[Special Collection] Paid Sick Leave and Sickness Benefits: Toward the Right to Rest When Sick
Review
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Medical certification in sickness benefit scheme (II): practical approaches for evaluating work disability
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Yangwoo Kim, Inah Kim
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Ann Occup Environ Med 2025;37:e24. Published online July 28, 2025
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DOI: https://doi.org/10.35371/aoem.2025.37.e24
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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
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An Evidence-Based Multidisciplinary Practice Guideline to Reduce the Workload due to Lifting for Preventing Work-Related Low Back Pain
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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
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Ann Occup Environ Med 2014;26:16. Published online June 24, 2014
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DOI: https://doi.org/10.1186/2052-4374-26-16
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Abstract
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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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