title: Swedish social insurance officers' experiences of difficulties in assessing applications for disability pensions--an interview study.
abstract: BACKGROUND
  In this study the focus is on social insurance officers judging applications for disability pensions. The number of applications for disability pension increased during the late 1990s, which has resulted in an increasing number of disability pensions in Sweden. A more restrictive attitude towards the clients has however evolved, as societal costs have increased and governmental guidelines now focus on reducing costs. As a consequence, the quantitative and qualitative demands on social insurance officers when handling applications for disability pensions may have increased. The aim of this study was therefore to describe the social insurance officers' experiences of assessing applications for disability pensions after the government's introduction of stricter regulations.
  
  
  METHODS
  Qualitative methodology was employed and a total of ten social insurance officers representing different experiences and ages were chosen. Open-ended interviews were performed with the ten social insurance officers. Data was analysed with inductive content analysis.
  
  
  RESULTS
  Three themes could be identified as problematic in the social insurance officers' descriptions of dealing with the applications in order to reach a decision on whether the issue qualified applicants for a disability pension or not: 1. Clients are heterogeneous. 2. Ineffective and time consuming waiting for medical certificates impede the decision process. 3. Perspectives on the issue of work capacity differed among different stakeholders. The backgrounds of the clients differ considerably, leading to variation in the quality and content of applications. Social insurance officers had to make rapid decisions within a limited time frame, based on limited information, mainly on the basis of medical certificates that were often insufficient to judge work capacity. The role as coordinating actor with other stakeholders in the welfare system was perceived as frustrating, since different stakeholders have different goals and demands. The social insurance officers experience lack of control over the decision process, as regulations and other stakeholders restrict their work.
  
  
  CONCLUSIONS
  A picture emerges of difficulties due to disharmonized systems, stakeholder-bound goals causing some clients to fall between two stools, or leading to unnecessary waiting times, which may limit the clients' ability to take an active part in a constructive process. Increased communication with physicians about how to elaborate the medical certificates might improve the quality of certificates and thereby reduce the clients waiting time.
authors.affiliation: Department of Community Medicine and Public Health, Orebro County Council, Orebro Sweden. berit.ydreborg@orebroll.se <berit.ydreborg@orebroll.se>
authors.forename: Berit
authors.initials: B
authors.lastname: Ydreborg
authors.forename: Kerstin
authors.initials: K
authors.lastname: Ekberg
authors.forename: Kerstin
authors.initials: K
authors.lastname: Nilsson
mesh_terms: D000288:Administrative Personnel / Q000523:psychology; D000328:Adult; D002568:Certification / Q000458:organization & administration / Q000592:standards; D003142:Communication; D003659:Decision Making, Organizational; D006077:Government Agencies / Q000458:organization & administration*; D006801:Humans; D018868:Insurance, Disability / Q000458:organization & administration*; D007407:Interviews as Topic; D008875:Middle Aged; D009874:Operations Research; D011340:Problem Solving; D036301:Qualitative Research; D012943:Social Security / Q000458:organization & administration* / Q000592:standards; D012946:Social Welfare / Q000191:economics*; D013548:Sweden; D013997:Time Factors; D014938:Work Capacity Evaluation; D016526:Workload