Controlling sickness absence: a study of changes in the Danish sickness absence legislation since 1973.

OBJECTIVES: To outline the principles underlying changes overtime in entitlement to sickness absence benefit in Denmark.
METHODS: The Danish sickness benefit scheme during the past 30 years has been studied based on a comprehensive review of the Sickness Benefit Act from 1973, and all later amendments to the act.
RESULTS: Entitlement to sickness benefit in Denmark has undergone considerable changes during the past 30 years. The guiding principles of the reforms have been financial savings in combination with an assumption that human behaviour can be controlled through bureaucratic administration with focus on monitoring and evaluation.
CONCLUSIONS: The Sickness Benefit Act was initially based on a broad concept of disease but the implementation underwent major changes. In the 1970s and 1980s entitlement to benefit depended very much on medical diagnosis. This practice changed and today's policy is to some extent a return to the biopsychosocial approach in the sense that the citizen is not regarded a passive victim of disease but an active player in influencing own working capacity. Added to this is, however, a new element of much tighter control leaving less room for autonomy.