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Risk of non-uniform assessments regarding sick leave for mental illness

In order to increase uniformity in the assessment of sick leave, the Swedish Social Insurance Agency’s use of the insurance medicine decision support should be improved in several areas, including with regard to persons with multiple ailments.

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For a sick person to be eligible for sickness benefits, the Swedish Social Insurance Agency must investigate the ill person’s ability to work.

In doing so, caseworkers may make use of the so-called “insurance medicine decision support” prepared by the National Board of Health and Welfare and the Swedish Social Insurance Agency. Among other things, the decision support includes recommendations regarding how long a period of sick leave should be granted for different diagnoses, and the aim is to increase legal certainty and uniformity.

The Swedish National Audit Office has examined the Swedish Social Insurance Agency’s administration of mental health cases, with a focus on the use of the insurance medicine decision support regarding sick leave.

We wanted to investigate whether the recommended sick leave periods are used uniformly by the Swedish Social Insurance Agency, and whether the use has been predictable for those insured, says Daniel Melén, the project manager for the audit.

Among other things, the audit indicates that caseworkers at the Swedish Social Insurance Agency find it difficult to apply the insurance medicine decision support to cases involving comorbidity, i.e., when the patient has been diagnosed with more than one diagnosis which in the worst cases interact in a manner that is likely to lengthen the treatment or recovery time.

In addition, the audit indicates that the decision support is not always used in a predictable and consistent way, says Auditor General Stefan Lundgren.

Recommendations

The Swedish National Audit Office is recommending that the Swedish Social Insurance Agency and the National Board of Health and Welfare review whether the decision support is used uniformly, including in relation to comorbidity.

The Swedish National Audit Office is also recommending that the Swedish Government task the National Board of Health and Welfare and the Swedish Social Insurance Agency with the joint mission of continuously monitoring and evaluating the decision support and its usage.

The audit is the second of two relating to the sickness certification process in cases of mental illness. The first report concerned the primary physician's ability to assess a patient’s ability to work, and was published on May 15, 2018.

Press contact: Olle Castelius, phone: +46 8-5171 40 04.

Presskontakt: , telefon: 08-5171 42 06.

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Updated: 25 October 2018

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