Sickness absence, Legislation Trends Co-operation

Abstract

All societies have two distributive systems, one based on work and one based on need, and there will always be a conflict between helping people in need without undermining the basic principle of distribution according to work. The overall aim of this study was to achieve a better understanding of how the dilemma of sickness absence has been managed in Denmark, by analysing the major reforms of the legislation, the available statistical data on sickness absence, and the practical implementation of recent legislative reforms from the perspective of different stakeholders. Entitlement to sickness benefit in Denmark had undergone considerable changes during the past 30 years. The guiding principles of the reforms were financial savings in combination with an assumption that human behaviour can be controlled through bureaucratic administration focused on monitoring and evaluation. Nevertheless, the study found a stable and largely unaltered pattern of sickness absence in Denmark during the past twenty years. The cooperation between general practitioners and case managers was hampered by lack of time, frequent staff turnover, lack of financial resources, and low accessibility. The motivation to co-operation was low due to low status of social medical issues, lack of feedback and lack of trust. The cooperation was characterised by sequential task integration. Stakeholders encountered difficulties when reciprocal task integration was needed. Decision making was affected by legal constrains and key stakeholders’ conflicting paradigms. There has been a considerable political focus on sickness absence and numerous reforms of the legislation have been launched to regulate the access to sickness benefit. In that light the poor quality of the national data to monitor the development is surprising. The ability-to-work method from 2003 reflects a culmination of the ‘activation’ policy introduced in 1990’s aiming at downscaling the influence of the physicians and putting more emphasis on input from the social service sector when granting sickness benefit. The implementation of these reforms has only fulfilled the political goals to a limited extent.