doctor might want the sick employee to return to work as quickly as possible. Complaints now appear to work against employees: some company doctors advise unsatisfied workers to quit voluntarily, according to employees' comments reported to the FNV.
The FNV's standpoint is unequivocal: occupational health and safety services should first of all support employees. However, the reality is that company doctors are neither employed by employee organisations, nor accountable to employees. These doctors work for the occupational health and safety services. In the context of privatisation, these services have been set up on a commercial basis, so they are motivated by profit and must sell their product. Companies are obliged to buy their services, but they can choose between more or less extensive packages. Research indicates that the majority of companies (55%) select a "meagre" package - which does not include prevention, for example. Only 20% choose a comprehensive package. These figures are quite disappointing, especially when one takes into account the fact that works council s have a legal right to approve the contract concluded between their company and an occupational health and safety service. Apparently, employee representatives are yet to become accustomed to their controlling role in these matters (NL9803165F).
These considerations have led three of the parties concerned to take a number of initiatives. The Secretary of State for Social Affairs has argued for improved information provision for employees, and stated that complaints procedures must become more accessible. The Secretary also supports the proposal put forward by the occupational health and safety services trade association (Brancheorganisatie van Arbodiensten, BOA) to establish an "appeals body". In addition, an initiative proposed by FNV and BOA to appoint an ombudsman for all occupational health and safety services has also received the Secretary of State's financial support.
Commentary
The Sickness Benefits Act has been the first legislative act in the social field to be subject to privatisation. Therefore, actions taken in bad faith, misunderstandings and ignorance can all be attributed to normal "growing pains". If it is assumed that the introduction of the free market into the social field involves a learning process, then appropriate legislative amendments can be defended (the prohibition of medical examinations for new personnel is an example of this). However, it has recently become clear that, in this context, a problem solved in one area then arises in another: employees are now working more often and for longer periods of time under temporary contracts. The new problem then subsequently also demands suitable amending legislation. Because many people still have negative associations with a Sickness Benefits Act subject to independent but bureaucratic implementation under government supervision, few wish to revert to the past. However, the idea has gained ground that privatisation and competition should be introduced less rashly, more carefully and in phases. The same holds true for the idea that more competition does not imply less government intervention; on the contrary, it in fact demands stringent legislation imposed by a firm state. (Marianne Grünell, HSI)