Biomedical subjects

H N Plomp

Publications and source records attributed to H N Plomp.

14 recordsLinked to original sources

PubMed2000

[Development of second-line occupational health services: toward an integrated network of insurers and care providers].

OBJECTIVE: To describe the development of the second-line Occupational Health Services and the role of private insurance companies in it over the period 1994-1999. DESIGN: Descriptive cross-sectional study. METHOD: Data were collected in 1999 from written documents and supplementary interviews with the five largest private providers of disability insurance, the National Insurance Institute, nine Occupational Health Services of different natures and 24 institutions for second-line occupational health service. RESULTS: After the privatization of the Health Law in 1996 and parts of the Law on disability Insurance, most employers covered the risk of continued payment of wages in case of disability with private insurers. These attempted to keep claims down by active engagement in arbitration, treatment and diagnostics of disabled employees so as to counteract avoidable absenteeism. Under the influence of the insurance companies, a trend developed toward integrated nation-wide chains in which the services provided by insurers, by occupational health services and by implementing institutions are geared for one another. CONCLUSION: Commercial provision of Occupational Health Service is a new, demand-active form of care provision in which the financier plays a key part. This provision of services supplied important innovating impulses for health care in its entirety because of its large scale, strong protocolling of processes and management on the basis of continuous cost-benefit analyses. A lucid and socially acceptable regulation of commercial providers of occupational health services was lacking.

Health Personnel↗

PubMed1999

[The social security reform: wide-ranging effects on companies as well as occupational health services].

OBJECTIVE: To evaluate the reactions of companies and Occupational Health Services (OHSs) to the reform of the social security system by the government of the Netherlands; especially to inventory to what extent intended effects (more handicapped workers employed, more reintegration efforts) and unintended effects (exclusion handicapped workers, deteriorated quality OHSs) occurred. DESIGN: Inventory survey. METHOD: Data on number of OHSs and their sizes and staff compositions were collected in September 1997 through a questionnaire sent to all members of the National Association of OHSs (BOA). In addition, data on efforts of enterprises in the area of working circumstances in 1996 and in 1997 were derived from the published results of enquiries by telephone among a representative random sample of 4,000 enterprises. RESULTS: The number of employees in the care of the OHSs was twice as high in 1997 as in 1991. The number of OHS staff members had also doubled, but the proportion of physicians among the total staff had decreased. The number of employees per physician had increased by 34%. The nature of the contracts concluded with enterprises shows that the extension of the market has not led to more extensive OHS care, although it has brought about greater variation. Generally, large companies developed a policy to prevent disability and to employ more handicapped workers, while small and medium-size companies more often tried to exclude people that is at risk for disability or absenteeism. CONCLUSION: Intended effects occurred to a limited extent in larger companies and unintended effects mainly in small and medium-size companies.

Disability Evaluation↗

PubMed1999

[Market effect on social security and occupational health services].

Between 1993 and 1998 a fundamental reform of the social security system and Occupational Health Services (OHSs) in the Netherlands was implemented in order to lower the relatively high sickness and disability rates. The principle of the government policy is to impose the financial consequences of incapacity for work as much as possible on those who cause it: employers and employees. The reform implies the creation of a market in both fields. Joining an OHS was made mandatory for all employers by ultimately the first of January 1998. Price and product competition between different suppliers of OHSs is promoted. This implies an explosive increase of the target population and the rise of commercial OHSs (which in 1997 provided for 570,000 employees). Other OHSs originated from industrial insurance boards (over 2 million) or from industrial health services (over 3 million). The change of system has increased the economic importance of sickness and health. The number of persons incapable for work has meanwhile grown, risk avoidance by enterprises being one of the causes. Owing to the enhanced interference of employers with absenteeism, the health care system is being asked for specific measures for employees and better contacts between industrial physicians and treating physicians.

Absenteeism↗

PubMed1999

[Professional integrity among commercial occupational health services].

In the field of Occupational Health Services (OHSs) a fundamental change of the regime of supply of services was implemented in the Netherlands between 1993 and 1998 by introducing market competition. This regime change is characterised as a shift from a suppliers' market where occupational physicians were able to determine the supply to a large extent, to a buyers' market where companies can choose from a large variety of services at different prices. The regime change does affect the position of the occupational physician drastically and many consider their professional integrity and independence threatened. To meet the demand for an independent judgement and advice in problems concerning the interaction between work and health, the professional group should organize itself more as a party in the market.

Adult↗

PubMed1999

Evaluation of doctor-worker encounters in occupational health: an explanatory study.

In this paper workers' evaluations of various types of doctor-worker encounters in occupational health (the open consultation hour, required visits after absence from work and visits for periodic medical examination) are described and explored. The aim was a better understanding of the consultation processes and its determinants in the field of occupational health. Semistructured interviews were conducted in a sample of 313 employees. Quantitative and qualitative analyses were carried out in order to explain the variations in the outcome parameters. The quantitative analysis showed that workers' evaluation of their encounter with the occupational physician was rather indeterminate and only correlated positively with the variable 'meeting workers' expectations'. The qualitative analysis generated a classification of the variety of workers' expectations. In the Role Differentiation Model this classification of workers' expectations is related to three specific role aspects: the expert-, the counsellor- and the mediator-role aspect. The model assumes that the occupational physician should be able perform the behavioural requirements of these role aspects, in order to meet the expectations of the workers in various situations. The Role Differentiation Model is a hypothetical model, partly based on the outcome of the study, which explains the variation in workers' evaluations and could also be used to develop practice guidelines.

Analysis of Variance↗

PubMed1998

The intention to utilize occupational health services.

Workers' intention to utilize the Occupational Health Service (OHS), conceived as a cost-benefit assessment of an action, is described for a series of conceivable situations. Data were acquired during interviews with a sample of 313 employees with an over-representation of workers with work-related health problems in three different companies. Only for problems that are perceived as medical, individual and work-related, do a substantial number of workers intend to utilize the occupational physician. For health and work-related problems of a collective character, the line of supervision is mostly preferred for use as an adviser. Workers' intention to utilize OHS is positively correlated with their attitude towards the occupational physician. No associations were found with self-reported health status, working environment or actual utilization of the OHS. It is concluded that the intention to utilize the OHS is an independent factor affecting the actual utilization and it should be seriously taken into consideration when evaluating or implementing the coverage by the OHS.

Back Pain↗

PubMed1997

Occupational stress management programmes: a practical overview of published effect studies.

There are many occupational stress management programmes available which are designed to prevent and cure the negative aspects of job-stress. The focus of the programmes can be directed towards the individual worker, the working group, the organization of the work or the organization as a whole. Moreover, programmes show a considerable variation with respect to the type of interventions they promote and their underlying assumptions, as well as their duration and costs. In this paper, effect studies of occupational stress programmes published between 1987 and 1994 are reviewed. The aim is to give a practical overview of the variety in occupational stress programmes, their scope, applicability and the evidence of their effectiveness. The paper updates the review by DeFrank and Cooper published in 1989.

Adaptation, Psychological↗

PubMed1996

The Amsterdam methadone dispensing circuit: genesis and effectiveness of a public health model for local drug policy.

During the 1970s, the Methadone Dispensing Circuit (MDC) was initiated by the municipality of Amsterdam in order to cope with the heroin addiction epidemic that afflicted the city. In the MDC, methadone is dispensed to opiate addicts on a maintenance basis in low-threshold public health programmes, as well as in high-threshold treatment programmes. The MDC is an essential part of the local drug policy in the city. It is designed to get in touch with all opiate addicts who are not able to manage their lives in a proper way, and to stimulate them to regulate their addiction. This paper describes the genesis of the MDC as a result of a historical and political process. Determining factors in this process proved to be the urgency of the drug problem, the widespread consensus among local politicians, most of the general practitioners (GPs) and alternative relief institutions about the low-threshold dispensing, and finally its success, particularly the lower rate of drug-related death and less disruption of public order. In the second part of the paper, data on the functioning and effectiveness of the MDC are presented. It is concluded that the effectiveness of the MDC could be improved by better management and the application of more sensible diagnostic methods. The transferability of the 'Amsterdam model' to other places is discussed; besides the burden of the drug problem, it depends on the acceptance of the underlying value orientation.

Cross-Sectional Studies↗

PubMed1996

Accessibility and utilization of occupational health services.

OBJECTIVES: The purpose of this study was to evaluate employees' utilization of occupational health services in three Dutch companies in which the access to such services (open consultation hour, summoning and periodic health examination) is organized differently. Accessibility to occupational health services is considered to be adequate if workers with work-related health problems are reached. METHODS: For a random sample (N = 911) utilization figures were determined. For a second, nonrandom sample (N = 313) with an overrepresentation of employees with work and health problems, interviews were conducted with regard to health and work problems and motives for utilizing occupational health services. RESULTS: Workers with different profiles of work and health problems were reached through different types of access to occupational health services. To a large extent, the utilization of occupational health services is determined by the organization of its access. CONCLUSIONS: Accessibility of occupational health services is an important prerequisite of effectiveness and therefore a serious object for health policy and evaluation.

Drug Industry↗

PubMed1993

Methadone maintenance clients in Amsterdam after five years.

The aim of the low-threshold Amsterdam Methadone Maintenance (MM) system is regulation of clients, i.e., the development of a way of life which is more acceptable to society and more satisfactory for clients. In this paper we describe the regulation of two random samples of clients who entered the Amsterdam MM 5 years earlier. Seventeen clients who left MM within 5 years are compared with 21 clients who stayed. The study indicates that clients who leave use less hard drugs and methadone, take better care of themselves, and have more often established a drug-free social network.

Adult↗

PubMed1993

Employees' and occupational physicians' different perceptions of the work-relatedness of health problems: a critical point in an effective consultation process.

In a survey on workers' attitude and behaviour towards the occupational health service (OHS) in their company, it appears that there is hardly any relationship between physicians' and employees' judgement on the work-relatedness of health problems presented during a consultation hour. This is considered an alarming outcome with severe implication for the doctor-client communication. In this article an explanation for this large discrepancy between the physicians' and employees' judgement is derived from the clarification given by employees and from theories on the lay-definition of health and illness and on doctor-patient interaction. Apart from factors already mentioned in the general literature on the doctor-patient relations, the socio-economic implications of the label of 'work-relatedness of health problems' in the field of the occupational health services, turns out to be an important factor in the explanation.

Adult↗

PubMed1992

Demand for alcohol treatment by problem drinkers.

Problem drinkers applying for treatment at both outpatient and inpatient treatment programs were compared with problem drinkers identified in a general population survey. The characteristics in which these populations differ were interpreted as factors contributing to the demand for treatment and, thus, indicative of the need for alcohol treatment. Older problem drinkers appear to apply for treatment more frequently, and the same is true for divorced and unemployed or disabled problem drinkers. More important, age, marital status, and employment status were found to contribute to the demand for alcohol treatment independent of alcohol consumption. It can be concluded from this study that the demand for alcohol treatment is not determined by alcohol consumption alone, suggesting that alcohol treatment should not only focus on alcohol consumption but also focus on problems related to marital and employment status in order to prevent future need for alcohol treatment.

Adult↗

PubMed1992

Workers' attitude toward the occupational physician.

This article presents research findings concerning workers' perception and opinion of the occupational health service (OHS) in three different Dutch companies. Beside comparing the effect of company characteristics, we were able to relate a worker's evaluation of the OHS to employee variables such as health status. We conclude that workers see clear differences in the tasks and functions of the occupational physician compared with those of the curative physician. Relations with and dependence on management is considered to be self-evident. A negative evaluation of the OHS is mainly because of unclarity and uncertainty as to how the occupational physician combines his/her responsibility toward individual workers with his/her responsibility toward the company. Suggestions are made for improvement of the reputation and credibility of the OHS.

Adult↗

PubMed1989

The interpretation of self-care: a difference in outlook between clients and home-nurses.

In this article, the client's interpretation of self-care and that of home-nurses are compared [1. Agthoven W. M. van and Zorg op Maat. Het afstemmingsproces tussen wijkverpleging, kliënt en informele zorgverlener. Instituut voor Sociale Geneeskunde, Vrije Universiteit (The process of directing self-care, informal and formal assistance). Department of Social Medicine, Free University, Amsterdam, 1985.] Self-care is defined, by two components: the decision (as to) what to do and the execution of the care. In estimating the client's capacity for self-care a limited number of discrepancies play a role on the physical level and many more on the psychosocial level. It is particularly in psychosocial care that a severe distortion occurs if the professional helper makes an estimate of the client's capacity to cope with the psychological and social aspects of care. The client finds himself much more capable, in this respect, than the home-nurse. Moreover, the client estimates the role of this professional helper in providing advice and guidance much lower than the helper in providing advice and guidance much lower than the helper indicates. Various discrepancies in outlook of client and home-nurse concerning self-care were indicated in the study and discussed in relation to Freidsons concept 'social construction of illness' and Scheff's ideas about 'negotiating responsibility'.

Attitude to Health↗