Activation, medicalisation and inter-organisational cooperation in health insurance – implications for frontline social work in Sweden

Abstract

ABSTRACTThis paper focuses on tensions between activation principles and medicalisation in the Swedish sickness insurance and its implications for frontline caseworkers in Social Security Agencies and Public Employment Services. The right to sickness cash benefits has become stricter and more conditioned upon the person’s work ability and employability. The paper describes recent policy changes towards activation and stricter entitlement criteria for sickness benefits policy and explores the consequences of such new activation policies in terms of changed work modes for caseworkers dealing with long-term sick people’s return-to-work process. It is concluded that on the one hand frontline work contains a significant portion of discretion and professional assessment of work abilities, and on the other hand rule-bound administrative work. Furthermore, frontline workers need to apply organisational professionalism as inter-organisational cooperation is required in order to support long-term sick people to return-to-work. Medicalisation of ill-health, manifested in the right to sickness benefits has not been substantially circumscribed by new activation policies in the sickness insurance.