Swedish rehabilitation professionals' perspectives on work ability assessments in a changing sickness insurance system.

PURPOSE: Changes in the Swedish sickness insurance system shifts focus from return-to-work to labour market reintegration. This article analyses Swedish rehabilitation professionals' perspectives on how the changed regulations affect practice, with a special focus on work ability assessments.
METHODS: Two groups of representatives (n = 15) from organizations involved in rehabilitation and return-to-work met at seven occations. The groups worked with a tutor with a problem-based approach to discuss how their practice is influenced by the changed regulations. The material was analysed inductively using qualitative content analysis.
RESULTS: The new regulations require developed cooperation among insurance, health care, employers and occupational health care; however, these demands are not met in practice. In work ability assessments, several flaws regarding competence and cooperation are identified. An increasing number of people previously assessed as work disabled are required to participate in labour market reintegration, which puts demands on professionals to engage in motivational activities, although this is perceived as hopeless due to the group's lack of employability.
CONCLUSIONS: The possibility for employers to sidestep their responsibility has increased with changed regulations. The overall lack of cooperation between relevant actors and the lack of relevant competence undermine the ambitions of activation and reintegration in the reform.