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The Europeanisation of Occupational Health Services

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The Europeanisation of Occupational Health Services Kannen kuva: Nanna Susi: Sateenkaaren tuolla puolen The Europanisation of occupational health services: A study of the impact of EU policies Riitta-Maija Hämäläinen People and Work Research Reports 82 Finnish Institute of Occupational Health Helsinki, Finland 2 CONTENTS ABSTRACT ................................................................. 11 1. INTRODUCTION ..................................................... 14 2. POLICY PROCESSES AND POLICY ANALYSIS .................. 19 2.1 Process of policy-making ....................................... 19 2.2 Theoretical frameworks for analysis of policy processes ................................................... 21 2.3 Policy processes for OHS ....................................... 23 3. RESEARCH TASKS, AIMS, AND ANCHORAGE .................. 27 4. STUDY DESIGN, DATA COLLECTION, AND ANALYSIS ....... 29 4.1 Qualitative comparative study of OHS ..................... 31 4.2 Collection of data ................................................. 35 4.2.1 Literature and document analysis ................... 38 4.2.2 Interviews .................................................. 39 4.3 Processing and analysing qualitative data ................ 42 4.3.1 Evidence-building in comparative multiple case study ...................................... 44 4.3.2 Analysing evidence in the multiple case study .. 46 5. THE POLICY ENVIRONMENT OF OHS ............................. 48 5.1 Contributions of the ILO and WHO to OHS ............... 48 5.2 Policy-making process within EU ............................. 54 5.2.1 Formal policy-making ................................... 58 5.2.2 Informal policy-making ................................. 61 5.2.2.1 Negotiation and bargaining ................ 62 5.2.2.2 Concessions and lobbying .................. 64 5.3 Competence of the European Community in OHS ...... 65 5.3.1 From treaties to the new treaty in 2009 .......... 66 5.3.2 Agreements on social rights and social policy ... 72 3 CONTENTS 5.3.3 From regulations and directives to open method of coordination ......................... 73 5.3.3.1 Directive ......................................... 74 5.3.3.2 Framework directive 89/391/EEC ........ 76 5.3.3.3 Protective and preventive services based on the framework directive ....... 78 5.3.3.4 Open method of coordination ............. 81 5.3.4 Creation of the internal market in the European Union ........................................... 83 5.3.4.1 Internal market, competition law and the ECJ ..................................... 83 5.3.4.2 Free movement of occupational health professionals .......................... 86 5.3.4.3 Free movement of services ................ 90 5.4 Policy environment affecting OHS ........................... 92 5.4.1 The role of social policy in the EU ................... 92 5.4.1.1 Phases of social policy development in the European Union ....................... 95 5.4.1.2 Social policy in EU context ................. 96 5.4.1.3 Health and safety at work .................. 100 5.4.2 European welfare states ............................... 103 5.4.2.1 Welfare state models and classifications .................................. 106 5.4.2.2 Criticisms of the three welfare state models .................................... 109 5.4.2.3 Welfare state in flux .......................... 111 5.4.3 European health services under reforms ......... 114 5.4.3.1 Impact of reforms on requirements for quality of OHS ............................. 118 5.4.4 Social dialogue in EU member states .............. 120 5.4.4.1 Labour market regimes ..................... 124 5.4.4.2 European industrial relations and welfare benefits ............................... 125 5.4.4.3 Collective bargaining ......................... 128 5.5 Interrelationship among different systems and regimes ............................................ 130 5.5.1 Reforms of the different systems ................... 133 5.5.2 Convergence ............................................... 139 5.5.3 Europeanisation .......................................... 141 5.6 Summary ....... ..................................................... 147 4 CONTENTS 6 OHS IN EU MEMBER STATES IN 2000 ............................ 151 6.1 Transposition of the Framework Directive 89/391/EEC for OHS ................................ 154 6.1.1 Institutions for OHS ..................................... 156 6.1.2 Requirements for occupational health services ............................................ 157 6.2 Competence of OHS professionals .......................... 161 6.2.1 Multidisciplinary OHS ................................... 163 6.2.2 Recognition of occupational health professionals ..................................... 166 6.2.3 Opinions on professional competence and work satisfaction ......................................... 169 6.3 Coverage of OHS .................................................. 171 6.3.1 Opinions on coverage, access, and equity of OHS ............................................. 174 6.3.2 Independence of OHS .................................. 176 6.3.3 Opinions on professional ethical standards ...... 177 6.4 Policies for OHS ................................................... 179 6.4.1 Policy formulation processes ......................... 183 6.4.2 Aims, objectives and mandates of OHS policies ............................................... 187 6.4.3 Policy of trade unions and employers’ organisations for OHS .................................. 194 6.5 Financing and organisation of OHS ......................... 196 6.5.1 Organisation of OHS .................................... 196 6.5.2 Funding of occupational health services .......... 199 6.6 Monitoring and evaluation of occupational health ...... 200 6.6.1 Monitoring of OHS ....................................... 200 6.6.2 Evaluation of OHS ........................................ 202 6.6.3 Indicators for the impact on occupational health ...................................... 204 6.6.4 Costs and benefits of OHS for enterprises ....... 206 6.6.5 Quality, institutional competence, and efficiency of OHS ......................................... 209 6.6.6 Overall impact and satisfaction with OHS ........ 215 6.6.6.1 Orientation of OHS towards employers’ and employees’ needs ....... 219 6.6.6.2 Focus of OHS on prevention in the workplace .................................. 220 6.7 Summary of the results......................................... 222 5 CONTENTS 7 DISCUSSION OF THE STUDY ........................................ 229 7.1 Socio-economic consequences on OHS .................... 230 7.2 Policies for OHS ................................................... 234 7.2.1 OHS in relation to different regimes ............... 236 7.2.2 Regulatory policy and compliance .................. 239 7.2.3 National implementation of framework directive 89/391/EEC ................................... 241 7.3 Actors for OHS ..................................................... 246 7.4 OHS as service provider: Variations in services among countries .................... 248 7.4.1 Competent occupational health professionals for all? .................................... 250 7.4.2 Occupational health for all? ........................... 251 8 VALIDITY AND RELEVANCE OF THE STUDY ..................... 253 8.1 Validity and credibility ........................................... 254 8.2 Comparability and generalisation ............................ 259 9 THE SIGNIFICANCE OF RESULTS .................................. 262 10 CONCLUSIONS ......................................................... 266 10.1 Impact of EU policies in OHS context ..................... 267 10.2 From harmonisation to Europeanisation .................. 272 10.3 Actors as policy initiators for OHS .......................... 276 10.4 From enterprise model of OHS to market model of OHS .......................................... 278 10.4.1 Market creation and competition for OHS ....... 280 10.4.2 Changing OHS provisions ............................ 283 10.5 From occupational health to quality of work and life ...................................................... 287 11 FINAL REMARKS ....................................................... 290 12 ACKNOWLEDGEMENTS .............................................. 293 13 BIBLIOGRAPHY ......................................................... 295 14 LIST OF PUBLICATIONS OF INTERNATIONAL ORGANISATIONS ...................................................... 323 15 ABBREVIATIONS ....................................................... 335 6 CONTENTS 16 APPENDICES ........................................................... 339 Appendix I Interview protocol .................................. 341 Appendix II Major institutions related to OHS ............. 355 Appendix III List of the main legislation concerning OHS in 15 EU member states .. 375 Appendix IV Some of the monitoring schemes related to occupational health .................. 379 Appendix V Schematic development of EU policies ...... 385 Appendix VI Typologies of welfare states ..................... 395 7 LIST OF FIGURES FIGURE 1 Global model for expert opinion formation and policy-making for OHS ............. 25 FIGURE 2 Elements of the study on OHS in EU member states ....................................... 30 FIGURE 3 Study design for OHS in EU policies ................ 31 FIGURE 4 Multiple sources of evidence used in the study ............................ 45 FIGURE 5 Examples of internal market aspects affecting OHS .............................................. 87 FIGURE 6 Structure for
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