3
1
Introduction
In this paper we study the effects of early interventions by the Swedish Social Insurance
Administration (SIA). The aim of these interventions is primarily to assess the individual’s
work capacity and possibilities for vocational rehabilitation. In the analysis we make use
of a large (~ 13,500 individuals) randomized experiment conducted in collaboration with
SIA in 2007. The randomization was performed on the inflow of sick absent individuals.
Individuals assigned to be treated were given priority to get two types of interventions
during a 6-week period. The first, denoted Sassam, screens the working capacity of the
individual and the need for vocational rehabilitation.
1
The second, AM, is a formalized
meeting between the sick reported individual, the SIA, and the employer where the
possibility to return to alternative work tasks are discussed and appropriate vocational
rehabilitation measures are decided upon. The individuals of the control group were not
given priority to these activities during the 6 weeks, but were offered the same activities
after the 6 weeks. The implication of the evaluation design is that the probability of
receiving the interventions is higher in the treatment group.
2
The present paper adds important insights on why early interventions may be
problematic if the intention is to reduce the inflow into disability benefits (DB). Autor and
Duggan (2010) suggest that increasing employer responsibility and early intervention at
the workplace are useful measures in reducing the inflow to DB. However, although
intuitive and theoretically motivated, the strategy of early intervention in a sickness
absence spell relies either on the presence of efficient back-to-work strategies or on
deterring effects from screening and monitoring. While the empirical literature offers no
strong support for reduced sickness absence from different vocational rehabilitations,
3
there is some evidence of reduced sickness absence from monitoring and time limits in
sickness insurance.
4
Since we lack data on the date of assignment to Sassam and AM,
such an analysis is however not possible in the present experiment.
Two Swedish reports have been generated from the present experiment.
Försäkringskassan (2010) concluded that those who were prioritized to Sassam and AM
also received rehabilitation measures earlier than those not prioritized. Engström et al.
(2010) analyzed the length of the ongoing sick spell and found no effect from being
prioritized to Sassam and AM on the exit rate.
1
Sassam is a Swedish abbreviation for “A formalized method for sick-leave investigation and
rehabilitation”.
2
AM is an abbreviation for “A coordination meeting”.
3
See, e.g., Elders et al. (2000), Bloch and Prins (2001), Alexandersson and Nordlund (2004), Andrén
and Palmer (2004), Blank et al. (2008), Försäkringskassan (2007), and van Oostrom et al. (2009,
2010).
4
See, e.g., Hesselius et al. (2005), Hägglund (2010), Johansson and Lindahl (forthcoming), and de
Jong et al. (2011).
