[Does systematic evaluation of sickness certification II lead to less use of health insurance?].
BACKGROUND
The increasing prevalence of disability pensioning in Norway has led to several attempts at strengthening the proactive role of the National Insurance System (NIS) in cases of long-term sick-listing. Since 1988, a special medical certificate is required after eight weeks of sick-leave. The aim of this study was to examine whether systematic evaluation of this medical certificate by NIS officers and NIS medical consultants could reduce future health insurance expenditure.


METHODS
In 1994 a randomised study using a paired design of the NIS local offices in the county of Hordaland was undertaken. All eight-week medical certificates in the intervention group (N = 2,237) were systematically reviewed, whereas standard routines were used for the control group (N = 1,764).


RESULTS
After three years, no significant differences were observed between the two groups in health insurance utilisation.


CONCLUSIONS
We conclude that local NIS offices are unable to use the information in the eight-week sick notes to effectively influence future utilisation of health insurance. The reason may be that NIS offices lack the skills necessary for early intervention in long-term sick-listing.
Ringdal
Peder Rolfssøn
PR
Seksjon for sosialmedisin Institutt for samfunnsmedisinske fag Universitetet i Bergen Ulriksdal 8C 5009 Bergen. peder.ringdal@isf.uib.no
Haug
Kjell
K
Maeland
John Gunnar
JG
D000328:Adult; D000368:Aged; D002568:Certification; D002983:Clinical Competence; D003253:Consultants; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D018868:Insurance, Disability / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D008875:Middle Aged; D009664:Norway; D010819:Physician's Role; D011361:Professional Competence; D018582:Sick Leave / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D012959:Socioeconomic Factors