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ABSTRACT
This paper focuses on tensions between activation principles and medicalisation in the Swedish sickness insurance and its implications for frontline caseworkers in Social Security Agencies and Public Employment Services. The right to sickness cash benefits has become stricter and more conditioned upon the person’s work ability and employability. The paper describes recent policy changes towards activation and stricter entitlement criteria for sickness benefits policy and explores the consequences of such new activation policies in terms of changed work modes for caseworkers dealing with long-term sick people’s return-to-work process. It is concluded that on the one hand frontline work contains a significant portion of discretion and professional assessment of work abilities, and on the other hand rule-bound administrative work. Furthermore, frontline workers need to apply organisational professionalism as inter-organisational cooperation is required in order to support long-term sick people to return-to-work. Medicalisation of ill-health, manifested in the right to sickness benefits has not been substantially circumscribed by new activation policies in the sickness insurance.
ABSTRAKT
Artikeln fokuserar spänningar mellan principer för aktivering och medikalisering i den svenska sjukförsäkringen. Rätten till sjukpenning har blivit inskränkt och beroende av personens arbetsförmåga och anställningsbarhet. Syftet är att beskriva hur policyintentioner och förändringar i lagstiftning om sjukförsäkring tillämpas av berörda organisationer och hur detta påverkar handläggare som bedömer rätten till sjukpenning och utreder långtidssjukas arbetsförmåga. Slutsatsen är att handläggarna har ett betydande mått av fritt skön och utrymme för professionella bedömningar, men de måste också följa ett antal regler och administrativa rutiner. De behöver utveckla en organisatorisk professionalism eftersom arbetet med långvarigt sjukas återgång till arbete kräver samverkan mellan organisationer. Den medikalisering av ohälsan som kommer till uttryck i rätten till sjukpenning har i praktiken inte begränsats i någon avgörande utsträckning genom den nya aktiveringspolitiken.
Disclosure statement
No potential conflict of interest was reported by the authors.
Notes on contributors
Rafael Lindqvist is Senior Professor at the Department of Sociology, Uppsala University, Sweden. His research interests relate to the development of social policies and social security in the Scandinavian countries, inter-organisational cooperation between professions, public and private stakeholders in the welfare system, vocational rehabilitation and activation of the long-term sick. He has also written on active citizenship for disabled people including persons with mental health problem.
Jörgen Lundälv is Associate Professor at the Department of Social Work, University of Gothenburg, Sweden. His research interests relate to social policies for disabled people, processes of social exclusion and participation, accessibility to the physical environment, and coping strategies after impairment caused by traffic accident. He has also written on injury prevention and safety in home- and built environments for disabled people including patient involvement, inclusive research and architecture.