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Sickness benefits and measures promoting return to work
Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Decisions concerning entitlement to sickness benefits have a substantial impact on the lives of individuals and on society. In most countries, such decisions are made by professionals working in public organisations, and there is much debate about the work performed by those experts, hence more knowledge is needed on this subject.

Objectives: The overall aim of the research underlying this thesis was to study, from different perspectives, the practices of actors involved in making decisions regarding the right to both sickness benefits and measures aimed at promoting return to work (RTW).

Materials and methods: Five separate studies were performed using different investigative designs, data, and data analyses. The first two studies (papers I and II) scrutinised scientific publications concerning the sickness certification practices of physicians and the routines of social insurance officers, respectively. The third investigation (paper III) assessed the quality of physician's sickness certificates as a basis for social insurance officers' decisions about sickness benefits. The fourth study (paper IV) examined the experiences of inter-organisational cooperation between public servants working at social insurance and employment offices. The last study (Paper V) analysed the experiences of patients regarding encounters with health care professionals and social insurance officers in this context.

Results: The twenty-six studies of physicians' sickness certification practices that were reviewed (paper I) focused on physicians, and occasionally on physicians and patients, but never on the interaction between them. Most of the studies emanated from Norway and Sweden, and were conducted by researchers in medical science, mainly physicians. Questionnaires were used to collect data in 80% of the studies. It was found that different physicians varied greatly in regard to the length of sickness absence they certified for similar patients.

All but two of the sixteen studies scrutinised in paper 11 were conducted by behavioural scientists using social science theory. In the majority of those investigations, data were obtained through interviews. The studies were done in Norway and Sweden, and dealt with different dimensions of managing clients, although only two of the investigations considered the actual granting of sickness benefits. The majority of the studies focused on coordination of RTW measures, and some of those indicated that gender bias affected the decisions that were made.

In the study presented in paper III, it was found that many of the analysed sickness certificates (n = 2,249) did not contain enough information to allow social insurance officers to determine eligibility for sickness benefits. General practitioners and physicians in training provided more essential data than did other categories of physicians, for example concerning the patients' occupational tasks. Statements about rehabilitation measures aimed at promoting RTW were not included on 60% of the certificates for women, compared to 36% of those issued for men.

As described in paper IV, analyses of fourteen interviews with public servants working together on the same cases in inter-organisational projects identified important areas of the experiences. The daily collaboration on cases enabled development of good relationships and improved what was referred to as cooperative competence. The collaborative nature of the project made it possible to include only those clients who were perceived as being motivated to participate in RTW measures. Close and more frequent interaction with clients proved to be beneficial in that it facilitated mobilisation of the clients. The discrepancy between the rules and regulations of the social insurance, and the unemployment authorities was an obstacle to cooperation.

In the study reported in paper V, eleven sickness benefit recipients were interviewed about how they experienced encounters with rehabilitation professionals. The experiences were assigned to five major categories: being treated with respect, feeling supported, establishing a personal relationship, perceiving demands as well-balanced, and participating in decisions regarding rehabilitation. Several interviewees believed that RTW might be promoted by positive encounters and hindered by negative interactions.

Conclusions: The overall conclusion that can be drawn from the current results is that there is insufficient knowledge concerning the sickness certification practices of physicians and the practices of social insurance officers regarding granting of sickness benefits. Closely related to the granting of sickness benefits, particulary given the work-line strategy in Sweden is the assessment of work capacity, which has, from the perspective of social insurance standards, been studied from a very limited viewpoint. The theoretical framework of research in this area need to be developed to provide better understanding of the mentioned practices and the interactions between the different professionals and between professsionals and clients, from the perspectives of both gender and ethnicity.

Place, publisher, year, edition, pages
Linköping: Linköpings Universitet , 2005. , 85 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 904
Keyword [en]
sickness absence, sickness benefit, practices, client, patients, sickness certification, sick leave, return to work, inter-organisational cooperation, gender, work capacity
National Category
Social Sciences
Identifiers
URN: urn:nbn:se:liu:diva-29403Local ID: 14742ISBN: 91-85299-08-1 (print)OAI: oai:DiVA.org:liu-29403DiVA: diva2:250217
Public defence
2005-06-10, Aulan, Hälsans Hus, Universitetssjukhuset, Linköping, 13:00 (Swedish)
Opponent
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2012-09-26Bibliographically approved
List of papers
1. Sickness certification practices of physicians: a review of the literature
Open this publication in new window or tab >>Sickness certification practices of physicians: a review of the literature
2003 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 31, no 6, 460-474 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In most Western countries the responsibilities of physicians include assessing work ability and issuing certificates for sickness absence and disability pension. These tasks often have a substantial impact on the lives of patients and constitute a financial burden on employers, insurance companies, and communities.

AIM: The aim was to review scientific studies on sickness certification practices of physicians published in English, Danish, Norwegian, or Swedish.

METHOD: Analyses were carried out of studies searched for through literature databases, reference lists, and personal contacts.

RESULTS: Twenty-six publications fulfilled the inclusion criteria. Most of these were published in the last decade. The studies focused on physicians, and occasionally on physicians and patients, but never on interaction between them. Data had generally been collected using questionnaires, some including case vignettes. There was a large variation in how long different physicians sickness-certified similar patients. Three comprehensive categories of studies were identified dealing with the following: (1). how physicians certify sickness; (2). factors that might affect the certification process; (i.e. elements related to the patient, to the physician, or to restrictions in insurance legislation); and (3). studies concerning attitudes. No studies were found that took into account the work conditions of the hospital or health-care organization in which the physician works.

CONCLUSIONS: The research problems were seldom medical in nature but were instead carried out within the realm of behavioural science and should preferably be conducted using theories from behavioural, social, and public health scientific theories. Furthermore, factors such as gender, ethnicity, and power should be taken into consideration in studies on this complex phenomenon.

National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-26249 (URN)10.1080/14034940310005367 (DOI)14675938 (PubMedID)10753 (Local ID)10753 (Archive number)10753 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
2. Gatekeepers in sickness insurance: a systematic review of the literature on practices of social insurance officers
Open this publication in new window or tab >>Gatekeepers in sickness insurance: a systematic review of the literature on practices of social insurance officers
2005 (English)In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 13, no 3, 211-223 p.Article in journal (Refereed) Published
Abstract [en]

Decisions concerning entitlement to sickness benefits have a substantial impact on the lives of individuals and on society. In most countries, such decisions are made by staff of private or public insurance organisations. The work performed by these professionals is debated, hence more knowledge is needed on this subject. The aim of the present study was to review scientific studies of the practices of social insurance officers (SIOs) published in English, Danish, Norwegian and Swedish. Studies were searched for in literature databases, in reference lists, and through personal contacts. Analyses were made of type of study, areas investigated, research questions, theories used, and the results. Sixteen studies were included. SIOs and several other actors are responsible for applying measures to minimise sick-leave and promote return to work (RTW). The studies focusing on coordination of such measures revealed that SIOs felt unsure about how to handle their contacts with clients and other actors. One study indicated that the SIOs, partly due to lack of time, accepted the recommendations of physicians instead of making their own judgments about granting sickness benefits. While all SIOs must make decisions concerning entitlement to sickness benefits on a daily basis, few of the reviewed studies scrutinised the actual granting of sickness compensation. The studies were also deficient in that they investigated the decision latitude of the SIOs from a very limited perspective, mainly on an individual level and often primarily in relation to colleagues and/or clients rather than to the laws and regulations of the sickness insurance. The concepts and framework in this area of research need to be developed to facilitate elucidation of the interaction between different actors in local spheres, professionals in different disciplines, and between welfare staff and individual citizens.

Keyword
Client, Cooperation, Return to work, Sick-leave, Sickness benefit, Social insurance officer
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-45458 (URN)10.1111/j.1365-2524.2005.00551.x (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13Bibliographically approved
3. Sickness certificates as a basis for decisions regarding entitlement to sickness insurance benefits
Open this publication in new window or tab >>Sickness certificates as a basis for decisions regarding entitlement to sickness insurance benefits
2005 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 33, no 4, 314-320 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

The sickness certificate is a major instrument for establishing contact and conveying information between two authorities that have a substantial impact on the life situation and work situation of the patients, as well as on the economic costs of the society.

AIM:

A study was undertaken to assess the quality of physicians' sickness certificates as a basis for social insurance officers' decisions regarding entitlement to sickness benefits.

METHOD:

Information on all 2,449 sickness certificates for sick-leave periods exceeding 28 days' sick leave period received at the social insurance offices in one Swedish county during one week in 2002 was coded and analysed.

RESULTS:

Information provided in the certificates was often not sufficient to allow social insurance officers to determine eligibility for sickness benefits. Qualitative analyses of certificates from general practitioners (GPs) revealed that 21% contained ambiguous statements about the medical disorder, 30% were unclear regarding the assessment of functional capacity, and 22% required additional information on both those aspects. Sickness certificates issued by GPs and physicians under specialist training, as compared with other categories of physicians, more often provided essential data, for example concerning the patient's occupational tasks and type of employment.

CONCLUSIONS:

Physicians often fail to contribute required information concerning functional capacity and other important aspects when issuing sickness certificates. This limits the use of these documents as a basis for decisions regarding sickness insurance benefits. The practical consequences of incomplete certificates might be delayed payment of benefits and delayed initiation of return to work measures.

Keyword
Sick leave, Sickness benefit, Sickness certificate, Sickness insurances
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-50273 (URN)10.1080/14034940510005798 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-12Bibliographically approved
4. Experiences of professionals participating in inter-organisational cooperation aimed at promoting clients' return to work
Open this publication in new window or tab >>Experiences of professionals participating in inter-organisational cooperation aimed at promoting clients' return to work
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Over the past decade, sickness absence has increased in Sweden and other Western European countries, with regard to both the number of people claiming sickness benefits and the length of the sick-leave spells. In Sweden, the activities initiated to promote RTW are performed in parallel by four different public organisations: the health services, the social services, the employment and the social insurance authorities. The present study focused on cooperation between professionals affiliated to the employment and social insurance authorities.

Aim: To gain deeper understanding on the experiences of professionals involved in cooperative projects aimed at promoting RTW among unemployed sickness benefit recipients.

Method: Qualitative analyses were performed of transcribed data from interviews of professionals participating in cooperative projects.

Result: The analyses identified four impmtant areas of the experiences of such cooperation. First, the daily collaboration on the same cases enabled development of good relationships and cooperative competence, which improved the contact with clients. Second, the cooperative projects made it possible to include only clients perceived motivated for RTW measures. Third, the closer and more frequent interaction with clients proved to be constmctive in that it facilitated recognition and mobilisation of the strengths and abilities of the clients in the RTW process. Fotnih, the differences in rules and regulations between the social insurance and the unemployment insurance standards was often mentioned, and were perceived to induce problems, for example, on how to assess the work capacity of clients.

Conclusion: The direct cooperation between the professionals from two different authorities was found to improve the application of RTW measures. The assessments of work capacity represent both important and complex tasks that professionals must perfonn without having access to either scientific knowledge or consensus agreement on which to base their decisions. Finally, it is important to gain further knowledge on how to create, develop, and maintain the 'cooperative competence' developed in the projects.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-81942 (URN)
Available from: 2012-09-26 Created: 2012-09-26 Last updated: 2012-09-26Bibliographically approved
5. Sickness absentees' experiences of positive encounters by healthcare and sickness insurance professionals: an interview study
Open this publication in new window or tab >>Sickness absentees' experiences of positive encounters by healthcare and sickness insurance professionals: an interview study
(English)Manuscript (preprint) (Other academic)
Abstract [en]

We need more knowledge on factors that can promote retum to work (RTW) grounded on peoples' own views. One such factor of importance is the way absentees themselves experience their interactions with professionals. The purpose of the study was to identify and analyse sick-listed persons' experiences of positive encounters with professionals.

An inductive and descriptive-qualitative approach was used to analyse transcripts from 11 semi-structured interviews with persons after or during long-term sickness absence. Being treated with respect, feeling supported, establishing a personal relationship, perceiving demands as well-balanced, and patiicipating in decisions regarding rehabilitation appeared as important qualities. Several interviewees believed that positive encounters might promote RTW.

Further research is needed to elucidate the aspects of such interactions that enhance empowerment and self-confidence in persons on sick leave, in order to develop professional treatment strategies that facilitates for rehabilitation, and to favour collaborative work between and within group of professionals.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-81943 (URN)
Available from: 2012-09-26 Created: 2012-09-26 Last updated: 2015-06-02Bibliographically approved

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