Influence of local structural factors on physicians' sick-listing practice: A population-based study
2005 (English)In: European Journal of Public Health, ISSN 1101-1262, Vol. 15, no 5, 470-474 p.Article in journal (Refereed) Published
Background: Physicians have a central role as gatekeepers to the social security system, including sick-listing. Variation in physicians' sick-listing practices has been demonstrated in several studies. The objective of this study was to determine whether local structural factors affect sick-listing practice. Methods: A total of 57 563 consecutive sick-listing certificates, issued during 4 months in 1995 and 2 months in 1996, were collected from the local branches of the National Social Insurance Office in eight Swedish counties. County code, local community population size and presence of a hospital in the area were used as indicators of local structural factors. Length of the sick-listing certificates and of the sick-listing episodes were used as outcome variables. Results: After ajustment for the influence of category of issuing physician, patients' age, sex and diagnosis ('case mix'), and type of certificate there was a large variation of the length of the sick-listing certificates and of the sick-listing episodes between counties, between communities of various size and between communities with or without a hospital in the area. All these factors were independently and significantly correlated to the length of the certificate and of the sick-listing episode. Conclusions: The results support the hypothesis that physicians' sick-listing practice is influenced by local structural factors. © The Author 2005. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Place, publisher, year, edition, pages
2005. Vol. 15, no 5, 470-474 p.
physicians' sick-listing practice
IdentifiersURN: urn:nbn:se:liu:diva-32237DOI: 10.1093/eurpub/cki029Local ID: 18112OAI: oai:DiVA.org:liu-32237DiVA: diva2:253059