Vocational rehabilitation, work resumption and disability pension : a register-study of cases granted vocational rehabilitation by social insurance offices in a Swedish county

Increasing figures for long-term sickness absence and disability pension are problems for many European countries where they have increased to burdensome levels, socially and financially. In a European study in 2003, Sweden showed the highest proportion of sick-listed with 4.5% of the employed work force absent due to sickness.

The primary aim of this thesis was to study the outcomes of decisions taken at the Social Insurance Offices in a Swedish county with regard to work resumption after vocational rehabilitation (VR). Another specific aim was to evaluate whether social insurance officers show conformity of attitude regarding professional practice in their application of the insurance system. The reasoning behind this is that outside the legal framework and official policy, consciously or subconsciously, there is a selection of sick-listed persons to VR, and that the selection influences the outcome with respect to work resumption or disability pension.

The study is based on all 832 clients granted VR (4.7 % of about 17,000 cases of sick listing) from six local social insurance offices in Sweden during 1998-99. Data were collected from mainframe registers and other records at each office. The register study was combined with a questionnaire study addressed to 30 social insurance officers at the offices. The questions concerned attitudes to the insurance system and the officers practice and application of the system.

The proportion of clients with sickness allowance that received any VR measures varied among the offices from 1.2 % to 8.7 %. Among those granted VR 36% were men and 64% women. The predominant diagnosis group was musculoskeletal disorders/pain conditions. Of all cases receiving VR, 52.4% resumed work and 46.2% ended with a disability pension allowance. Two years after finalised VR a large proportion of the temporary disability pensions had become permanent. Among cases granted VR, those undergoing detailed investigation showed the lowest figures of work resumption, while those who did job training showed higher figures. The distinguishing factor between remaining at work and relapsing into sick-leave by the two-year follow-up was the duration of sick-leave.

Those most likely (odds ratios) to remain at work two years after completed rehabilitation were industrial employees who had short sickness absence, had been selected for job training as a VR measure and were aged 16-29 years. Intra-county differences occurred in processing cases of sick-leavers who take part in VR measures. The local social insurance offices with the highest and lowest outcome rates of work resumption and disability pension, respectively, selected clients for VR from different categories of cases. The differences in characteristics appeared as duration of sick-listing. The offices whose clients had long sickness absence, including processing time for VR, and frequently used detailed investigation as a VR measure, showed more disability pension grants as outcomes of VR. Social insurance officers from different local insurance offices differed in their attitudes towards the social insurance system and its clients.

List of scientific papers

I. Ahlgren A, Bergroth A, Ekholm J (2004). Work resumption or not after rehabilitation? A descriptive study from six social insurance offices. Int J Rehabil Res. 27(3): 171-80.
https://pubmed.ncbi.nlm.nih.gov/15319686

II. Ahlgren A, Broman L, Bergroth A, Ekholm J (2005). Disability pension despite vocational rehabilitation? A study from six social insurance offices of a county. Int J Rehabil Res. 28(1): 33-42.
https://pubmed.ncbi.nlm.nih.gov/15729095

III. Ahlgren A, Bergroth A, Ekholm J, Schüldt K (2006). Work resumption after vocational rehabilitation. A follow-up two years after completed rehabilitation. [Submitted]

IV. Ahlgren A, Bergroth A, Ekholm J, Schüldt K (2006). Selection of clients for vocational rehabilitation at six local social insurance offices. A combined register and questionnaire study on rehabilitation measures and attitudes among social insurance officers. [Submitted]