Social Insurance Office Research Articles

Collaboration in the return-to-work process after sick leave due to common mental disorders: a qualitative study of stakeholders’ views on goals and roles

BackgroundThis study explores how the goals of collaboration in the return-to-work (RTW) process for people with common mental disorders are described by the stakeholders involved, and how they experience stakeholders’ roles and responsibilities in relation to these goals.MethodsInterviews were conducted with 41 participants from three Swedish regions. Nine of the participants were workers, six employer representatives, four occupational health professionals, four social insurance officers, 18 RTW coordinators and five physicians. Thematic analysis was conducted.ResultsThree main themes and overarching goals when collaborating on RTW were identified. In the first theme, ‘creating an informative environment’, all stakeholders emphasised clear roles and responsibilities. The second theme, ‘striving for consensus in an environment of negotiations’, addressed negotiations about when and how to collaborate, on what and with whom, and reveal different views on stakeholders’ goals, roles and responsibilities in collaboration. The third theme identified goals for ‘creating a supportive environment’ for both workers and other stakeholders. Coordinators are found to have an important role in achieving a supportive environment, and in neutralising power imbalances between workers and their employers and social insurance officers.ConclusionsCompeting goals and priorities were identified as hindering successful collaboration, contributing to a spectrum of complex versus easy RTW collaboration. This study suggests some basic conditions for achieving a collaborative arena that is neutral in terms of power balance, where all stakeholders can share their views.

De‐gendering parents: Gender inclusion and standardised language in screen‐level bureaucracy

AbstractSwedish welfare organisations have a long history of promoting gender equality and inclusivity, involving implementation of more gender‐inclusive language (e.g., non‐gendered terminology). This study analysed the use of non/gendered expressions at the Swedish Social Insurance Agency, as state policy is realised in conjunction with personalised service in textual interaction in screen‐level bureaucracy. We drew on conversation analysis and membership categorisation analysis to analyse 378 email interactions between clients and social insurance officers, focusing on gendered institutional terminology and gendered person references. The findings suggest that social insurance officers avoided a heteronormative language, in line with Swedish official public language policy, but that a gender‐neutral language may come at the cost of formality, standardisation, and de‐personalisation. The study brings new knowledge on the ways in which street‐level bureaucrats manage responsiveness and standardisation in digital text‐based interaction with clients.

Prevention and treatment of psychiatric disorders through physical activity, exercise, and sport

Prevention and treatment of psychiatric disorders through physical activity, exercise, and sport

A scooping review of Scandinavian studies of sick‐listed' and social insurance officers' experiences of their encounters'

AbstractIn the Scandinavian countries, social insurance officers (SIOs) hold key positions with regard to coordinating the return‐to‐work (RTW) process of workers on long‐term sick‐leave. This article aimed to systematically explore the experience of encounters between the sick‐listed and SIOs and set out the current scientific knowledge base on factors related to the encounter that are perceived as having an impact on the sick‐listed's RTW. A scoping review was conducted that included peer‐reviewed articles published in the English language in the period January 2000 to February 2021. Of the 435 articles reviewed to determine eligibility, 38 were included. Most of the articles included were qualitative (68%) and focused on the sick‐listed's experience of encounters with RTW professionals. The main finding of this review is that the majority of the sick‐listed perceived the encounters with SIOs as positive. The perspective of SIOs was less subject to study, and the research focus was more often concerned with practical aspects of the encounter, such as stakeholder cooperation and the impact of policy on SIOs' working conditions. Furthermore, we found that SIOs experience challenges in stakeholder cooperation and in performing workability assessments, especially where objective medical information is scarce. The findings of this review suggest that future studies should pay more attention to the SIO perspective in encounters between sick‐listed and SIOs.

Evolution of disability pension after renal transplantation: methods and results of a database linkage study of the Swiss Transplant Cohort Study and Swiss Disability Insurance.

In Switzerland, certain patients with disabilities and reduced working ability are entitled to a disability pension granted by the Swiss Federal Social Insurance Office (FSIO). The aim was to assess the evolution of disability pension and work capacity after kidney transplantation and thereby pilot the procedures linking FSIO data with Swiss Transplant Cohort Study (STCS) data. The current study pilot tested the record linkage of FSIO data with data from the STCS in a single-centre, observational setting. Patients were requested to consent to the use of their Swiss social security number (SSSN) for the purpose of record linkage. A privacy preserving trust centre approach was implemented with blinded statistical analysis. Between May 2008 and December 2015, 282 working-age renal transplant recipients of the University Hospital of Basel transplant centre were eligible for inclusion and 136 (48%, median age 48 years) consented to the use of their social security number and record linkage. The FSIO datasets of all patients were successfully retrieved and linked to STCS data in the trust centre and were numerically analysable. Yearly FSIO allowance data were available for the entire study duration. Fifty-five patients (40%) were registered as disability insurance recipients (DIR). In the entire population, the proportion of working patients slightly decreased from 76% to 72% between the pre-transplant and the post-transplant period. This was due to the lower proportion of patients working after transplantation in DIR compared with non-recipients (non-DIR) (DIR: 60% before vs 44% after; non-DIR: 83% before vs 88% after). In the DIR group, the proportion of patients not working increased from 36% to 49%, whereas in non-DIR the proportion changed only marginally (14% to 12%). The average disability insurance allowance was CHF 1172 per month. It changed from CHF 1135 before transplantation to CHF 1209 after transplantation (p = 0.59). In the Swiss healthcare and social insurance system, record linkage studies combining clinical datasets with data from FSIO are feasible but associated with great efforts and resource needs. The lack of changes in disability allowances after kidney transplantation should be further investigated in the nationwide setting.

Predicting the duration of sickness absence due to knee osteoarthritis: a prognostic model developed in a population-based cohort in Sweden

BackgroundPredicting the duration of sickness absence (SA) among sickness absent patients is a task many sickness certifying physicians as well as social insurance officers struggle with. Our aim was to develop a prediction model for prognosticating the duration of SA due to knee osteoarthritis.MethodsA population-based prospective study of SA spells was conducted using comprehensive microdata linked from five Swedish nationwide registers. All 12,098 new SA spells > 14 days due to knee osteoarthritis in 1/1 2010 through 30/6 2012 were included for individuals 18–64 years. The data was split into a development dataset (70 %, nspells =8468) and a validation data set (nspells =3690) for internal validation. Piecewise-constant hazards regression was performed to prognosticate the duration of SA (overall duration and duration > 90, >180, or > 365 days). Possible predictors were selected based on the log-likelihood loss when excluding them from the model.ResultsOf all SA spells, 53 % were > 90 days and 3 % >365 days. Factors included in the final model were age, sex, geographical region, extent of sickness absence, previous sickness absence, history of specialized outpatient healthcare and/or inpatient healthcare, employment status, and educational level. The model was well calibrated. Overall, discrimination was poor (c = 0.53, 95 % confidence interval (CI) 0.52–0.54). For predicting SA > 90 days, discrimination as measured by AUC was 0.63 (95 % CI 0.61–0.65), for > 180 days, 0.69 (95 % CI 0.65–0.71), and for SA > 365 days, AUC was 0.75 (95 % CI 0.72–0.78).ConclusionIt was possible to predict patients at risk of long-term SA (> 180 days) with acceptable precision. However, the prediction of duration of SA spells due to knee osteoarthritis has room for improvement.

The association between decision-making skills and subjective decision outcomes among administrative officers in the Swedish Social Insurance Agency.

Social insurance administrative officers’ decision‐making skills influence their efficiency at work and their general well‐being. At work their tasks are characterised by complexity and a need for order and accountability. Moreover, cases should usually be handled and finalised within the imposed time frames. We investigated skills related to decision‐making success among social insurance officers. In total, 118 administrative officers at the Swedish Social Insurance Agency (66% response rate) responded to questions on scales and measures relating to cognitive‐rational, socio‐emotional and time approach features of decision‐making skill. In addition, they responded to questions on three scales pertaining to outcomes of everyday decisions in terms of subjective everyday difficulties, tendencies to burnout and depressive symptoms. The results showed that cognitive‐rational competence was associated with lower reports of subjective everyday difficulties and depressive symptoms and thereby contributed to the explained variance in decision outcomes. Furthermore, socio‐emotional and time approach features of decision‐making skills contributed to the explanation for subjective everyday difficulties, tendencies to burnout and depressive symptoms. The results corroborate the basic assumption and usefulness of a broad approach in the definition and assessment of decision‐making skills in human service professions in general, and of administrative officers in social insurance agencies in particular. Recommendations for future research and the implications of the results are discussed.

Primary care physicians’ concerned voices on sickness certification after a period of reorganization. Focus group interviews in Sweden

Objective: This study explored the views of primary health care (PHC) physicians on sickness certification after reforms in 2005 prompted by the Swedish government to increase the quality and decrease the inequalities, and costs of sickness certification.Design: Qualitative design with focus group interviews. Data were analysed using qualitative content analysis.Setting: Urban and rural PHC centres in Region Västra Götaland, Sweden.Subjects: GPs, interns, GP trainees and locums working in PHC centres 2015. Six focus group interviews with 28 physicians were performed.Main outcome measures: Experiences and reflections about the sickness certification system.Results: The latent content was formulated in a theme: ‘The physicians perceived the sickness certification process as emotive and a challenge to master with differing demands and expectations from authorities, management and patients’. Sickness certification could be easy in clear-cut situations or difficult when other factors besides the pure medical were ruling the decisions. The physicians’ coping strategies for the task included both active measures (cooperation with health care staff and social insurance officers) and passive adaptation (giving in or not caring too much) to the circumstances. Proposals for the future were to transfer lengthy sickness certifications and rehabilitation to specialized teams and increase cooperation with rehabilitation coordinators and social insurance officers.Conclusions: Political decisions on laws and regulations for sickness certification impacted the primary health care making the physicians’ work difficult and burdensome. Their views and suggestions should be carefully considered in future organization of primary care. KEY POINTSIn 2005 Swedish government introduced reforms to decrease the inequalities and costs of sickness certification and facilitate the physicians’ work. Focus group interviews with Swedish primary care physicians revealed that sickness certification was challenging due to differing demands from authorities, management and patients.Coping strategies for the sick-listing task included both active measures and passive adaptation to the circumstances.A proposal for future better working conditions for physicians was to transfer lengthy sickness certifications and rehabilitation to specialized teams.

The quality of the sickness certificate. A case control study of patients with symptom and disease specific diagnoses in primary health care in Sweden

Objective: To compare information in sickness certificates and rehabilitation activities for patients with symptom diagnoses vs patients with disease specific diagnoses.Design: Retrospective case control study 2013–2014.Setting: Primary health care, Sweden.Subjects. Patients with new onset sickness certificates with symptom diagnoses n = 222, and disease specific diagnoses (controls), n = 222.Main outcome measures: Main parameters assessed were: information about body function and activity limitation in certificates, duration of sick leave, certificate renewals by telephone, diagnostic investigations, health care utilisation, contacts between patients, rehabilitation coordinators, social insurance officers, employers and occurrence of rehabilitation plans.Results: Information about body function and activity limitation was sufficient according to guidelines in half of all certificates, less in patients with symptom diagnoses compared to controls (44% vs. 56%, p = 0.008). Patients with symptom diagnoses had shorter sick leave than controls (116 vs. 151 days p = 0.018) and more certificates issued by telephone (23% vs. 15% p = 0.038). Furthermore, they underwent more diagnostic investigations (32% vs. 18%, p < 0.001) and the year preceding sick leave they had more visits to health care (82% vs. 68%, p < 0.001), but less follow-up (16% vs. 26%, p < 0.008). In both groups contacts related to rehabilitation and with employers were scarce.Conclusion: Certificates with symptom diagnoses compared to disease specific diagnoses could be used as markers for insufficient certificate quality and for patients with higher health care utilisation. Overall, the information in half of the certificates was insufficient and early contacts with employers and rehabilitation activities were in practice missing.KEY POINTSSymptom diagnoses are proposed as markers of sickness certification quality. We investigated this by comparing certificates with and without symptom diagnoses.Certificates with symptom diagnoses lacked information to a higher degree compared to certificates with disease specific diagnoses.Regardless of diagnoses, early contacts between patients, rehabilitation coordinators and social insurance officers were rare and contacts with employers were absent.

Physician’s views on social insurance officers’ encounters and competence regarding sick-leave cases

Physician’s views on social insurance officers’ encounters and competence regarding sick-leave cases

Employment Prospects of Young Adults With Mental Disorders

AbstractWe examine how type of diagnosis, educational trajectories and educational qualifications affect the employment prospects of young adults with mental disorders. We draw on a novel dataset based on data from the Swiss Federal Social Insurance Office. Our analysis shows that individuals with mental disorders that typically have an onset in early childhood, those who experience educational trajectories including special needs education, and those attaining higher levels of qualification are more likely to be employed in early adulthood.

Muscular weakness in adolescence is associated with disability 30 years later: a population-based cohort study of 1.2 million men

ObjectiveTo investigate the associations of muscular strength in adolescence with later disability pension (DP), across different body mass index (BMI) categories and in combination with aerobic fitness.MethodThis prospective cohort study...

Healthcare expenditures and the role of demografic change : An analysis of statutory health insurance data

The development of healthcare expenditures and the impact of demographic change are the subject of acontroversial debate. Yearly healthcare expenditures have more than doubled between 1992 and 2015 and are often justified by the aging demographic. The majority of expenses are paid by the statutory health insurance (SHI). The aim of the current study was to evaluate the contribution of the demographic change to increasing total per capita expenditures in the SHI as well as to analyze the development and the impact in individual areas of spending.We calculated average per capita expenditures from 2004 to 2015 based on data from the German Federal (Social) Insurance Office. Information on the age distribution in SHI was derived from official statistics of the Federal Ministry of Health. To determine the impact of demographic change on per capita expenditures, age distribution was standardized based on 2004 data. Additionally, the impact of inflation and other factors was determined.The results show an increase in per capita expenditures from €1722 in 2004 to €2656 in 2015 (+54.2%). Assuming aconstant age distribution at the 2004 level, average per capita expenditures would have increased by 44.9%. The relative share of demographic change is only 17.3%; 32.2% could be explained by inflation and 50.5% are based on other factors. We observed large differences in the increase for the individual areas of spending, which can partly be explained by the impact of demographic change.This analysis illustrates that the demographic change is not the frequently claimed cost driver in healthcare. Other factors have asubstantially greater impact on healthcare expenditures.

Who among patients with acquired brain injury returned to work after occupational rehabilitation? The rapid-return-to-work-cohort-study

Background: Acquired brain injury (ABI) is known to be severely disabling. On average, 40% of employees return to work (RTW) within two years after injury. There is, however, limited research on what might contribute to successful RTW.Aim: To examine factors that might impact the time-to first RTW for patients with ABI, participating in a RTW-program.Methods: The study was designed as a cohort study of patients on sick leave due to mild or moderate ABI (n = 137). The mean age of the patients was 51 years, and 58% were men. The most common diagnoses were stroke (75%) and traumatic brain injury (12%). Data were collected through questionnaires, and combined with register data on sickness absence. Survival analyses were used to analyse the effect of different variables on time to first RTW (full or partial), at one- and two-year follow-up.Results: Generally, women (HR = 0.447; CI: 0.239–0.283) had higher RTW-rates than men, and patients with non-comorbid impairments returned to work earlier than patients with multiple impairments. Although not statistically significant, receiving individual consultations and participating in group-sessions were generally associated with a delayed RTW at both follow-up-times. The only service-related factor significantly associated with delayed RTW was meetings with the social insurance office (HR = 0.522; CI: 0.282–0.965), and only at one-year follow-up.Conclusions: Women and patients with non-comorbid impairments returned to work earlier than men and patients with multiple impairments. There seems to be an association between intense and long-lasting participation in the RTW program and prolonged time-to first-RTW, even after controlling for level of cognitive impairments and comorbidity.Implications for RehabilitationAcquired brain injury (ABI) is known to be severely disabling, and persons with ABI often experience difficulties in regard to returning to work.This study provides information on prognostic factors that might contribute to return to work (RTW) for patients with acquired brain injury, both at the individual level, but also in regard to service and timing characteristics.Knowledge about such factors provide rehabilitation professionals with information about effective service components that might help patients with ABI to RTW, and thus makes it possible to adapt and adjust the services to the patient’s situation.Furthermore, having more knowledge on factors that contribute to RTW gives clinics the opportunity to select patients that might benefit the most from these services, thereby making them more effective.

Who initiates and organises situations for work-related alcohol use? The WIRUS culture study.

Alcohol is one of the leading causes of ill health and premature death in the world. Several studies indicate that working life might influence employees' alcohol consumption and drinking patterns. The aim of this study was to explore work-related drinking situations, with a special focus on answering who initiates and organises these situations. Data were collected through semi-structured group interviews in six Norwegian companies from the private ( n=4) and public sectors ( n=2), employing a total of 3850 employees. The informants ( n=43) were representatives from management and local unions, safety officers, advisers from the social insurance office and human-resource personnel, health, safety and environment personnel, and members from the occupational environment committee. Both qualitative and quantitative content analyses were applied in the analyses of the material. Three different initiators and organisers were discovered: the employer, employees and external organisers. External organisers included customers, suppliers, collaborators, sponsors, subcontractors, different unions and employers' organisations. The employer organised more than half of the situations; external organisers were responsible for more than a quarter. The differences between companies were mostly due to the extent of external organisers. The employer initiates and organises most situations for work-related alcohol use. However, exposure to such situations seems to depend on how many external relations the company has. These aspects should be taken into account when workplace health-promotion initiatives are planned.

Sickness Absence and Disability Pension After Breast Cancer Diagnosis: A 5-Year Nationwide Cohort Study.

Purpose To explore future diagnosis-specific sickness absence and disability pension among women with breast cancer compared with women without breast cancer. Also, to examine associations with disease-related and sociodemographic factors among those with breast cancer. Methods Longitudinal register data on 3,547 women living in Sweden (age 20 to 65 years) who were first diagnosed with breast cancer in 2005, and a matched comparison cohort (n = 14,188), were analyzed for the annual prevalence of diagnosis-specific sickness absence and disability pension over 5 years. Logistic regressions were used to explore associations of disease-related and sociodemographic factors with future sickness absence and disability pension among women with breast cancer. Results Immediately after being diagnosed with breast cancer, the proportion of women with sickness absence was high but decreased continuously from the 1st through 5th year after diagnosis (71%, 40%, 30%, 22%, and 19%, respectively). In comparison, the range for women without breast cancer was 17% to 11%, respectively. The higher prevalence of sickness absence after breast cancer was mainly a result of breast cancer diagnosis, not a mental diagnosis, or other somatic diagnoses. Advanced cancer at diagnosis, > 90 days sickness absence before diagnosis, low education, and being born outside Sweden were associated with higher odds ratios for sickness absence and disability pension (odds ratio range, 1.40 to 6.45). Conclusion The level of sickness absence increased substantially in women with breast cancer during the first year after diagnosis and approached the level of breast cancer-free women in the following years; however, even in the first year, most women were not on sickness absence for a substantial time, and even in high-risk groups, many were not on sickness absence or disability pension in the following years. Information about relatively low future sickness absence and disability pension levels can be used by patients when planning their work, by health care professionals, and by social insurance officers. Employers and Occupational Health Services need this information to adequately handle workplace adjustments.

Translating Machine or Creator? On Finnish-Swedish Community Interpreting in Sweden

The paper relates the objectives and preliminary results from a project on Finnish/Swedish community interpreting in Sweden, the so called FIKON-project at the Department of Finnish, Stockholm University (Swed. Finsk-svensk kontakttolkning i Sverige). A point of departure for the investigation are the ethical recommendations to interpreters formulated by the Swedish National Board of Trade, according to which the interpreter has to act neutrally and objectively. The data, deriving from 32 tape recordings in four different communicative settings (social insurance office, doctor/patient-conversation, consultation of diabetes nurse and courtroom proceedings), show a considerable deviation in the acting of the interpreters relative to the recommendations. A theoretical framework for an analysis of the data is the skopos theory.

Hospital Planning Mass Destruction Incidents

With the expansion in overall fear mongering episodes, clinic catastrophe arranges should be investigated to guarantee they incorporate readiness components that are one of a kind to weapons of mass obliteration (WMD) occurrences. The act of crisis arranging shifts significantly among clinic offices. The way of the healing center arranging process mirrors an office's size, capacities, and assets. Bigger social insurance offices have more assets and work force and more prominent hierarchical many-sided quality in therapeutic specialization. Such doctor's facilities have a tendency to make formalized procedures and depend all the more intensely on composed plans and between organization understandings.

The emergence of indicators of integrated vocational rehabilitation in Sweden: How working through coordination agencies made all the difference

Since 2004, a little more than a decade ago, the Swedish government passed legislation which enabled the four primary organisations in public sector vocational rehabilitation to form Coordination Agencies, themselves a fine example of organisational integration. These agencies offered The Social Insurance Office, The Job Centre, County Councils, responsible for healthcare, and local municipalities, responsible for social services, financial coordination and support in the organisation of joined-up and integrated services. The Coordination Agencies also have responsiblities in the area of evaluation and support learning within the local system. Since 2012, in response to the need for more useful measures to follow and evaluate successful integrated services, three coordination agencies teamed up to gather and subsequently pick key indicators. With support from Örebro University and The National Board of Health and Welfare, and financing from the Swedish government, measures were developed and, during 2015-2016 are being quality tested in 15 pilot Coordination Agencies across the country. This poster presentation will offer the opportunity to connect and learn how Coordination Agencies function as key enablers for this remarkable development and the potential for more learning of how organising for integrated services can be accelerated.

Economic aspect of treatment in geriatrics

AbstractIntroduction.There are few publications related to the economic analysis of the cost of care and treatment of geriatric patients as compared with other fields of medicine. Aging of the population, especially in highly civilized countries is inevitable. Cost index is used in the literature to analyse the utility costs. They reflect the so-called cost-effectiveness of medical procedures with the estimated remaining number of years adjusted quality of life.Aim.Economic evaluation of treatment in geriatrics. Rating demographic and economic situation in Poland on the basis of statistical data.Material and methods.PubMed database was searched through and the base of Polish Central Statistical Office (CSO) was used. Qualified articles on the economic efficiency of the treatment of older people in terms of coexistence of multi morbidity were used for the analysis. Also, the existing legal acts and publications of the Polish National Health Fund, the reports from the Supreme Chamber of Control, data from the CSO, the Ministry of Health and Social Insurance Office were taken into account. Statistical analyses were performed basing on data from the CSO.Conclusions.Multiple morbidities are usually correlated with a significant increase in the use of resources, as it “multiplies” the costs of health and social care. The incidence of comorbidities has increased due to the effectiveness of treatment of chronic diseases, such as cancer, together with the increasing age of the patients. So there is a need for a system of health and social care, which will take into account the economics, and which will evolve and follow the problems that emerge. First of all, the authors recognize the need to create a properly equipped hospital wards and geriatric clinic. It is also important to take into account the cost-incurrence of geriatric treatment so that the provider would have the ability to optimally treat patients comprehensively and not only their singular particular diseases.