title: Promoting occupational health interventions in early return to work by implementing financial subsidies: a Swedish case study.
abstract: BACKGROUND
  In 2010, the Swedish government introduced a system of subsidies for occupational health (OH) service interventions, as a part in a general policy promoting early return to work. The aim of this study was to analyse the implementation of these subsidies, regarding how they were used and perceived.
  
  
  METHODS
  The study was carried out using a mixed-methods approach, and comprises material from six sub-studies: a register study of the use of the subsidies, one survey to OH service providers, one survey to employers, one document analysis of the documentation from interventions, interviews with stakeholders, and case interviews with actors involved in coordinated interventions.
  
  
  RESULTS
  The subsidized services were generally perceived as positive but were modestly used. The most extensive subsidy--for coordinated interventions--was rarely used. Employers and OH service providers reported few or no effects on services and contracts. OH service providers explained the modest use in terms of already having less bureaucratic routines in place, where applying for subsidies would involve additional costs. Information about the subsidies was primarily communicated to OH service providers, while employers were not informed.
  
  
  CONCLUSIONS
  The study highlights the complexity of promoting interventions through financial incentives, since their implementation requires that they are perceived by the stakeholders involved as purposeful, manageable and cost-effective. There are inherent political challenges in influencing stakeholders who act on a free market, in that the impact of policies may be limited, unless they are enforced by law.
authors.affiliation: National Centre for Work and Rehabilitation, Department of Medical and Health Sciences, Linköping University, Linköping 58183, Sweden. christian.stahl@liu.se
authors.forename: Christian
authors.initials: C
authors.lastname: Ståhl
authors.forename: Allan
authors.initials: A
authors.lastname: Toomingas
authors.forename: Carl
authors.initials: C
authors.lastname: Aborg
authors.forename: Kerstin
authors.initials: K
authors.lastname: Ekberg
authors.forename: Katarina
authors.initials: K
authors.lastname: Kjellberg
mesh_terms: D017598:Efficiency, Organizational; D005378:Financial Support; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D009786:Occupational Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D019982:Organizational Case Studies; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D012042:Registries; D012050:Rehabilitation, Vocational / Q000379:methods*; D062707:Return to Work; D018582:Sick Leave; D011795:Surveys and Questionnaires; D013548:Sweden