Annals of Occupational and Environmental Medicine

[Special Collection] Paid Sick Leave and Sickness Benefits: Toward the Right to Rest When Sick

Review

Medical certification in sickness benefit scheme (II): practical approaches for evaluating work disability: Yangwoo Kim, Inah Kim; Ann Occup Environ Med 2025;37:e24. Published online July 28, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e24

Abstract Abstract in Korean PDF Supplementary Material

Work disability evaluation plays a central role in medical certification in sickness benefit schemes. This guides effective decision making for return-to-work timelines. Countries that incorporate it have varied approaches. To improve fairness and consistency, Sweden adopted disease-specific guidelines, particularly for complex health conditions such as mental disorders, cancer, and neurological diseases, whereas in the United Kingdom, a fit note system highlights the ease of fitness-for-work assessments in clinical settings. For a successful implementation of the sickness benefit scheme in Korea, it is essential to review international acumen in work disability evaluation and medical certification. This study also examines challenges that physicians face in certification, factors influencing assessments, and the usefulness of disease-specific guidelines. In many countries, administrative burdens, uncertainty in diagnosis, and ethical conflicts complicate physicians' tasks. Countries such as Sweden, France, and Ireland, have addressed these issues by developing structured certification tools and support systems. Learnings from the recent Korean pilot programs, this review identifies the following core priorities: developing disease-specific guidelines, providing clinical support for physicians’ decisions, and integrating occupational health expertise. These guidelines should function not only as administrative checklists, but also as potential clinical tools that consider both patient functionality and job characteristics. Finally, this study offers policy and practical insights to help design a consistent and fair medical certification system for Korea’s sickness benefit program that encourages timely medical intervention, prevents presenteeism, and promotes sustainable workforce reintegration.

상병수당 제도에서의 의료인증체계(2): 근로능력 평가의 실제
근로능력 평가는 상병수당 의료인증체계에서 가장 핵심적인 요소로, 근로활동불가기간을 정확히 산정하여 근로자의 적절한 직장복귀를 지원한다. 국가마다 근로능력 평가 방식은 상이하며, 형평성과 일관성을 제고하기 위해 스웨덴 등은 질병별 가이드라인을 도입하였다. 특히 스웨덴은 정신질환, 암, 신경계 질환과 같이 평가가 어려운 질병군까지 포함하는 포괄적인 지침을 보유하고 있다. 영국의 핏 노트 제도는 업무적합성 평가를 임상 현장에서 어떻게 적용할 수 있는지에 대한 구체적 사례를 제공한다.
한국의 상병수당 제도가 성공적으로 도입되기 위해서는, 근로능력 평가와 상병수당 의료인증에 관한 국제적 경험을 고찰하는 것이 필수적이다. 본 연구에서는 의료인증 과정에서 의사가 겪는 어려움, 근로능력 평가에 영향을 미치는 요인, 질병별 가이드라인의 활용 가능성 등을 함께 분석하였다. 여러 나라에서 진단 불확실성, 행정 부담, 윤리적 갈등 등으로 인해 의료진이 인증 업무에 어려움을 겪고 있으며, 스웨덴·프랑스·아일랜드 등은 이를 해결하기 위해 구조화된 인증 도구와 지원 체계를 마련하고 있다.
한국의 시범사업 경험을 바탕으로, 본 논문은 질병별 가이드라인 개발, 임상의의 의사결정 지원 체계 마련, 직업보건 전문성의 제도적 통합을 제시하고자 하였다. 이러한 지침은 단순한 행정 문서가 아닌, 환자의 기능과 직무 특성을 반영한 임상 도구로서 기능해야 할 것이다.

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Predictors of prolonged sickness absence after work injuries: a retrospective study using Tukey’s Fence in 66,658 Hong Kong workers
Ziyu Wan, Hayley Y.W. Gu, Heidi K.Y. Lo, Jianfei Xie, Karen P.Y. Liu, Andy S.K. Cheng, Peter H.F. Ng
BMC Public Health.2025;[Epub] CrossRef

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Review

An Evidence-Based Multidisciplinary Practice Guideline to Reduce the Workload due to Lifting for Preventing Work-Related Low Back Pain: P Paul FM Kuijer, Jos HAM Verbeek, Bart Visser, Leo AM Elders, Nico Van Roden, Marion ER Van den Wittenboer, Marian Lebbink, Alex Burdorf, Carel TJ Hulshof; Ann Occup Environ Med 2014;26:16. Published online June 24, 2014; DOI: https://doi.org/10.1186/2052-4374-26-16

Abstract PDF

We developed an evidence-based practice guideline to support occupational safety and health (OSH) professionals in assessing the risk due to lifting and in selecting effective preventive measures for low back pain (LBP) in the Netherlands. The guideline was developed at the request of the Dutch government by a project team of experts and OSH professionals in lifting and work-related LBP. The recommendations for risk assessment were based on the quality of instruments to assess the risk on LBP due to lifting. Recommendations for interventions were based on a systematic review of the effects of worker- and work directed interventions to reduce back load due to lifting. The quality of the evidence was rated as strong (A), moderate (B), limited (C) or based on consensus (D). Finally, eight experts and twenty-four OSH professionals commented on and evaluated the content and the feasibility of the preliminary guideline. For risk assessment we recommend loads heavier than 25 kg always to be considered a risk for LBP while loads less than 3 kg do not pose a risk. For loads between 3–25 kg, risk assessment shall be performed using the Manual handling Assessment Charts (MAC)-Tool or National Institute for Occupational Safety and Health (NIOSH) lifting equation. Effective work oriented interventions are patient lifting devices (Level A) and lifting devices for goods (Level C), optimizing working height (Level A) and reducing load mass (Level C). Ineffective work oriented preventive measures are regulations to ban lifting without proper alternatives (Level D). We do not recommend worker-oriented interventions but consider personal lift assist devices as promising (Level C). Ineffective worker-oriented preventive measures are training in lifting technique (Level A), use of back-belts (Level A) and pre-employment medical examinations (Level A). This multidisciplinary evidence-based practice guideline gives clear criteria whether an employee is at risk for LBP while lifting and provides an easy-reference for (in)effective risk reduction measures based on scientific evidence, experience, and consensus among OSH experts and practitioners.

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Original Article

Knowledge, Attitude and Practice on Industrial Safety and Health in Technical High School Students: Sung Pil Choi, Chung Yill Park, Hyeon Woo Yim; Korean Journal of Occupational and Environmental Medicine 2001;13(2):171-179. Published online June 30, 2001; DOI: https://doi.org/10.35371/kjoem.2001.13.2.171

Abstract PDF

OBJECTIVES
This study was carried out to determine the knowledge(K), attitude(A) and practice(P) on major industrial safety and health problems among on-the-job training students.
METHODS
We used self-administered questionnaire regarding rules or regulations, the management of hazardous materials, the work place hygiene, the use of protective device, arrangement and improvement job site, ventilation, safety and health education, and inspection and management of equipment.
RESULTS
In general, the mean score of KAP in educated group compared with non-educated group was significantly higher. As increasing the frequency of education, the mean scores of KAP were increased. There were not significant differences among 'work duration' groups on total mean scores of knowledge and practice. But on that of the attitude, there was significant differences among 'work duration'groups. There were significant differences among 'size of enterprise'groups on total mean scores of knowledge and attitude. But on that of the practice, there was no significant differences among'size of enterprise' groups. In stepwise multiple regression analysis, education frequency and method were significantly attributed to KAP, but the coefficient of determination were low.
CONCLUSIONS
it is suggested that the increase of education time was the most important thing for improving the knowledge, attitude and practice on industrial safety and health in technical high school students.

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A Study on the Preceding Researches for the Safety Behavior in Construction
Simon Hang-Bok Rhee, Chi-Don Oh, Jin-Woo Choi
Journal of the Korea Safety Management and Science.2013; 15(3): 19. CrossRef

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Original Article

Perception, Attitude and Praetical Behavioral Change of Industrial Health Care Manager toward Group Health Care System: Kyoo Sang Kim, Jaehoon Roh, Yeon Soon Ahn; Korean Journal of Occupational and Environmental Medicine 1994;6(2):411-420. Published online September 30, 1994; DOI: https://doi.org/10.35371/kjoem.1994.6.2.411

Abstract PDF

To evaluate the change of perception, attitude and practice toward Group Health Care Systerl for small and medium industries, a survey using self-administered questionnaire was conducted to a part of industries in Inchon area, in year 1992 and 1993. major dependent variables were perception, attitude, and practical behavioral change related with Croup Health Care System ; these variables were measured by 3-point Likert like scale. 47 industries were used in analysis. Psrception of year 1993 was higher (1.25) than that (1 34) of 1992. Attitude of yeal. 1993 was also slightly higher (1.46) than that (1.43) of 1992. Both data indicated positive attitude. Practice of year 1993 was slightly lewer (0.86) tHan that (0.90) of 1992, but its change didn't have any statistical significance. In year 1992, major determinants of perception, attitude and behaviral change were sex and age of industrial health care manager ; they had positive efffct upon perception and practice. In yeal. 1993, it was sex of health care manager; it had influenced upon practice. Both year 1992 and 1993, perception was higher and attitude was more positive. In the case of higher perception or positive attitude, practice was active accordingly. To accelerate the behavioral change of health care manager, it is necessary to eaucate them continuously.

Citations

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Practice status of specialized agencies for occupational health management of small- to medium-size enterprises and the factors improving their performance: a cross-sectional survey study
Saerom Lee, Jun-Pyo Myong, Eun-A Kim, Huisu Eom, Bowha Choi, Young Joong Kang
Annals of Occupational and Environmental Medicine.2017;[Epub] CrossRef

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Original Article

The Factors associated with Knowledge, Attitude and Practice Regarding Occupational Health Among Small and Medium Scale Industry Workers: Chung Yill Park, Kang Sook Lee, Won Chul Lee, Se Hoon Lee; Korean Journal of Occupational and Environmental Medicine 1994;6(1):42-55. Published online February 28, 1994; DOI: https://doi.org/10.35371/kjoem.1994.6.1.42

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This study was carried out to determine the knowledge(K), attitude(A) and practice(P) on major occupational health problems among small and medium scale industry workers in Kimpo area. We used self-administered questionnairs regarding the emergency treatment on accident, the management of hazardous materials, the work place hygiene, the health risk of young workers and female works, the use of protective device, prevention of occupational disease, the periodic physical examination and the occupational health administration. The results obtained were as follow; 1. There were significant differences among age groups on the KAP. The teenage group had the lowest scores. As the age increased, total mean scores of KAP were increased concurrently, and this trend was statistically significant. 2. There was significant differences between male and female subjects on total mean scores of knowledge. But on that of the attitude and practice, there was no significant difference between male and female subjects. 3. As the size of enterprise increased, the mean scores of knowledge, attitude and practice were increased, but this trend was not statistically significant. 4. As the work duration increased, the mean scores of the attitude and the practice were increased. But the mean scores of the knowledge did not show this trend. 5. The white collar workers had significant higher scores than blue collar workers on knowledge, but there were not significant differeneces on attitude and practice. 6. The significantly associated variables on knowledge were work status and sex. On attitude and practice, age and work duration were significantly associated variables, but the degree of association was low. 7. When stepwise multiple regression analysis was done, work status, sex, age were significantly attributed to knowledge, age and sex wwere attributed to attitude, and age was attributed to knowledge, but the coefficient of determination were very low. In conclusion in small and medium scale industry workers, there were weak or no effects of age, sex of enterprise, work duration and work status on knowledge, attitude and practice regarding occupational health. So, it is suggested that all the members of the workers should be included in health education program for the workers.

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