[Exclusion risks of people with limited work capacity: "The system is not designed for you to be ill so often."]

Abstract

Purpose: Chronic illnesses can significantly impair social participation and lead to disintegration, poverty and isolation. The aim is to trace the exclusion risks of people whose ability to work is at risk or already reduced due to illness.

Methods: The study is based on problem-centered interviews with 50 people insured by the German Pension Insurance (GPI) Bund or Nord who, according to GPI routine data, have a high risk of premature retirement due to illness. Recruitment and sampling were conducted using a letter and a questionnaire, which wer sent to a total of 4,000 insured persons. The analysis followed a mix of sequential-narrative and category-based approach, supplemented by a systematic-contrastive case comparison.

Results: People with reduced earning capacity are at risk of falling into a spiral of exclusion that can be accelerated or slowed down by various factors. Periods of incapacity to work, reductions in working hours and potential job loss and unemployment lead to financial losses, which can result in further restrictions on participation in the areas such as leisure, housing and consumption. Social participation can also suffer as a result. All of this, can further impair health and accelerate the spiral of exclusion.

Conclusion: In order to counteract disease-related social exclusions, comprehensive strategies are required that focus in particular on care and work-related exclusion factors without losing sight of "classic" categories of inequality.