Termination of sickness benefits or transition to disability pension after changes in sickness insurance: a Swedish register study.
OBJECTIVE
To assess whether the changes in Swedish sickness insurance in 2008 were associated with termination of benefits (TOB) or transition to disability pension (DP) for individuals in compensated sick leave of varying duration. Changes were (1) introduction of sick-listing guidelines and (2) stricter criteria for eligibility to disability pension and sickness cash benefit and time limits for the latter.


METHODS
The study population consisted of 2 556 211 cases of compensated sick leave with onset during 2006-2010 from the Swedish national social insurance registers. TOB and DP were analysed with Cox-proportional hazard regression.


RESULTS
After the introduction of sick-listing guidelines, TOB increased for both women [hazard ratio (HR) 1.10] and men (HR 1.07). The additional introduction of stricter rules 4 months later were modestly associated with TOB (HR: women 1.01, men 0.99) and transition to DP among men decreased with stronger associations for spells exceeding 180 days (HR 0.86). For women transition to DP surprisingly increased with stricter criteria (HR 1.09), although this pattern was reversed in sick leave spells exceeding 1 year (HR 0.90).


CONCLUSIONS
Introducing sick-listing guidelines for different illnesses and diseases could have had a considerable impact on TOB. The additional introduction of stricter eligibility rules and time limits seem to have contributed less to TOB but clearly reduced DP in longer sickness spells.
Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden. ulrik.lidwall@socialagency.se
Ulrik
U
Lidwall
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D018868:Insurance, Disability / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D008875:Middle Aged; D010415:Pensions / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012042:Registries; D012044:Regression Analysis; D012307:Risk Factors; D018582:Sick Leave / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D012943:Social Security / Q000458:organization & administration* / Q000639:trends; D012959:Socioeconomic Factors; D013548:Sweden; D055815:Young Adult