Exploring Interactions in the Sickness Insurance System in Terms of Power and Trust.
Elin A Karlsson, Jan L Sandqvist, Ida Seing and 1 others
PMID 34935082WHAT IT FOUND
Clients on long-term sick leave described trying to prove their work ethic during evaluations, even pushing past their limits.
They felt distrusted by the system, while clinicians who knew them often verified their genuine effort and desire to return to work.
Key findings
01Clients often pushed themselves too hard during work ability evaluations to prove they wanted to contribute to society.
02Treating physicians frequently verified clients' strong motivation and efforts to return to work in their medical certificates.
03Clients felt their own narratives were neglected and that they were suspected of malingering by the insurance agency.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The study only included clients who had been sent for a work ability evaluation, so it does not represent all people on sick leave. The participants had been on sick leave for a long time, which might make them more defensive about their work ethic than someone with a shorter absence. Case managers and insurance physicians were not interviewed, so their perspective on the process is missing. The study was conducted in Sweden's comprehensive tax-funded system, so the specific dynamics may not transfer directly to other countries' insurance systems.
Declared interests
The study was funded by Linköping University. The researchers stated they had no connection with the Social Insurance Agency and were unable to affect official decisions regarding the clients' benefits.
The easy way to misread this
Do not interpret this study as evidence that a specific clinical intervention improves return-to-work outcomes. It is a qualitative description of clients' experiences with the administrative and assessment processes of the Swedish sickness insurance system.