Sickness absence and Disability Management in Sweden

1
Sickness absence and Disability Management in
Sweden

• John Selander, PhD
• Centre for Studies on Rehabilitation
• Mid-Sweden University
• Östersund, Sweden

2
Sickness absence in Sweden

• 9 million inhabitants
• 5.3 million are working age
• 200 000 on long-term sickness absence
• 550 000 on disability pension
• A significant problem!

3
On Swedish sickness insurance

• Everyone aged 16-65 years is covered by a
  compulsory social sickness insurance.
• Income related benefit (80).
• Any type of illness/injury.
• Medical certificate after 7 days
• Taxable as an income.
• Unlimited in time.

4
Average number of days on sick-leave for Swedes
1970-2004
Days
30
25
20
15
10
5
0
1970
1973
1976
1979
1982
1985
1988
1991
1994
1997
2001
2004
Year
5
Sick days and unemployment
Sick days
Unemployment
30
12
25
10
8
20
Sick days
15
6
10
4
Unemployment
5
2
0
0
1970
1972
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
6

• Regional differences in sickness absence
• Sick days Disability pension

7
Sickness absence and unemployment Sick
days Unemployment
8
Sickness absence in Sweden from a European
perspective
DK
FI
FR
DE
NL
NO
SE
UK
EU1
2
9
Disability Management in Sweden

• A comprehensive social insurance system!
• Social insurance office responsible authority
• Co-ordination and supervision
• Significant employer responsibilities!
• The workplace is viewed as the optimal
  environment for ill-health prevention and
  rehabilitation!

10

• Employer responsibilities
• Rigorous laws!
• safe working environment
• ill-health prevention
• Employer primarily responsible for RTW process.
• The employer shall
• investigate potential rehabilitation needs
• conduct a rehabilitation investigation
• initiate (and pay for) RTW programmes/ activities

11

• Other important stakeholders in DM
• The individual
• Early and co-ordinated rehabilitation for clients
  in need
• Both rights and obligations
• The physician
• Sickness certificate for clients unable to work
  due to illness/injury
• Provide appropriate treatment

12

• Identified problems in Swedish DM
• The social insurance office
• More a passive administrator, than an active
  co-ordinator.
• Substantial work load!
• The employer
• Often fairly passive.
• Rehabilitation investigations seldom conducted.
• Often late and of questionable quality.
• Often unwilling to pay for RTW programmes/activiti
  es.

13

• The individual
• Only few receive RTW activities.
• Early rehabilitation is rare.
• The physician
• Sickness certificates of questionable quality.
• Clients wishes, rather than health status.
• Limited knowledge of work place.

14
How can DM be improved?

• Jobs needed!
• A more flexible labour market
• 1.2 millon Swedes not in work
• Danish flexicurity
• Legal rights to receive RTW activities

• Economic incentives
• For employers
• For individuals
• Education
• For employers
• For physicians
• For social insurance officers

15
Disability pensioners in Sweden 1970-2004
Thousands
600
500
400
300
200
100
0
1970
1972
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
16

• How are these fluctuations explained?
• Differences in general health?
• Generous sickness insurance?
• State of the market/unemployment?
• Other explanations?

17

• How are these differences explained?
• Differences in general health?
• Demographical differences?
• State of the market/unemployment?
• Other explanations?