Return-to-work intervention for cancer survivors: budget impact and allocation of costs and returns in the Netherlands and six major EU-countries

Table 3 Distribution of RTW intervention costs and financial returns across the stakeholders for the Netherlands

	Health insurance	Hospitals/Health care providers	Employers	Patients/Employees	The state	Pension insurance scheme
Responsibilities in RTW	General responsibility for reimbursing necessary health care		Sick pay for first 2 years, reintegration of sick employees into the workplace		Sick pay after 2 years of inability to work
Carrying the costs of RTW interventions	Reimbursement for patients with multidisciplinary rehabilitation need	Intervention costs
Receiving the financial returns of RTW	Lower future health care costs, however, high budget impact		Fewer productivity losses, no replacement for employee needed	Ability to generate an income		Less early-retirement-pension payments
	-	--	-	+	--	-
Incentive for financing RTW for cancer patients^a	Lower future health care costs are long-run, considerable budget impact	Carrying the costs, but not receiving financial returns.	Status quo is financially beneficial for employers.	Incentive for an acceptable out-of-pocket payment	Not receiving any financial returns	Status quo is financially beneficial.

^aThe distribution of costs and financial benefits in which the costs as well as the financial returns are incurred by the same stakeholder, incentivizes the financing and implementation of RTW. For stakeholders who receive financial benefits, but do not need to carry the costs, the current financing arrangement is very attractive. Thus, they do not have an interest in changing the financial structure. However, if they would need to take over (a part of) the financing, this would be acceptable. For stakeholders who need to carry the costs, but do not receive financial returns, an incentive to finance RTW does not exist, as they it will only cost them

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