[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.