Britt E Arrelöv1, Lars Borgquist, Kurt F Svärdsudd. 1. Uppsala University, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology Section, Uppsala, Sweden. britt.arrelov@pubcare.uu.se
Abstract
BACKGROUND: Physicians have a central role as gatekeepers to the social security system, including sick-listing. Variation in physicians' sick-listing practices has been demonstrated in several studies. The objective of this study was to determine whether local structural factors affect sick-listing practice. METHODS: A total of 57,563 consecutive sick-listing certificates, issued during 4 months in 1995 and 2 months in 1996, were collected from the local branches of the National Social Insurance Office in eight Swedish counties. County code, local community population size and presence of a hospital in the area were used as indicators of local structural factors. Length of the sick-listing certificates and of the sick-listing episodes were used as outcome variables. RESULTS: After adjustment for the influence of category of issuing physician, patients' age, sex and diagnosis ('case mix'), and type of certificate there was a large variation of the length of the sick-listing certificates and of the sick-listing episodes between counties, between communities of various size and between communities with or without a hospital in the area. All these factors were independently and significantly correlated to the length of the certificate and of the sick-listing episode. CONCLUSIONS: The results support the hypothesis that physicians' sick-listing practice is influenced by local structural factors.
BACKGROUND: Physicians have a central role as gatekeepers to the social security system, including sick-listing. Variation in physicians' sick-listing practices has been demonstrated in several studies. The objective of this study was to determine whether local structural factors affect sick-listing practice. METHODS: A total of 57,563 consecutive sick-listing certificates, issued during 4 months in 1995 and 2 months in 1996, were collected from the local branches of the National Social Insurance Office in eight Swedish counties. County code, local community population size and presence of a hospital in the area were used as indicators of local structural factors. Length of the sick-listing certificates and of the sick-listing episodes were used as outcome variables. RESULTS: After adjustment for the influence of category of issuing physician, patients' age, sex and diagnosis ('case mix'), and type of certificate there was a large variation of the length of the sick-listing certificates and of the sick-listing episodes between counties, between communities of various size and between communities with or without a hospital in the area. All these factors were independently and significantly correlated to the length of the certificate and of the sick-listing episode. CONCLUSIONS: The results support the hypothesis that physicians' sick-listing practice is influenced by local structural factors.
Authors: Johanna Kausto; Jos H Verbeek; Jani H Ruotsalainen; Jaana I Halonen; Lauri J Virta; Eila Kankaanpää Journal: Cochrane Database Syst Rev Date: 2019-05-14
Authors: Johanna Kausto; Tom Henrik Rosenström; Jenni Ervasti; Olli Pietiläinen; Leena Kaila-Kangas; Ossi Rahkonen; Jaakko Harkko; Ari Väänänen; Anne Kouvonen; Tea Lallukka Journal: BMJ Open Date: 2021-12-03 Impact factor: 2.692
Authors: Britt Arrelöv; Kristina Alexanderson; Jan Hagberg; Anna Löfgren; Gunnar Nilsson; Sari Ponzer Journal: BMC Public Health Date: 2007-10-02 Impact factor: 3.295