Long-term work incapacity and reintegration: a necessary approach, but at what cost?

It only took about nine months this time, but as of 3 February, Belgium has got a new government.

It's no secret that the Belgian healthcare sector has been facing a lot of challenges lately. In 2024, it experienced significant protests. Those were primarily aimed at opposing proposed government austerity measures. Healthcare workers expressed concerns over deteriorating working conditions. The sector faced issues such as staff shortages, increased workloads, and the need for better support and recognition. Especially in the aftermath of the COVID-19 pandemic.

For those reasons, healthcare workers have been apprehensive about the new coalition agreement.

In line with its predecessor, the new government wants to optimize healthcare costs. According to the agreement, it plans on doing so through a series of new measures.

Among other things, it introduces stricter policies to reintegrate long-term sick workers. The new system would put more responsibility on employers and doctors. They are expected to work together to stimulate a faster return to work.

But while the aim of reducing long-term absences is good, the methods raise serious concerns.

Reducing long-term absences is a valid goal, but at what cost—and to whom?

Increased financial and administrative pressure on employers

Up until now, employers didn't have to cover any salary costs beyond the first month of incapacity. The new reform changes that.

Companies (excluding SMEs) will now have to cover 30% of the sickness benefits for the two months following the guaranteed salary period. This aims to encourage proactive absence management. However, it may discourage hiring employees with medical histories. This adds an unintended layer of discrimination.

The companies that are affected (250 employees or more) represent 0.1% of employers in Belgium. That said, they concentrate 34.9% of total employment in the country. Therefore, the measure will affect a significant number of workers.

This represents an estimated total extra cost of €35.3 million per year for large employers.

Beyond financial responsibility, the reform also imposes new administrative obligations. After eight weeks of absence, employers must request an evaluation of the worker’s reintegration potential. If deemed possible, a reintegration process must start. Large companies face penalties if this is not initiated within six months.

The risk? Reintegration driven by compliance rather than well-being. Companies may feel pressured to rush return-to-work processes. In other words, they might focus more on avoiding fines than on ensuring a sustainable and tailored reintegration.

How does this compare with the neighboring countries?

Other European countries requite employers to set up return-to-work processes within 6 to 8 weeks of absence.

But sanctions are not necessarily the way to go as we can see with, among others, Germany and the Netherlands. We'll focus on those as they are both neighbors to Belgium and among the countries with the most comprehensive return-to-work system.

Germany

The German model is relatively close to the Belgian model in terms of compensation (employer pays the employee's wages in full for 6 weeks until a mutual fund takes over).

But support and prevention are where the difference is made.

German authorities provide employers with targeted financial and institutional support to encourage successful reintegration after long-term sick leave. Here are the main mechanisms:

1. Statutory Accident Insurance (DGUV):
The DGUV supports employers by funding workplace adaptations and reintegration measures. This includes financial assistance for modifying workstations or tools to accommodate employees returning from illness or injury. It also helps cover the implementation of graded return-to-work (GRTW) programs, easing employees back into their roles gradually.

2. German Pension Insurance (Deutsche Rentenversicherung):
This body offers medical and vocational rehabilitation benefits to support return to work. Employers can receive funding for workplace adjustments and training that help reintegrate employees with long-term health conditions.

3. Federal Employment Agency (Bundesagentur für Arbeit):
Employers may access wage subsidies to reduce the cost of reintegrating employees, along with financial support for on-the-job training. These measures aim to close skill gaps and facilitate a smoother return to productive employment.

As a result, 75 to 90% of employees who have followed a gradual return-to-work trajectory are successfully reintegrated into the workforce.

In comparison, only 30.8% of employees on long-term sick leave in Belgium return to work within one year. And while instating return-to-work policies isn't a bad thing on its own, relying on sanctions rather than support might cause the new Belgium system to not work as well as the German one.

Netherlands

Dutch employers cover 70% of an employee’s wages for up to two years—a much higher financial burden.

But reintegration is not only an obligation. It's a structured, collaborative process involving:

• Early intervention measures. Employers must engage occupational health services and develop an individualized reintegration plan. And they have to do it within weeks of absence.
• A phased return-to-work system. Employees gradually resume work while receiving adapted tasks. They're not pushed into full-time reintegration.
• Legal incentives for prevention. Companies are encouraged to invest in workplace well-being. This, in turn, reduces absenteeism in the first place.

Belgium’s reform introduces financial penalties for companies and rigid timelines for employees. But it lacks the preventive and supportive framework that drives successful reintegration elsewhere. The new policy needs a stronger focus on prevention and personalized reintegration. Otherwise, it risks prioritizing cost-cutting over sustainable workforce well-being.

Tighter control over medical professionals

A new platform will require general practitioners, occupational health doctors, and insurance doctors to increase collaboration. From the first month of incapacity, practitioners will share medical certificates. From there, doctors must consider alternative job options when issuing or extending certificates.

The medical certificate of incapacity is set to become a certificate of aptitude. This is a clear shift towards prioritizing a faster return to work.

Doctors who often issue long-term incapacity certificates will be strictly monitored. Any perceived abuse could lead to sanctions, raising serious concerns about medical independence.

Will doctors be able to prioritize patient well-being over administrative pressure? Or will decisions be influenced by a system focused on reducing absenteeism rather than ensuring proper recovery?

Workers caught between recovery and compliance.

Workers on long-term sick leave will now have their benefits regularly reassessed. If a review decides they have some work capacity, they must start a reintegration process. Inadequate cooperation could lead to sanctions.

This creates a one-size-fits-all approach to recovery, which contradicts medical realities. Sociologist Thomas Périlleux warns against that. He notes that recovery does not follow administrative or legal timelines. For instance, recovery from burnout can take years. Studies suggest that 10–15% of burnout cases may never result in a return to work.

Rushing employees back too soon could increase relapse rates. This harms both workers and businesses.

Key considerations for a balanced approach

Instead of just enforcing reintegration, we need a more holistic approach. We need to emphasize prevention, flexibility, and individual support. Key aspects should be reconsidered:

Policymakers should:

• Encourage and incentivize companies to implement mental health prevention strategies. They can do so by offering tax benefits or subsidies for businesses investing in burnout prevention.
• Shift from punitive measures to support-based reintegration. This ensures that companies receive guidance and resources instead of only facing penalties.

Employers should:

• Adopt flexible reintegration frameworks that allow workers to return at a pace suited to their recovery. The Netherlands offers a strong model to follow. Employers collaborate with employees to create individualized return-to-work plans. These plans consider each person's unique recovery process.
• Conduct regular mental health check-ins. Those help identify early signs of burnout and long-term stress, preventing avoidable absences.

Workplace leaders should:

• Foster a supportive workplace culture. They can integrate mental health training for managers, create peer support networks, and offer flexible work options. This helps employees balance recovery and productivity.
• Go beyond compliance. See reintegration as a chance to build a healthier, more sustainable workplace.

Well-being cannot be regulated solely through obligations and penalties. Reintegration policies must consider both the individual recovery process and the workplace environment. Otherwise, they risk causing more harm than good.