Organizational contexts and social change in rehabilitation

Abstract

Abstract To a large extent, opportunities of working with a chronic disease or disability, and risks of early exit from paid work are contingent on legal regulations and on the structures of medical and vocational rehabilitation services. Legal regulations concern regular retirement, early retirement due to disability pension, and processes of return to work. In all instances, active and passive labour market and social policies exert a decisive impact, and these policies vary widely across countries. Special attention is given to organizational features in the provision of medical and vocational rehabilitation services. Despite their reasonable availability, these two services are often not well coordinated, as illustrated in the case of cardiac rehabilitation and of return to work with mental disorder. In medically dominated fields of rehabilitation the pro-active role of patients was disregarded for a long time, but recent attempts to empower patients with chronic health impairments became more visible. In this chapter, some examples of this social change are described. In the final part, we develop some suggestions on how future developments can contribute to successfully coping with the burden of chronic disease and disability in working populations.