Estonia: Employment opportunities for people with chronic diseases

  • Observatory: EurWORK
  • Topic:
  • Labour market policies,
  • Work organisation,
  • Disability and chronic disease,
  • Avalikud teenused,
  • Working conditions,
  • Social policies,
  • Published on: 20 November 2014



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Estonia
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Disclaimer: This information is made available as a service to the public but has not been edited by the European Foundation for the Improvement of Living and Working Conditions. The content is the responsibility of the authors.

In Estonia, the concept of incapacity to work is used in the field of social  and employment policy. The definition is based on health conditions and people with chronic disease could apply for insurance payment and services. There is large share of people with chronic diseases that are inactive or unemployed. Employment of people with chronic diseases depends on both their willingness to work and also supply of suitable employment and working conditions that could take into account their special needs. The policy measures have enabled inactivity and have not provided enough support for staying in work and return to work.

Block 1: Concept, definitions, sources of information and methodological issues on chronic diseases and work from the national perspective

1.1. National definition of chronic disease

What definitions of “chronic diseases” in an employment context are used in your country?

What are the sources of these definitions (legislation, statistical sources, administrative documents, social security/health insurance systems)?

What concrete chronic diseases are included in these national definitions?

In Estonian public health and health care system, the WHO definition of chronic diseases and international classification of diseases is used. In the field of social and employment policy, the concept of incapacity to work is used (in addition to the concept of disability). The State Insurance Act (§ 16) defines total permanent incapacity for work and permanent partial incapacity for work:

  • A person with a serious functional impairment caused by an illness or injury due to which he or she is not able to work in order to support himself or herself, is totally incapacitated for work.
  • A person who is able to work in order to support himself or herself but who due to a functional impairment caused by an illness or injury is not able to perform work suitable for him or her in the amount corresponding to the general national standard for working time is partially incapacitated for work.

Although the definition above takes into account both health and ability to perform suitable work, person’s permanent incapacity to work is evaluated only based on his or her health conditions. In other words, in practice it is assumed that the person is incapacitated by his/her health conditions not by access to suitable employment and enabling working conditions.

The extent of permanent incapacity depends on persons’ medical diagnosis, that includes both chronic illnesses (for instance chronic renal failure) and permanent loss of function or structure (for instance deafness) (Sotsiaalministri määrus Töövõime kaotuse protsendi määramise juhend/ en Regulation of the Minister of Social Affairs “The Guidelines for Determining Incapacity for Work”). In sum, people with chronic diseases are eligible for permanent incapacity to work and corresponding replacement income and services.

1.2. Information on national sources of statistical information dealing with the issue of chronic diseases and their relation to employment and working conditions

Social Insurance Board (SKA) is currently the gateway for people with permanent incapacity to work, including people with chronic diseases and related health conditions to apply for social insurance benefits and social services. As a result, it is the source for official administrative statistics on incapacity to work. The board applies the definition of incapacity for work as specified by State Pension Insurance Act. The statistics is made available by Statistics Estonia.

In addition to official administrative statistics, prevalence of health conditions including long lasting health problems are described by population census. The latest census in Estonia took place in 2011. Long-term illness or health problem was defined as an illness or a health problem which had lasted or was expected to last for at least six months. This also includes health problems from which a person had suffered for a long time, but which had not been diagnosed by a doctor. In addition, long-term health problems include recurrent health problems, including conditions which were controlled or relieved by regular administration of medication or other treatments.

Employment opportunities and working conditions of population with chronic diseases can be described by Estonian Labour Force survey that is part of EU labour force survey. In 2011 the questionnaire incorporated an ad-hoc block of questions about health conditions and capacity to work. The EU labour force survey ad-hoc module is named Employment of disabled people. The questionnaire defined chronic diseases with the question do respondent has any long term illness or other disorder which has lasted or is likely to last for six months or longer (the questionnaire had a distinct question about disability). By design the ad hoc block of the survey is cross-sectional survey of Estonian 16-64 years old population.

Block 2: Prevalence, recent evolution and effects of the problem of chronic diseases among workers and companies

2.1. People affected by chronic diseases and employment

The results of the 2011 Population and Housing Census show that the total Estonian population in 2011 was 1, 294, 455, of which 388,077 has long-term illness or health problem. That is 30% of the population self-reported a health problem which had lasted or was expected to last for at least six months. The share of population with long-term illness or health problem is considerably bigger in older age groups (see also Table 1).

Table 1: Population with long term illness or health problem in age groups, 2011
 

Total population

0-14

15-29

30-49

50-64

65 and older

Total population

1,294,455

199,891

254,857

352,517

257,750

229,440

Chronic illness or health problem

388,077

14,349

33,200

71,900

112,909

155,719

% of population with chronic illness or health problem

30.0%

7.2%

13.0%

20.4%

43.8%

67.9%

Source: Statistic Estonia, last updated 30.07.2013

According to Social Insurance Board administrative statistics (see Table 2), around 10% of Estonian population in age 20 to 64 has permanent incapacity to work and proportion has been increasing year over year. This might be both due to ageing of the population and economic-social incentives, for instance unemployment, low income to enter into occupational disability benefit system. The increase has triggered discussion on sustainability of the social security system.

Table 2: 20-64 Years Old Population with 10-100% Incapacity to Work, 2008-2012
 

2008

2009

2010

2011

2012

Total Population (in thousands)

814,3

820,7

827

832

832,1

Population with Incapacity to Work (in thousands)

71,5

81,6

83,4

79,4

89,2

% of Population with Incapacity to Work

8.8%

9.9%

10.1%

9.5%

10.7%

Source: Statistic Estonia, last updated 12.06.2014

Population with incapacity to work are considerably more likely inactive than the total population (Table 3). In 2012, labour force participation rate of people with incapacity to work was only 51%, which is 29 percentage point lower than that of total population. Also, those people with incapacity and willing to work have more difficulty in entering into employment as their unemployment rate is about 6 percentage point higher.

Table 3: Employment of 20-64 Years Old Population with 10-100% Incapacity to Work, 2008-2012
 

2008

2009

2010

2011

2012

Total Population

Participation rate, %

80.9%

80.4%

79.8%

80.0%

79.7%

 

Employment rate, %

76.6%

69.5%

66.4%

70.1%

71.7%

 

Unemployment rate, %

5.2%

13.5%

16.8%

12.3%

10.1%

Population with Incapacity to Work

Participation rate, %

44.6%

46.3%

49.9%

51.8%

50.8%

 

Employment rate, %

40.3%

34.2%

33.8%

39.7%

42.4%

 

Unemployment rate, %

9.4%

25.9%

32.2%

23.4%

16.6%

Source: Statistic Estonia, last updated 12.06.2014

Additionally, the statistics does not indicate that the economic downturn influenced population with permanent incapacity to work more severely. For instance, unemployment rate increased about three times for both total population and for population with chronic diseases from 2008 to 2010.

Employment opportunities and working conditions could be described by Estonian Labour Force Survey. According to the survey, in 2011 about 51% of unemployed people with chronic diseases are not looking for a job due to health reasons. Also, the survey indicates that 10% of people with chronic diseases consider that their employment is or would be limited due to lack of qualification or experience, 29% consider that their employment is or would be limited due to lack of suitable job, 10% due to transportation issues, 8% due to lack of autonomy or flexibility in work arrangements.

Employment opportunities for people with chronic diseases could vary across different sectors and occupations. According to the labour force survey, people with chronic diseases are not likely to work in specific sector but are more likely to work on lower occupational positions than people with no chronic diseases (Table 4).

Table 4: Occupational Segregation by Chronic Disease (Age 15-64), 2011

 

Population without chronic diseases

Population with chronic diseases

Total

Managers (ISCO 1)

9.1%

5.4%

8.1%

Professionals (ISCO 2-3)

31.8%

20.4%

28.7%

Service staff (ISCO 4-5)

19.6%

20.2%

19.7%

Skilled workers (ISCO 6-8)

31.1%

37.6%

32.8%

Elementary occupations (ISCO9)

8.1%

16.4%

10.3%

Source: Statistic Estonia, Estonian Labour Force Survey 2011, authors calculations

For instance, the table indicates that people with chronic diseases are two times more likely work on elementary occupations that population without chronic diseases. This could be outcome of both access to education but also access to higher positions due to supply of enabling work environment and working conditions, and discrimination. Further research is needed to estimate relative importance of these factors.

2.2. Working conditions of employed people affected by chronic diseases

Reconciliation of working and non-working life: are people with chronic diseases allowed special conditions in terms of work-life balance, flexibility at work to cope with the diseases/attend treatment, ability to set their own working time arrangements, etc.?

Career and employment security: to which extent and how is the employment status of people with chronic diseases affected by their health situation?; is there an impact in their remuneration levels/conditions?; in what measure is there a repercussion on their employment security and working career?; are they allowed/forced to changes in their jobs?

Skills development: in what measure have chronic diseases an impact in the access of workers to training activities promoted by the employer? Has the training anything to do with the disease situation?

Are there any significant differences in these working conditions according to different groups of affected workers (type of disease, gender, age, sector, etc.)?

Are there any significant changes in recent years? Possible effects of the economic crisis on these situations, if any.

The only source for describing working conditions of people with chronic diseases is Estonian Labour Force Survey 2011 that had an ad hoc module on health and disability. According to the survey, about 92% of employed persons are employees and there is no statistically significant difference between people with chronic diseases and without chronic diseases. Also, about 95% consider their employment permanent and similarly there is no statistically significant difference between people with chronic diseases and without chronic diseases.

About 91% are employed full time and there is no statistically significant difference between people with chronic diseases and without chronic diseases, neither are there statistically significant differences in the will to work shorter or longer than they currently do.

People with chronic disease are more likely to work during evening hours – about 27% percentage of people with chronic disease work frequently (i.e. at least half the working days) between 6-12 PM while about 20% of people without chronic diseases work at that part of the day (there are no statistically significant differences in night work). This might indicate that people with chronic diseases have not that good access to daily work opportunities, but could also indicate the need to reconcile work and life, including need to participate in health and social services during daytime.

About 8% of employed persons work at least partially sometimes outside office and do telework (including homework, remote work) and there is no statistically significant difference between people with chronic diseases and without chronic diseases.

About 14% of people with chronic diseases consider that their current job requires a lower level of education than they have which is a little bit higher compared to people without chronic disease (about 10%). The small difference in proportions indicates that people with chronic diseases are a bit more likely over skilled for their job. Also, there is no significant difference in participation in training and retraining courses.

In sum, the presented statistics on employment opportunities and working conditions indicates that large proportion of people with chronic diseases is inactive or unemployed. At the same time the working conditions of employed people with chronic diseases are not that different from employed persons without chronic diseases. This indicates that employment of people with chronic diseases depends on both willingness to work and also supply of working conditions that could take into account their special needs and thus enable their labour market participation. Still, more in-depth analysis is needed to understand their employment opportunities. Likewise, active policy measures to support their willingness and opportunities to work needs more attention.

Block 3: Policies and measures adopted by public and private agents to favour the employment situation and working conditions of people with chronic diseases

3.1. Description of main policy measures/initiatives developed by public authorities or social partners

In Estonia, employers does not have obligation to employ people with chronic diseases or occupational disability. Also, employers have limited obligation in reactivation and rehabilitation to help people with chronic diseases in staying in work or return to work. According to employment contracts act that went into force in 2009, employer is obliged to ensure working conditions corresponding to occupational health and safety requirements (§ 16) but could terminate an employment if the employee has been unable to perform their duties for over four months due to their state of health (§ 54). At the same time, state supports employment of people with chronic diseases by social tax incentives (Social Tax Act § 6) and compensating expenses that are needed for workplace adaptation (Labour Market Services and Benefits Act § 20). These measures decrease employers’ labour costs.

People with chronic diseases could apply for permanent incapacity pension (State Pension Insurance Act). The pension is monthly financial social security benefit for people who due to illness or injury are not capable of earning a living, or whose performance in employment is limited. Persons’ eligibility to the replacement income does not depend on his/her activity in labour market, i.e. they do not have to look for a suitable job and they do not have to take part in active employment services (State Pension Insurance Act §18).

People with chronic diseases that have incapacity to work are eligible for social rehabilitation that includes physiotherapy services, action therapy services, and social work services etc. Also, people with incapacity to work and willing to work (both unemployed and at risk of losing their jobs) could apply for labour market services and benefits (Labour Market Services and Benefits Act). The act considers people with incapacity to work a risk group that need additional help upon commencing employment (§ 10). According to the act (§ 9), special services for the risk group are adaptation of premises and equipment, special aids and equipment, communication support at interviews, and working with support person. Still, due to low activity rate of the group and supply of labour market services and rehabilitation services, the take up of these measures is quite low.

Due to increase in share of population with permanent incapacity, share of inactive population with incapacity, shortcomings in staying-in-work/return-to-work policy measures, and the need to improve the sustainability of social insurance system, the Sotsiaalministeerium is currently preparing to reform the system. According to the policy document (in English The principles and schedule of the system to support ability to work), the first step of the reform is to move from the evaluation of incapacity to evaluation of capacity to work that includes professional recommendations to employee and assistance to employer. Also the first step of the reform includes change in eligibility for replacement income and implementation of activity requirements– person with partial capacity to work is eligible for benefit if he/she is (1) employed, (2) unemployed and participates in labour market measures, or (3) acquires formal education. These first steps are expected to go into force in July 1 2015.

Social partners have more or less supported the reform, but have pointed out the complexity of the reform of which some aspects have not got necessary attention. For instance employee representatives have argued that the proposed measures deal with outcomes, and prevention of health risks need more attention. The reform proposes too little initiatives for employers to improve working conditions adapt work environment and improve skills of their employees. Also the supply of services, including case management and assistance in adapting work environment is lacking. Employers’ representatives have suggested that the Government would start sooner rather than later discussion on work accidents and occupational diseases insurance reform model that is crucial for prevention of incapacity and improving working conditions, work environment. At the same time, employers’ representatives are reluctant to introduce measures that would increase labour costs if other labour taxes remained the same. Also, taking into account variety of measures and complexity of administrative processes that need to be changed and effectively put to work, interest groups and social partners have pointed out that the reform should not be rushed.

3.2. Examples of enterprises and/or collective agreements implementing initiatives or establishing clauses to support people with chronic diseases

There is no information about collective agreements that determine employment opportunities or working conditions for people with (chronic) health problems. Also, although there are not initiatives that specifically focus to support people with chronic diseases, there have been some initiatives to support employment opportunities of population with health problems and occupational disability. For instance, in 2009 a social enterprise MTÜ Abikäsi started with labour mediation in cooperation with number of companies to improve employment for people with special needs.

Also, according to Estonian regulations, neither employer nor health insurance fund is obliged to pay sickness benefit for the first three calendar days of employees’ temporary incapacity to work. However, it is quite widespread good practice that employers have committed to pay the benefit also for these days. The initiative might be beneficial for people with chronic diseases whose health problems tend to periodically worsen or reoccur.

Commentary

There is a large share of people with chronic diseases that are inactive or unemployed. Employment of people with chronic diseases depends on both their willingness to work and also supply of working conditions that could take into account their special needs. The policy measures have enabled inactivity and have not provided enough support for staying in work and return to work. The future reform will have to introduce measures to prevent chronic health problems and support employment of people with chronic health problems.

References

Töövõime toetamise süsteemi põhimõtted ja ajakava (in english The principles and schedule of the system to support ability to work)

http://www.sm.ee/fileadmin/meedia/Dokumendid/TVK/T%C3%B6%C3%B6v%C3%B5ime_toetamise_s%C3%BCsteemi_p%C3%B5him%C3%B5tted_ja_ajakava.pdf

State Pension Insurance Act https://www.riigiteataja.ee/en/eli/ee/Riigikogu/act/515012014003/consolide/current

Labour Market Services and Benefits Act

https://www.riigiteataja.ee/en/eli/ee/514012014003/consolide/current

Employment Contracts Act

https://www.riigiteataja.ee/en/eli/ee/Riigikogu/act/530102013061/consolide

Social Tax Act

https://www.riigiteataja.ee/en/eli/514112013022/consolide

Sotsiaalministri määrus Töövõime kaotuse protsendi määramise juhend (in English Regulation of the Minister of Social Affairs “The Guidelines for Determining Incapacity for Work”).

https://www.riigiteataja.ee/akt/163243

Social Benefits for Disabled Persons Act https://www.riigiteataja.ee/en/eli/ee/Riigikogu/act/514112013021/consolide

2011 Population and Housing Census http://www.stat.ee/phc2011

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