Implementation of standardized time limits in sickness insurance and return-to-work: experiences of four actors.
OBJECTIVE
In 2008, time limits were introduced in Swedish sickness insurance, comprising a pre-defined schedule for return-to-work. The purpose of this study was to explore experienced consequences of these time limits. Sick-listed persons, physicians, insurance officials and employers were interviewed regarding the process of sick-listing, rehabilitation and return-to-work in relation to the reform.


METHODS
The study comprises qualitative interviews with 11 sick-listed persons, 4 insurance officials, 5 employers and 4 physicians (n = 24).


RESULTS
Physicians, employers, and sick-listed persons described insurance officials as increasingly passive, and that responsibility for the process was placed on the sick-listed. Several ethical dilemmas were identified, where officials were forced to act against their ethical principles. Insurance officials' principle of care often clashed with the standardization of the process, that is based on principles of egalitarianism and equal treatment.


CONCLUSIONS
The cases reported in this study suggest that a policy for activation and early return-to-work in some cases has had the opposite effect: central actors remain passive and the responsibility is placed on the sick-listed, who lacks the strength and knowledge to understand and navigate through the system. The standardized insurance system here promoted experiences of procedural injustice, for both officials and sick-listed persons.
National Centre for Work and Rehabilitation, Department of Medical and Health Sciences, Linköping University, Sweden. christian.stahl@liu.se
Christian
C
Ståhl
Ulrika
U
Müssener
Tommy
T
Svensson
D018166:Health Care Reform / Q000331:legislation & jurisprudence; D006801:Humans; D007348:Insurance, Health / Q000331:legislation & jurisprudence*; D007407:Interviews as Topic; D010820:Physicians; D036301:Qualitative Research; D012050:Rehabilitation, Vocational; D018582:Sick Leave / Q000191:economics / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013548:Sweden; D013997:Time Factors; D014937:Work / Q000191:economics; D014938:Work Capacity Evaluation