Legal and policy approaches to implementing return to work program in Singapore - IFDM 2018
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A Great Workforce A Great Workplace
Legal and policy approaches to implementing
return to work program in Singapore
Dr Sylvia Teo
Sr Principal Specialist(RTW Unit)
TWSH & RTW, WSHC, TAL
International Forum on Disability Management 2018
Vancouver, Canada
October 14-17, 2018
© 2018 Government of Singapore 1
A Great Workforce A Great Workplace
Cost Benefit of RTWC Intervention
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
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
Costs
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
Net Benefit of RTWC intervention = $1,516.43 - $672.43
= $844 per injured employee
© 2018 Government of Singapore 2Changes to Work Injury Compensation Act
A Great Workforce A Great Workplace
(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 Amendment
• Psychotherapy to facilitate
• Functional capacity evaluation; and RTW-related
• Worksite assessment activities
© 2018 Government of Singapore 3A Great Workforce A Great Workplace
What are the main challenges?
I in 4 were unemployed
7 in 10 had no change in job-scopes
Base
Employment Status % n 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 © 2018 Government of Singapore 4A Great Workforce A Great Workplace
Physical and Psychological Impact
Felt tired easily/ other physical
44.2%
discomforts at work
Difficult to perform work at previous
39.1%
stds
standards
Fear that certain work activities will
24.6%
lead to harm/ injury
Felt a lack of support/
10.6%
understanding at work
Felt discriminated at work 6.4%
Did not face any challenges 10.3%
0.0% 10.0% 20.0% 30.0% 40.0% 50.0%
Findings from the study “Social and Financial Impact of Work Injuries for Local Workers” by WSHI
2014
© 2018 Government of Singapore 5A Great Workforce A Great Workplace
Types of support needed
31% stated
change of job
scope
30% stated job
redesign
24% would like
to have flexi-
hours
© 2018 Government of Singapore 6A Great Workforce A Great Workplace
Where Do our injured Employees go?
Non- Grand % of
Local Local Total Total
NATIONAL UNIVERSITY HOSPITAL
(SINGAPORE) PTE LTD 463 830 1293 21.2%
TAN TOCK SENG HOSPITAL 443 968 1411 23.2%
96% of WIC cases are seen at 7
SINGAPORE GENERAL HOSPITAL 399 396 795 13.1%
CHANGI GENERAL
Public HOSPITAL
hospitals 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%
Distribution of WIC Cases 2016 © 2018 Government of Singapore 7A Great Workforce A Great Workplace
National RTW programme
RTW Unit Affiliated RTW Centers
• Drive RTW programme • Dedicated clinics offering
RTW services
• Oversee and coordinate
implementation of the RTW • Sited within the acute public
programme hospitals which handle 96%
of the WIC cases
• Monitor progress and review
its effectiveness
© 2018 Government of Singapore 8A Great Workforce A Great Workplace
National RTW Programme seeks to address gaps
Awareness gap Capability gap Process gap Funding gap
• Educate key • Build a pool of • Set up affiliated • Provide seed
stakeholders on certified RTW RTW centres in funding to
the benefits of coordinators public hospitals public hospitals
RTW through through funding and: to kick-start
engagement and formal • Develop RTW RTW
outreach (e.g. certification workflow programme
info-graphics, programmes# • Identify
guidelines, workers who • Set up a new
advisories) can benefit RTW Grant to
early support injured
• Monitor workers and
outcomes employers to
RTW
RTW unit (WSHC) to drive efforts and build capabilities
# 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
© 2018 Government of Singapore 9Public Hospitals -- Affiliated RTW
A Great Workforce Centers
A Great Workplace
Dedicated clinics offering RTW services
• 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
© 2018 Government of Singapore 10A Great Workforce A Great Workplace
MOM’s
MOM’sRTW Grant
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.
© 2018 Government of Singapore 11A Great Workforce A Great Workplace
Monitoring Monitoring
RTW Co-ordinators will collect and report the following indicators to MOM
Demographics Work-related Health-related RTW Programme
outcomes outcomes specific indicator
• Employee’s info • Time to RTW • Quality of life • Medical and
• Company’s info • Income prior measure rehabilitation
• Injury suffered injury and post (EQ5D/5L) costs incurred
• Medical RTW • Functional • Take-up rate and
treatment • RTW rate at ability at 3, 6 9 reasons for non-
3,6,9 months mths participation
• Category of RTW • Self-efficacy • Drop-out rates,
scale reasons for
drop-out
• ROI
Key performance Indicators in assessing effectiveness of program :
a.Return to work rate (target 90%)
b.RTW Participation rates (target 90%)
© 2018 Government of Singapore 12A Great Workforce A Great Workplace
Workplace Safety and Health Awards
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
© 2018 Government of Singapore 13A Great Workforce A Great Workplace
RTW Models in Singapore: Current
Workplace Hospital-Based Model Insurance-
based Model Based Model
RTW co-ordinators are
RTW Co-ordinators occupational/physiotherapists RTW
are appointed by /medical social workers or coordinators are
company nurses appointed by
insurance
e.g. Keppel First hospital to roll out RTW companies
Offshore and clinical services is TTSH in Oct
Marine 2017 e.g. AIA, AXA
© 2018 Government of Singapore 14The Present : A Great Workforce A Great Workplace
“ The Hospital Model” of RTW program
Feb 2018 – Singapore
General Hospital
May 2018 – Ng Teng Fong
Oct 2017 – Tan General Hospital Nov 2018-Khoo Jan 2019-Sengkang
Tock Seng Hospital Teck Puat Hospital General Health
Jun 2018 – Changi General
Hospital, National
University Hospital
Jul-Dec 2017 Jan-Jun 2018 Jul-Dec 2018 Jan 2019
Training of RTWCs
3 RTW Co-ordinator workshops,
NIDMAR (web-based) learning,
On-the-Job training
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)© 2018 Government of Singapore 15A Great Workforce A Great Workplace
RTW Milestones
RTW Milestones
• Engaged TTSH Visit to SOCSO 1st RTW Minister’s Approval Conducted 3 RTWC
to conduct a Rehab Centre in Seminar for Implementation work
RCT to Malacca led by (Visiting Expert of RTW Program on shops to train 40
showcase
Senior govt Series) 14th Feb Allied Healthcare
benefits of RTW
Co-ordinator official with a professionals
based system total of 17 Establishment of a
for delegates from 1st RTWC Return to Work Unit
rehabilitation of Singapore workshop by in WSH Council on
injured National TTSH – 14 persons 1st April 7 Occupational and
employees. Employers trained, from Physiotherapists
• Focus on Federation, TTSH, insurers, Tan Tock Seng successfully attained
Medical insurers, loss-adjustors, Hospital provides professional
Rehabilitation healthcare sector private healthcare RTW clinical services NIDMAR
with RTW and Ministry of sector and by Oct 17 certification-
services done Manpower(MOM) Voluntary Welfare CDMP/CRTWCs
on ad-hoc basis organizations
2010-12 2015 2016 2017 2018
© 2018 Government of Singapore 16A Great Workforce A Great Workplace
RTModels in Singapore: Longer Term
Insurance-
Workplace
Based Model
based Model
RTW Co-ordinator
RTW Co-ordinator
are appointed by
are appointed by
insurance
company
companies
Eg. Keppel Offshore
Eg. AIA, AXA,
and Marine
Liberty Mutual
© 2018 Government of Singapore 17The Future: “ The Workplace Model” of RTW program 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) Partnership Development of competencies /capability in RTW coordination through certification Collaboration Active referral of injured worker to RTW program by company-based RTWC (system of referral) Mutual support 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)
A Great Workforce A Great Workplace
Legislative and Policy Challenges
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
© 2016 Government of Singapore 19A Great Workforce A Great Workplace
Desired RTW Framework
• Reports injury early Provision of a supportive
and seeks treatment environment to IW,
•Compliant to medical includes
treatment and rehab • Time off for medical
•Adheres to RTW plan treatment /rehab
•Trust RTWC •Provision of job
•Remains motivated and accommodation
keen to RTW •Retention of IW
•Prompt payment of bills
Supported by
Affiliated RTW Centres RTW Unit and Tripartite partners • Processing and paying WIC
• Monitoring outcome indicators compensation
• Provide occupational rehab services • Ensure IW receive medical •Step in to facilitate RTW in
• Hospital-based RTWCs initiates treatment and due compensation specific cases(complicated,
RTW process through • Engage Tripartite partners to delayed recovery)
A. Initial Assessment, FCE support RTW • Tracking of cost of rehab and
B. Individualised RTW plan • Step in to facilitate RTW in specific case management services in
C. Identify barriers and challenges cases insurers’ database
D. Conduct worksite assessment © 2018 Government of Singapore 20You can also read
