Essays on Sickness Insurance, Absence Certification and Social Norms

The thesis consists of an introductory chapter and three essays, considering sickness insurance, social norms and absence certification. The first essay, Group-Specific Social Norms and Economic Incentives in a General Welfare System, investigates the interaction between economic incentives and social influences in a general welfare system. We relate the results to sickness insurance. The model in Lindbeck, Nyberg & Weibull (1999) is modified by dividing the population into two groups, which are governed by group-specific social work norms. The behaviour of the two groups is studied in separate welfare systems as well as a shared system. We find that group affiliation matters for the generosity of the welfare policy, in terms of tax rate and transfer level, and for the share of transfer recipients. Furthermore, in a first-best scenario, it is observed that a restriction on the recipient share in exchange for a generous transfer may be optimal. Regarding the social norm, we find an ambiguous effect on the optimal welfare policy in a first-best scenario, whereas it implies a transfer increase in a second-best scenario. In the second essay, Sickness Absence Certification, we model sickness absence certification by assuming that the physician may certify absence for a worker without verifying that his ability to work is impaired due to sickness. Physicians with ?strict? as well as ?lax? sick-listing routines interact with workers who differ in their motivation for work. Depending on the physician type, or types, available and the expectations thereof, ?less motivated? workers are sick-listed regardless of working ability, while ?motivated? workers are sick-listed conditional on the observation of health-related ability impairment. We consider various policy instruments that the insurer may employ against a perceived misuse of the insurance and discuss their welfare implications, taking into account the match between worker and physician as well as the match between labour activity and working ability. The third essay, Occupational Physicians and General Practitioners ? Implications for Sickness Absence Certification, compares the certification practices of the occupational physician with those of the general practitioner. Whereas the latter adjusts his practices to the preferences of the worker, the former may have a restrictive attitude towards sick-listing, due to the client?s, that is the firm?s, influence. In contrast to the occupational physician's assessment of working ability, the general practitioner's assessment is imprecise, which implies an over-certification of sick-leave claims. Both ?less motivated? and ?motivated? workers prefer physicians with adjustable practices, resulting in different treatments of the workers regarding absence certification, provided that workers are able to attach expectations about treatment to individual physicians. However, ?motivated? workers also prefer correct information about ability, implying a risk of ?involuntary? sickness absence when general practitioners certify absence

Verksamhet i förändring - Försäkringsmedicinska verksamhetens roll i sjukskrivningsprocessen och på Försäkringskassan

Rapporten utvärderar och diskuterar situationen för Försäkringskassans försäkringsmedicinska verksamhet efter de senaste årens stora förändringsarbeten; reformen av sjukskrivningsprocessen och Försäkringskassans fusion. På basis av intervjuer med i första hand försäkringsmedicinska rådgivare, behandlar rapporten konsekvenserna för försäkringsmedicinska verksamheten i allmänhet men aktiviteterna i sjukförsäkringen i synnerhet

Organisatoriska vägval -- En studie av Försäkringskassans förändringsarbete

The Swedish Social Insurance Agency is an important part of the Swedish welfare state. The Agency has recently made a number of major changes, such as establishing a new internal organization and reforming processes for decision making. Many of these changes have been controversial. Critics have complained that the Agency shows a lack of efficiency, has failed to make payments on time, and has been too harsh in its application of eligibility rules. The changes have put the agency at a number of crossroads, many of them recurring from earlier reforms, in dealing with problems such as regional differences in the application of rules. In this article, some of these choices are discussed. The discussion departs from four dichotomies: uniformity-local adaptation; centralization-decentralization; specialization-generalist approaches; and closeness-distance. These dichotomies are illustrated with examples from the agency. The general conclusion is that although the change process has taken a rocky road, there has been a great deal of internal consistency in the combination of measures taken

Endogenous social norms - implications for optimal welfare state programs

This paper investigates the implications of an endogenous social work norm for the optimal welfare state program. Assuming that individual productivity is observable, the analysis finds that restrictions on program participation, implying a larger benefit to a smaller group of recipients, may be welfare improving. However, the effect of the norm is indeterminate. The disutility of non-compliance suggests a higher benefit; the endogeneity of the norm suggests a lower benefit. Assuming that individual productivity is not observable, the analysis finds that the social norm unambiguously contributes to increased program generosity. However, for sufficiently generous policies, the norm contributes to program retrenchment

Sickness insurance and social norms. Interaction between formal and informal rules in a welfare state context.

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