Sickness Insurance Research Articles

Institutionalizing suspicion: Tracing the decline of the Swedish sickness insurance system in the 2000’s

This article presents an analysis of Swedish sickness insurance in the 2000’s, outlining cultural and structural shifts in political and institutional design. The study is based on analytic dualism and Margaret S. Archer’s morphogenetic model, which is used to create an analytical narrative focusing on political and institutional developments. The narrative identifies two distinct phases: one period of rapid cultural and structural change (morphogenesis), and one of institutionalization of the new structure (morphostasis). The narrative describes how a key element of the Swedish welfare state, sickness insurance, underwent a transition from an encompassing and generous to a strict and suspicious system, and how this was effectively solidified politically and organizationally. This is related both to a broader shift toward neoliberal and workfare policies, and to the specific socio-cultural and social interactions between agents to reform the system. The analysis provides a contribution to the literature by providing an internationally relevant empirical case of how an encompassing system has undergone a period of substantial decline, and by presenting a coherent long-term narrative which temporalizes this development into specific timepoints and phases.

The cost of saying no: general practitioners’ gatekeeping role in sickness absence certification

BackgroundGeneral practitioners (GPs) have an important gatekeeping role in the Norwegian sickness insurance system. This role includes limiting access to paid sick leave when this is not justified according to sick leave criteria. 85% of GPs in Norway operate within a fee-for-service system that incentivises short consultations and high service provision. In this qualitative study, we explore how GPs practise the gatekeeping role in sickness absence certification.MethodsQualitative data was collected through six focus group interviews with 33 GPs, working in practices with a minimum of four practising GPs, in different geographical regions across Norway, including both urban and rural areas. Data was analysed using Braune and Clarke’s thematic analysis approach.ResultsOur results indicate that GPs’ sick-listing decisions are largely driven by patient demand and preferences for sick leave. GPs reported that they rarely overrule patient requests for sickness absence, including in cases where such requests conflict with the GPs’ opinion of whether sick leave is justified or benefits the patient. The degree of effort made to limit unjustified or non-beneficial sick leave seems to depend on the GPs’ available time and perceived risk of conflict with the patient. GPs generally expressed dissatisfaction with their role as certifiers of sickness absence.ConclusionOur study suggests that GPs’ decisions about sickness certification is largely driven by patient preferences. The GPs’ gatekeeping function is limited to negotiations about grade and duration of absence spells.

Social Insurance Literacy Among the Sick-listed-A Study of Clients' Comprehension and Self-Rated System Comprehensibility of the Sickness Insurance System.

Sickness insurance systems and their processes have been studied in terms of transparency, comprehensibility and fairness, highlighting the importance of just procedures that make sense to clients. Related research demonstrates differences between groups of clients, pointing towards a social gradient. The concept of social insurance literacy and the Social Insurance Literacy Questionnaire (SILQ) was recently developed and serves as a measure for client's ability to obtain, understand and act on information in a sickness insurance system, relating to the comprehensibility of the information that the system provides. The purpose of this study was to investigate social insurance literacy among clients on sick leave and its associations with perceived justice, being granted sickness benefits and background factors. This was a questionnaire study with clients on sick leave in Sweden. In the selection process 3993 clients were invited, of which 1173 recently had their sickness benefits withdrawn. Those who answered the SILQ (n = 1152) also answered a perceived justice measure and accepted sharing register data from the Swedish Social Insurance Agency. Data were analyzed through regression analysis. The findings demonstrate that clients' perceptions of system comprehensibility and the status of their sick leave case was significantly associated with perceived justice, and being granted sickness benefits, while their individual abilities to obtain, understand, and act on information had lesser influence. The system's ability to provide understandable information seems more important than clients' abilities to comprehend it. From a client perspective, a just system seems to be related to their experiences of the sick leave process (i,e., whether they had an ongoing or closed case) rather than their skills to obtain the correct information.

Community health workers as bridge builders towards integrated care?

In response to COVID-19 pandemic, which exacerbated the access to care challenges for people living in socio-economic vulnerable circumstances, the Belgian Federal Government gave the National Institute for Sickness and Disability Insurance (NIHDI) and the National InterMutualist College (Intermut) the task to introduce community health workers (CHWs) throughout Belgium. CHWs are “frontline public health worker[s] who [are] a trusted member of a community or who has a thorough understanding of the community being served. This relationship allows CHWs to serve as a link between health and social service programs and the community to promote access to services and improve the quality and cultural competence of service delivery” (Centers for Disease Control and Prevention, 2020: p. 50). They share a lived experience with people who live in vulnerable circumstances and are trusted members of local communities. CHWs can improve access to care for people living in vulnerable circumstances and make a valuable contribution to addressing the social determinants of health (Damio et al., 2017). They bring care closer to a patient, their household and community (Peretz et al., 2020, Perry and Hodgins, 2021).
 CHWs occupy a unique position between the community and the health system. This constitutes an essential advantage of their work, but it also demands that CHWs are both embedded in the community and have a functional relationship with actors in the health system (LeBan et al., 2021, Lewin et al., 2021, Perry et al., 2021, Schneider and Lehmann, 2016).
 This is a balancing act, which is an ongoing challenge today in various CHW programs world-wide, as well as in the Federal CHW project in Belgium. Lack of integration and synchronization between CHW programs and local health systems, risks to result in fragmented service delivery (Afzal et al., 2021). In this workshop we will explore together with the participants how to counteract this fragmentation and what the potential role of CHWs could be in integrated care?
 The workshop aims to integrate the vision of various participants: policy makers, researchers, clinicians, citizens, patients and caregivers who are interested in the potential of CHWs in integrated care.
 
 - Introduction (15 minutes): the workshop participants will receive an introduction into the Federal CHW project, framed in the global CHW landscape.
 - Presenting a case study (15 minutes): The role of the CHW in between the community and health system will be presented by different stakeholders involved: CHWs; the Health Kiosk as an example of community engagement; and primary health care providers.
 - Group work (20 minutes): The participants of the workshop will be invited to discuss the potential role of CHWs in integrated care and their embeddedness in the health system. The group will be divided in two smaller groups in which two themes will be discussed in-depth – facilitated by the workshop organizers.
 - Feedback & closing (10 minutes): the small groups will feedback to the plenary group with the most imminent discussion points of their discussion group. The take home message will then be summarized by the workshop organizers.

Convince with facts: Information effects on attitudes to the sickness insurance in Sweden

AbstractDoes factual information matter for policy evaluations and attitudes? Previous research has provided different, and partly contradictive, replies to this question. To test the effect of concrete facts on attitudes, we provide findings from a survey web‐experiment concerning satisfaction with the universal sickness insurance. The treatments in the experiment are short facts from official reports on how the insurance actually work and is used. Our dependent variables are general satisfaction with how the insurance works, as well as trust for the responsible agency administering the insurance and more specified perceptions on capacity, precision, and fairness of the insurance. The results show that under certain circumstances, policy‐specific information does have an effect – even though the effects are not consistent. Effects of the information were mainly found on general evaluations of the sickness insurance rather than on specific attitudes. Furthermore, we conclude that, contrary to expectations, the effects were not conditional on left–right position, subjective knowledge, political interest, or proximity.

Specifics of the social security systems in the Czech Republic and Slovakia with a focus on maternity and parenthood

This paper analyses and compares the specifics of the social security systems in the Czech Republic and Slovakia with a focus on maternity and parenthood. The chosen topic is illustrated by diagrams of social security systems, namely state social support benefits and sickness insurance benefits. The article focuses specifically on maternity, parental and paternity benefits as well as birth grants and pregnancy allowances. The aim of the paper is to present and evaluate the specifics of the social security systems with a focus on these benefits as well as their amount and to point out their differences. The methods used in the paper are description, descriptive analysis, comparative analysis and comparison. To obtain the data and information used in the paper, literature and legislation of the Czech Republic and Slovakia were used. The results of the analysis and comparison will be beneficial not only for the scientific community but also the general public.

Gaps in the welfare state: A role-based model of poverty risk in the U.S.

Research clearly demonstrates that income matters greatly to health. However, income distribution and its relationship to poverty risk is often misunderstood. We provide a structural account of income distribution and poverty risk in the U.S., rooted in the 'roles' that individuals inhabit with relation to the 'factor payment system' (market distribution of income to individuals through wages and asset ownership). Principal roles are child, older adult, and, among working-age adults, disabled individual, student, unemployed individual, caregiver, or paid laborer. Moreover, the roles of other members of an individual's household also influence an individual's income level. This account implies that 1) roles other than paid laborer will be associated with greater poverty risk, 2) household composition will be associated with poverty risk, and 3) income support policies for those not able to engage in paid labor are critical for avoiding poverty. We test hypotheses implied by this account using 2019 and 2022 U.S. Census Current Population Survey data. The exposure variables in our analyses relate to roles and household composition. The outcomes relate to income and poverty risk. In 2019, 40.1 million individuals (12.7% of the population) experienced poverty under the U.S. Census' Supplemental Poverty Measure. All roles other than paid laborer were associated with greater poverty risk (p < .001 for all comparisons). Household composition, particularly more children and disabled working-age adults, and fewer paid laborers, was also associated with greater poverty risk (p < .001 for all comparisons). Five key policy areas-child benefits, older-age pensions, disability and sickness insurance, unemployment insurance, and out-of-pocket healthcare spending-represented gaps in the welfare state strongly associated with poverty risk. The role one inhabits and household composition are associated with poverty risk. This understanding of income distribution and poverty risk may be useful for social policy.

Stationäre und ambulante Heilverfahren der Deutschen Gesetzlichen Unfallversicherung

It is one objective of German Social Accident Insurance (DGUV) to restore the health and performance of insured persons after an accident "using all appropriate methods". Because of the legal requirements, possible rehabilitation may greatly differ from that provided by sickness or pension insurance. This article provides an overview of the available treatments after accidents at work and the rehabilitation phase in which they may be used.

The financial situation before and after first-time psychiatric in-patient diagnosis of schizophrenia spectrum, bipolar, and major depressive disorder

Schizophrenia spectrum, bipolar, and major depressive disorders are severe mental illnesses (SMIs) that not only entail great suffering for those affected but also major societal costs. In this study, I use administrative register data to provide a detailed picture of the financial situation of people with SMI in Sweden during a period of ±10 years around first-time psychiatric in-patient diagnosis of schizophrenia spectrum, bipolar, and major depressive disorders. Receiving a diagnosis was associated with a considerable drop in earnings, which was largely compensated for by social transfers: mainly sickness and disability insurance. However, there were also large and increasing pre-diagnosis earnings gaps, relative to matched comparison groups, especially among those with schizophrenia spectrum disorders. These gaps were to a lesser extent compensated for by social transfers. Consequently, there were permanent and increasing – due to lost earnings growth – income differentials. Hence, findings in previous studies are confirmed: even in an advanced welfare state, people with SMI – especially those with schizophrenia – have an extremely weak position on the labour market and an equally difficult financial situation.

Zadłużenie składkowe jako przyczyna przedawnienia prawa do świadczeń z ubezpieczenia chorobowego przysługującego przedsiębiorcy

Contributory debt as a cause of the statute of limitations on the right to sickness insurance benefits of an entrepreneur As of January 1, 2022, the act on monetary benefits from social security in case of sickness and maternity was amended, consisting, amongst other things, of the introduction of Article 2a, which modified the mechanism for acquiring the right to sickness insurance benefits for persons who are contributors to their own insurance. The purpose of the new regulation was to connect the acquisition of the right to benefits with the absence of a contributory debt exceeding 1% of the minimum wage, under the pain of the statute of limitations in the event of failure to settle the debt within six months from the date the right to benefits arises. The article presents the subject and object scope of the new legal regulation, discusses the concept of contributory debt, analyzes the legal nature of the statute of limitations and also points out the circumstances that may affect its course. The study makes extensive use of court case decisions regarding Article 6(2) and (3) of the act on social insurance for accidents at work and occupational diseases.

Pre-welfare state provision and adverse selection: enrolment in a Swedish nationwide health insurance society

Mutual benefit societies evolved as the major provider for sickness, accident and life insurance in the late nineteenth and early twentieth centuries on both sides of the Atlantic. One of the major problems facing insurers was the risk of adverse selection, i.e. that unhealthy individuals had more incentives than healthy individuals to insure when priced for the average risk. By empirically examining whether longevity among insured individuals in a nationwide mutual health society was different from a matched sample of uninsured individuals, we seek to identify the presence of adverse selection. We find no compelling evidence showing that unhealthy individuals were more likely to insure, or reasons to believe that problems related to adverse selection would have been a major reason for government intervention in the health insurance market in Sweden.

Comprehensive sickness insurance, EU citizenship rights and residence rights of Chen carers: And all this after the UK has left the EU …: VI

Comprehensive sickness insurance, EU citizenship rights and residence rights of Chen carers: And all this after the UK has left the EU …: VI

Austerity and identity formation: How welfare cutbacks condition narratives of sickness.

In recent years, Swedish sick insurance has become more restrictive. In this article, we analyse how people not being granted payments, despite being seriously ill, are affected. Scholarship on identity formation and sickness stress the importance of constructing narratives in order to come to terms with one’s situation. Our analysis of 30 qualitative interviews with people diagnosed with ME/CFS shows that workfare politics conditions such identity formation and often prevents it from taking place. Interviewees describe extreme stress as a result of their contacts with the Social Insurance Agency (SIA), which results in a perpetual crisis that is renewed with each new denied application. In particular, the sense of not having a future means that it is hard to construct narratives to make sense of one’s situation. To escape the perpetual crisis, some people have politicised their situation, constructing a narrative about themselves as suffering from oppressive politics. Others have escaped by not applying for sick insurance or other social insurances. But generally speaking, the most common effect of being denied sick insurance is an ongoing crisis that leads to deteriorating health.

PERHITUNGAN MEDICAL REIMBURSTMENT PREMIUM DAN DAILY BENEFIT PREMIUM UNTUK SICKNESS INSURANCE

The purpose of this study is to calculate premiums for sickness insurance using Helligman Pollard's law of mortality. This research will focus on Medical Reimburstment Premium and Daily Benefit Premiums. Data on the size of claims, z (frequency of claims per individual) and d (duration of claims) where z has a Poisson distribution (0.8) and claims size is lognormally distributed (1,5,1). The premium calculation will be aggregated for 5 years and starting from the age of 15 years to 70 years. The premium for daily benefits is higher than the premium for medical reimbursement for all ages. The lowest premium is premium for 25-30 years old, which is 8.518657957 for medical reimbursement premium and 41.79084811 for daily benefit premium, while the highest premium is for 65-70 years old, which is 114.2254996 for medical reimbursement premium and 258.6346296 for daily benefit premiums.&#x0D; Keywords : Sickness Insurance, Premium, Medical Reimburstment, Daily Benefit

질병·상해보험 표준약관의 ‘동호회 활동 목적의 전문등반’ 면책사유에 관한 연구

The standard terms and conditions of Personal accident and Sickness Insurance compensate for sudden, external and identifiable event that happens by chance, but "professional climbing for the purpose of job, duty and club activity" shall not be compensated unless additional contracts. An insured person, a member of the mountaineering club and an educational technology director of the Gwangju Metropolitan Federation of the Korea Alpine Federation, fell and died while climbing the 8,586m above sea level in Kanchenjunga. The Supreme Court cannot be regarded as professional climbing for the purpose of job or duties ① because it is not a professional climbing for the purpose of maintaining a living, such as the Brand Climbing Team or the Business Team, ② The parallel listing of "the purpose of the club’s activities" along with "job and duty" in the exclusionary provision, is based on the fact that the club’s activities are repeated for a certain period of time, such as job or duty. ③ In other words, in the case of overseas expedition climbing, several people form a team and it will take a considerable period of time from the preparation stage to the actual climbing stage, so it cannot be considered for the purpose of club activities just because several people prepared for a long time and did professional climbing together. ④ In addition, the Gwangju Mountaineering Union, which limited membership requirements to member organizations, was not allowed to join, and the Gwangju Mountaineering Union was not directly or indirectly involved in the expedition. ⑤ In the case of the Himalayan Kanchenjunga expedition, death benefit should be paid because it is not a "professional climbing for the purpose of club activities" stipulated in the exclusionary provision because people from different mountaineering clubs are only one-time. A professional mountaineer who has climbed alpine more than 8,000 meters four times in the past while interpreting the purpose of the club’s activities excessively reduced and recognized the insurer’s responsibility for paying a death benefit again during alpine climbing, making the exclusionary provision useless. Therefore, it is judged that the best way is to clearly define "professional climbing for the purpose of club activities", separate Alpine climbing, and enter into an insurance contract through additional subscription and acceptance procedures for "Professional sports Applicable to the policy" to meet the original purpose of exclusionary provision. It is expected that disputes related to professional climbing for the purpose of club activities will be minimized through the revision of the standard terms and conditions in the future.

Support for Informal Carers: Has the New Benefit Improved Their Ability to Care?

The purpose of this article is to evaluate the subjective impact of provided care on the quality of life of informal carers, to assess the institution of long-term carer's allowances from the viewpoint of informal carers, and to identify additional social policy tools that could, in carers' opinion, improve the provision of care. Our research shows that provision of care leads to a reduced quality of life for a significant number of respondents. It is confirmed that respondents' welfare is negatively influenced by a lack of funding and weak development of social services. It is not proven that the long-term carer's allowance is a comprehensible benefit increasing the carers' quality of life providing enough motivation to care. This sickness insurance benefit is intended primarily for a temporary lack of self-sufficiency, with the prospect of future improvement. Long-term or permanent lack of self-sufficiency and the related care must be secured by social support and assistance mechanisms, including respite care, and ought to be funded outside the framework of sickness insurance.

Exploring Interactions in the Sickness Insurance System in Terms of Power and Trust

Purpose Activation policies and efforts to reduce sick leave rates has influenced sickness insurance systems in Western countries, which has led to social security being more connected with work and attempts to expose malingering among the sickness absent. The aim of this study was to explore how power and trust are expressed by clients and stakeholders within the Swedish sickness insurance system. Methods This was a longitudinal qualitative study based on semi structured interviews and case files from 31 clients on sick leave in Sweden. Data was analyzed using a thematic analysis. Results The main theme ‘Acts of power and distrust’ illustrates how stakeholders’ express suspicions towards each other, and how clients need to demonstrate desire and efforts to return to work which other stakeholders verified. Conclusions The clients desire to prove themselves able to contribute to society was prominent in this study and power relations need to be acknowledged, in particular between client and the SIA. Further, to preserve citizens trust in the system, the system needs to demonstrate trust also in the clients.

Overview of recent cases before the Court of Justice of the European Union (March 2021-September 2021)

In O.D. and Others v INPS (C-350/20), the Court dealt with the refusal of the Italian authorities to grant childbirth and maternity allowances to third-country nationals falling within the scope of the Single Permit Directive. In CG (C-709/20), the Court considered the refusal of the UK authorities to grant social assistance to an economically inactive EU citizen resident under the UK scheme adopted in the context of Brexit. In AB v Olympiako (C-511/19), the Court found that the Greek legislation, adopted in the context of the economic crisis, placing public sector workers in a labour reserve system is not discriminatory on grounds of age. In WABE and MH Müller Handel (C-804/18 and C-341/19), the Court clarified what circumstances could justify differential treatment indirectly based on religion or belief. The Court confirmed the direct effect of the principle of equal pay for male and female workers enshrined in Article 157 TFEU for cases of work of equal value in Tesco Stores (C-624/19). In Team Power Europe (C-784/19), the Court specified under which criteria a temporary-work agency could be considered as pursuing ‘substantial activities’ in a Member State. In A (C-535/19), the Court held that a Member State cannot exclude an economically inactive EU citizen from its public sickness insurance system but does not have to grant access free of charge. In FORMAT (C-879/19), the Court confirmed that Article 14(2) of Regulation 1408/71 does not apply to a person who, under a single employment contract concluded with a single employer, works in several Member States for more than 12 months in each of those Member States. Finally, in PF (C-27/20), the Court dealt a national legislation which uses the penultimate year preceding the payment period as the reference year for the calculation of family allowances to be allocated.

Social validity of work ability evaluations and official decisions within the sickness insurance system: A client perspective.

BACKGROUND:Studies of the social validity of work ability evaluations are rare, although the concept can provide valuable information about the acceptability, comprehensibility and importance of procedures.OBJECTIVE:The aim of this study was to explore clients’ perceptions of social validity of work ability evaluations and the following official decisions concerning sickness benefits within the Swedish sickness insurance system.METHODS:This was a longitudinal qualitative study based on interviews with 30 clients on sick leave, analyzed through deductive content analysis.RESULTS:Clients’ understanding of the evaluation was dependent on whether the specific tests were perceived as clearly related to the clients’ situation and what information they received. For a fair description of their work ability, clients state that the strict structure in the evaluation is not relevant to everyone.CONCLUSION:The work ability evaluations indicate low acceptability due to lack of individual adaptation, the comprehensibility varied depending on the applicability of the evaluation and information provided, while the dimension ‘importance’ indicated as higher degree of social validity. The official decision about sickness benefits however was considered unrelated to the evaluation results, lacking solid arguments and sometimes contradictory to other stakeholders’ recommendations indicating poor social validity.

The Welfare State Upholders: Protests Against Cuts in Sickness Benefits in Sweden 2006–2019

The power resource approach (PRA) claims that the labour movement continues to be the most prominent defender of the welfare state. The new politics thesis (NPT), on the other hand, claims that the welfare state has created new interest groups in the form of welfare clients who have taken over as the most prominent welfare state upholders. In an attempt to empirically evaluate these claims, we present a study of the extent to which clients and the labour movement have been involved in protests against cutbacks in the Swedish sickness benefit from 2006 to 2019. The article contributes to the welfare state literature by studying a most likely case for PRA‐style interest group mobilization both in terms of country (Sweden) and policy area (sickness insurance). It also tests the claim from PRA scholars that client interests are uncommon in these contexts. Our results show that protest engagement among client groups is greater than the engagement among the labour movement when looking at protests directed specifically against cuts in the sickness benefit programme. However, when broader protests against cutbacks in several transfer programmes are taken into account, the number of protests initiated by clients and by the labour movement is comparable. Overall, our results suggest that both the PRA and the NPT are needed to explain current developments in social democratic welfare states like Sweden.