title: Quality in sickness certificates in a Swedish social security system perspective.
abstract: OBJECTIVE
  In Sweden, the information in the sickness certificate is crucially important for the sick-listed person as well as for the Swedish Social Insurance Agency and the sick-listed person's employer. The certificate is used as the basis for deciding whether a person is entitled to sickness benefits. Further, it communicates information significant for the return-to-work process. The aim of the study was to evaluate the quality of sickness certificates issued in primary health care and examine if the patients' or physicians' gender influences the information in the sickness certificate.
  
  
  METHODS
  An insurance specialist at the Swedish Social Insurance Agency assessed the quality of the stated information in a sample of 323 certificates issued by 146 different general practitioners at 29 different primary health care centres in northern Sweden.
  
  
  RESULTS
  Thirty-four percent of the certificates did not contain sufficient information requested. The areas of the certificates in need of supplementary information were mainly the descriptions of impairment of body function and activity limitation. More certificates issued for women than certificates issued for men lacked the required information. Full-time sick leave was more often prescribed for male patients than for female. Significant differences between certificates issued for women and certificates issued for men appeared in the group of musculoskeletal diseases. No differences in quality aspects connected to physicians' gender were found.
  
  
  CONCLUSIONS
  Our study indicates a need for increased knowledge about the descriptions of functioning for sick-listed persons; more cooperation between health professionals in primary health care and a better gender awareness in health care encounters.
authors.affiliation: Department of Community Medicine and Rehabilitation, Division of Occupational Therapy, Umeå University Sweden marine.sturesson@vll.se.
authors.forename: Marine
authors.initials: M
authors.lastname: Sturesson
authors.affiliation: County Council of Västerbotten, Sweden.
authors.forename: Sonya Hörnqvist
authors.initials: SH
authors.lastname: Bylund
authors.affiliation: Department of Health Sciences, Mid Sweden University, Sweden.
authors.forename: Curt
authors.initials: C
authors.lastname: Edlund
authors.affiliation: Department of Community Medicine and Rehabilitation, Division of Occupational Therapy, Umeå University Sweden.
authors.forename: Annie Hansen
authors.initials: AH
authors.lastname: Falkdal
authors.affiliation: Department of Community Medicine and Rehabilitation, Division of Occupational Therapy, Umeå University Sweden.
authors.forename: Birgitta
authors.initials: B
authors.lastname: Bernspång
mesh_terms: D002568:Certification / Q000592:standards*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards; D062707:Return to Work; D012737:Sex Factors; D018582:Sick Leave; D012943:Social Security; D013548:Sweden; D014938:Work Capacity Evaluation
keywords: Disability and Health; International Classification of Functioning; Sick leave; gender; insurance medicine; primary health care