Working paper 2015-3

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2 Institutional background
2.1 The medical rehabilitation guarantee
In 2008, the Swedish government launched a medical rehabilitation
guarantee, containing additional funding to the county councils for evidence
based treatments of mental illness and pain in back and shoulders. Mental
disorders and musculoskeletal diseases each accounted for about 30
percent of the total sick leave costs in Sweden by the time the program
was introduced, and the purpose was both to prevent sick leave and to
promote return to work for individuals on sick leave with these diagnoses.
The treatments qualifying for additional funding include CBT for individuals
with mental illness and MDT for individuals with pain in back and
shoulders.5 The diagnoses qualifying for treatment within the medical
rehabilitation guarantee are listed in Appendix A. Since the target groups
differ, the treatments are not substitutes for each other, and the evaluation
does not concern the relative merits of the two types. However, the fact
that the treatments are targeted at the two main causes of work absence
and the rehabilitation guarantee affected the supply of the treatments in a
similar manner makes them interesting to analyze jointly.
This paper focuses on the medical rehabilitation guarantee in Skåne county
council, a council in the south of Sweden which covers 33 of Sweden’s 290
municipalities and has a population of about 1.25 million individuals out of
about 9.5 million in all of Sweden. To receive compensation for the
treatments, clinics had to obtain a contract with the county council in which
they proposed offering the treatments with qualified personnel. When the
medical rehabilitation guarantee was launched in 2008, there was a lack of
personnel with the qualifications needed to provide CBT and MDT. The
medical rehabilitation guarantee therefore expanded gradually. Initially,
clinics who already had the qualifications to provide the rehabilitation
measures received the contracts. Education programs and other efforts to
increase the number of certified personnel resulted in an expansion of
certified clinics over time. and in Appendix B show the
number of clinics with a contract to provide CBT and MDT in the Skåne
municipalities on 1 January 2010, 1 January 2011, 1 January 2012 and 30
November 2012. The figures show that the number of contracts varied
across municipalities and increased gradually over time.
The assessment of whether the individual qualified for CBT or MDT should
be made at the primary care unit where the patient was listed. After that,
the patient could choose among the contracted clinics within the entire
Skåne county.
5 Also interpersonal therapy qualified for compensation but this type of treatment
was very rare. To the extent that it does appear, it will be included with CBT in the
analysis.