• The number of people on long-term sick leave has been rising almost constantly since the early 2000s.
• Treatment and reintegration pathways need to be designed in a more cohesive manner, while taking into account the individual’s state of health. The earlier reintegration is begun, the more likely it is to succeed.

The number of people in Belgium who have been on sick leave for over twelve months has been growing almost constantly since the early 2000s. Amongst private sector employees alone, some 285 000 women and 187 000 men had been out of work for over a year for this reason at the end of 2022.

While average levels of health are improving, the probability of becoming unfit for work continues to rise, even when factoring in the effects of population ageing and increased female labour force participation.

Not all workers are situated equally when it comes to the risk of becoming unfit for work. The risk is highest for blue-collar workers, with higher risk exposure in certain sectors (particularly logistics, manufacturing, security and surveillance services, cleaning, home help and elderly care, etc.) despite the preventive measures that have already been put in place by employers.

More support to encourage a return to work

To better reintegrate people who are on sick leave, all parties involved must work in sync: from the worker, the employer, the occupational physician and the attending physician to health insurance funds, public employment services and their healthcare partners.

Different pathways are available to encourage reintegration into the labour market. Workers can seek the support of an occupational physician, with whom they can assess the possibilities of resuming work (partially or fully) and whether adaptations to their workplace are possible. This support can take the form of an informal pre-return-to-work visit or a more structured reintegration trajectory. Public employment services and their partners can, meanwhile, provide guidance and training to people who are unable or unwilling to return to their current place of work.

A partial return to work, combining a proportion of one’s salary with sickness benefits, is the most widely used pathway: 120 000 people made use of it in 2021, more than double the number recorded in 2015.

An earlier start to reintegration

Although the number of people making use of reintegration pathways is increasing, this has not (yet) led to an uptick in the numbers leaving the benefits system: the probability that a period of sick leave will last at least a year has held steady at around 20%. The fact that people often embark on a reintegration pathway only late into their period of absence contributes to this situation.

Following a period of sick leave, a significant proportion of people find a job with a new employer, and in most cases in a new sector. The support available from public employment services can help people who need to broaden their skills or wish to reorientate their careers after a period of sick leave. However, this support is rarely used.

Recent reforms to the sick leave system, in both the private and public sectors, are a step in the right direction. The pathways for treatment and reintegration need to be considered more holistically. Results show that providing guidance earlier and speeding up the start of reintegration, while taking into account the individual’s state of health, are key to improving the integration of people with health problems and thus contributing to an inclusive labour market in which everyone’s skills are fully utilised.