Sick-listing adherence: a register study of 1.4 million episodes of sickness benefit 2010-2013 in Sweden.

Ola Leijon,Niklas Österlund,Malin Josephson

doi:10.1186/s12889-015-1741-2

Ola Leijon, Niklas Österlund + Show 1 more

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https://doi.org/10.1186/s12889-015-1741-2

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Abstract

BackgroundThis register study aims to increase the knowledge on how common it is that sickness benefit recipients are sick-listed for as long as their physician prescribes in their medical sickness certificate, i.e. sick-listing adherence, or wholly/partly bring return-to-work (RTW) forward, i.e. early RTW.MethodsThe unit for analysis was an episode of 100% sickness benefit, commenced between 1 January 2010 and 31 December 2013. Completed episodes of sickness benefit and full or partial early RTW was analysed by comparing the prescribed length of sick leave in medical sickness certificates and benefit days disbursed by the sickness insurance system. Probability for a full and partial early RTW was estimated with hazard ratio (HR) using the Cox proportional hazard model.ResultsIn total, about 1.4 million episodes of sickness benefit (60% women) were included in the study. The overall sick-listing adherence was 84% for women and 82% for men during the first year of sick leave. Adherence varied between 82 and 87% among women and between 79 and 86% among men with regard to ICD-10 diagnosis chapter. The probability of an early RTW varied between diagnosis chapters, where mental disorders was associated with a lower probability of a full early RTW among women and men (HR 0.52 and HR 0.47) as well as a partial early RTW (HR 0.51 and HR 0.46). Younger age (16–29 years), high educational level and high income was associated with a higher probability of an early RTW, while older age (≥50 years), not native-born, low educational level, unemployment and parental leave were associated with a lower probability.ConclusionThe study demonstrates that sick-listing adherence is relatively high. Probability of an early RTW differs with regard to diagnosis chapter, demographic, socioeconomic and labour market characteristics of the sickness benefit recipients. Interventions intended to improve the sick-listing process, and to affect the length and degree of sick leave in certain target groups, should include measures targeted at physicians’ sick-listing practices. Policies and economic incentives aimed at promoting RTW need to focus on individuals’ residual capacity for work.

Highlights

This register study aims to increase the knowledge on how common it is that sickness benefit recipients are sick-listed for as long as their physician prescribes in their medical sickness certificate, i.e. sick-listing adherence, or wholly/partly bring return-to-work (RTW) forward, i.e. early RTW
Older age (≥50 years), not native-born, low educational level, unemployment and parental leave were associated with a lower probability of a full or partial early RTW
Our study found that high educational level and high income was associated with a higher probability of an early RTW

Summary

Introduction

This register study aims to increase the knowledge on how common it is that sickness benefit recipients are sick-listed for as long as their physician prescribes in their medical sickness certificate, i.e. sick-listing adherence, or wholly/partly bring return-to-work (RTW) forward, i.e. early RTW. The same type of medical, individual and social factors seems to influence both an individual’s steps and decision to be/not to be on sick leave and decision to terminate sick leave and return to work [1]. In 2003, the World Health Organization (WHO) adopted the following definition of adherence to longterm therapy: ‘the extent to which a person’s behaviour – taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider’ [16]. This definition implies that adherence encompasses health-related behaviours and self-management that extend beyond taking prescribed pharmaceuticals. Meta-analyses have demonstrated that the objective severity of disease conditions and patients’ awareness of this severity [20], as well as physician–patient communication [21], can predict patient adherence

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