19(23)
6
Conclusions
The main finding in this paper is that introducing time-restricted working
capacity assessments in the public SI system have strengthened the
downward trend in sickness absence in Sweden. This seems to be the result
of people with relatively better health and better opportunities to work
returning to work at a higher rate. Analysing the effect of benefit eligibility
checks on the 91st and 181st sickness days, large and significantly positive
effect on the exit rate – which is approximately synonymous with return to
work – are found around the assessment on the 181st day. Smaller, but
significant, positive effect are also found before the working capacity
assessment at 91 days. The fact that the exit rate increased before the
actual assessments suggests that the positive effects primarily stem from
the increased monitoring, rather than from the stricter enforcement of the
SI rules themselves.
Perhaps the effects would have been even more pronounced had the new
rules been applied more consistently from the start. A survey performed on
sick episodes initiated in the autumn of 2008 shows that the 91-day
assessment had been performed in fewer than 20% of the spells. We can
therefore assume that the assessments were not in fact performed in a
significant portion of the July group in this study.
In total, the reform reduced the average number of compensated days in
the SI system by 0.27 days. This might appear to be a small impact for
such a considerable change in policy. However, the vast majority of those
reporting sick are not directly affected by the time limits. Fewer than 20%
of the sick spells reach 91 days and fewer than 10 % are still in progress at
181 days. The large reform impact on return to work at 6 months thus
concerns too few to have an impact on the overall average of all sick spells.
However, since long-term sickness often works as a first step towards
permanent disability benefits, the impact of the reform on the public budget
should not be underestimated.
The results demonstrate a regional pattern, with large positive effects in big
city areas and no effects in small municipalities. The result is possibly due
to the larger labour markets offering more opportunities and stronger
incentives to work. The result could also be due to region-specific
differences in norms and attitudes towards reporting sick. For instance,
sickness absence is considerably higher in the regions reporting a zero
effect from the reform.
