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Backgrounds: Few studies have addressed the specific contribution of health in relation to socio-demographic and motivational aspects to re-entering paid employment. The purpose of this study among beneficiaries of unemployment benefits is to evaluate the detrimental effects of poor health and a lack of motivation on the likelihood of getting a job and to develop a decision support model that predicts remaining unemployment after 12 months., Methods: A longitudinal cohort study was conducted among people on unemployment benefit (UB) or social insurance benefit (SIB). The time-window of the study was 18 months. Written questionnaires were filled out 3 months post-benefit assessment, 6, 12 and 18 months. Multivariate logistic regression analysis was used to identify the barriers of re-entering paid employment. Subsequently, a predictive model was constructed to estimate the probability for every combination of determinants for a person to remain unemployed in the next 12 months., Results: Older age (≥55 years), a poor perceived health, and a lack of willingness to accept a job were the most prominent predictive factors for remaining unemployed after 12 months in both UB and SIB groups. Lower education in the UB group and being married or living together and poor self-reliance in the SIB group were additional risk factors for long-term unemployment., Conclusion: Vocational rehabilitation of people on long-term social benefit should address perceived health, socio-demographic, and motivational aspects as key factors that determine prolonged unemployment. A predictive flow chart can be used to detect most vulnerable persons at risk for remaining long-term unemployment.

Background: Unemployed persons have a poorer health compared with employed persons and unemployment may cause ill health. The aim of this study was to investigate the effect of re-employment on quality of life and health among unemployed persons on social benefits., Methods: A prospective study with 18 months follow-up was conducted among unemployed persons (n=4,308) in the Netherlands, receiving either unemployment benefits or social security benefits. Quality of life, self-rated health, and employment status were measured at baseline and every 6 months of follow up with questionnaires. Generalized estimating equations (GEE) modeling was performed to study the influence of re-employment on change in self-rated health and quality of life over time., Results: In the study population 29% had a less than good quality of life and 17% had a poor self-rated health. Persons who started with paid employment during the follow-up period were more likely to improve towards a good quality of life (OR 1.76) and a good self-rated health (OR 2.88) compared with those persons who remained unemployed. Up to 6 months after re-employment, every month with paid employment, the likelihood of a good quality of life increased (OR 1.12)., Conclusions: Starting with paid employment improves quality of life and self-rated health. This suggests that labour force participation should be considered as an important measure to improve health of unemployed persons. Improving possibilities for unemployed persons to find paid employment will reduce socioeconomic inequalities in health.

Objective: The purpose of this study is to determine what client, needs assessor, and agency factors explain variation in decision making by long-term care needs assessors concerning clients requesting admission to a residential home., Method: Hypothetical case vignettes were sent to needs assessors allocating services for the elderly. Multilevel logistic regression analysis provided random and fixed effects., Results: The authors found random effects of the level of needs assessors are negligible, of the level of agencies small though statistically significant, clients receiving largest relative share of the variance. The amount of care already present appeared most important in the decision. Needs assessors were willing to support their clients' wishes only when they were clearly motivated. Policy implications considering the tension between clients' preferences and equity are discussed.