(029) Early retirement pensioners diagnosed with mental and behavioral disorders caused by psychoactive substances (ICD F11-19 block) in Germany - characterization and utilization of medical rehabilitation

Publication Number: 692

Background: In order to avoid early retirement (ER) the German statutory pension insurance fund covers the cost of rehabilitation for employees whose working capacity is endangered due to health problems. However, the granting of medical rehabilitation must adhere to the principles of economic efficiency and frugality (§ 13 (1) SGB VI, Federal Ministry of Justice 2022).

Objectives: We aimed to describe the use of medical rehabilitation among insured persons received a disability pension due to mental and behavioral disorders caused by psychoactive substances (section F11–19 according to ICD-10) with special consideration of sociodemographic determinants.

Methods: Analysis based on 20% random samples of administrative pension records from the Research Data Centre of the German Federal Pension Insurance, which include all new cases of early retirement (ER) from 2001 to 2020 (DRV FDZ 2022).
We estimated risk of non-utilization of medical rehabilitation using logistic regression models. Age, gender, marital status, nationality, place of residence, education, level of employment, annual income as well as pension payment amount were considered as potential risk factors.

Results: The data set contains 681,189 insured persons aged up to 64 years who were granted an EM pension for the first time between 2001 and 2020.
After exclusion of persons who received occupational rehabilitation, 661,227 persons are left, of whom 371,180 (56.5%) did not receive medical rehabilitation in the five years before the granting of ER pension.
Among them, 4,122 (0.6 %) persons received a ER pension due to mental and behavioral disorders caused by psychoactive substances. Compared to all ER pensioners, pensioners in this group were younger, more often male and of lower socio-economic status. 2,934 out of 4,122 (71.2%) did not receive medical rehabilitation. Risk factors for not utilization of medical rehabilitation are male gender, living on their own, low or unknown education, low or unknown job requirement profile, low income as well as low pension payment amount.
For example, adjusted risk (Odds Ratio [95%-CI]) among persons with low income (1st quartile vs. 4th quartile), was 2.6 [1.9;3.7]. Using pension payment amount instead of income in multiple logistic regression model showed similar pattern.

Conclusions: ER pensioners due to mental and behavioral disorders caused by psychoactive substances are significantly less likely to take advantage of a medical rehabilitation before being granted an ER pension.
One reason for the social inequality in the implementation of the principle "rehabilitation before pension" could be the difficulty of complying with the economic efficiency and frugality requirement when granting medical rehabilitation measures for economic disadvantaged persons.