Långtidssjukskrivna och deras medaktörer en studie om sjukskrivning och rehabilitering

Sammanfattning: Aims: The starting point of this study was the experience of great problems with persons on long-term sick leave in the county of Västerbotten. In order to illuminate the situation we designed a study of the actors most involved who dealt with persons on long-term sick leave. These actors were the medical doctors; the employers: the social insurance officials; and members of the board of social insurance and persons reporting on the cases to the board. One aim was to describe and analyse the situation for persons on sick leave. Another aim was to describe and analyse the perception of the role the different actors played when dealing with persons on long-term sick leave. The third aim was to describe and analyse the different actors' views of each other, and of the co-operation around the persons on long-term sick leave.Method and material: Interviews with persons on sick leave, employers, social insurance officials and medical doctors. Questionnaires were sent to persons on sick leave, doctors and the members of the board of social insurance and those reporting on the cases. The interviews were audio- taped and transcribed word by word. Coding and analysis of collected data was done simultaneously by performing new interviews, using an adjusted form of grounded theory with the purpose of trying to find patterns and contexts. The aim was to describe the subjective experiences of how the actors look upon their situation and their way of coping with it.Results: The interviews with the employers showed great differences in attitudes and ways of treating employees, which also led to different models for dealing with work environment, sickness absence and rehabilitation. We divided the employers into five different "ideal types". Two of them could be described as "well-functioning" with regard to rehabilitation, and three of them as "less well-functioning". A high degree of flexibility characterises the successful employer, and he also takes good care of his personnel. The good employer also co-operates with other actors. The employers that are not well-functioning are not engaged in making adjustments, and have little confidence in their staff; the unions within their field are weak.Interviews with medical doctors revealed that they felt lonely, and that the demands were frustrating to them. They also had feelings of losing the locus of control. The doctors showed lack of knowledge of the labour market and the social insurance legislation, which made their work harder. They experienced that their lack of time made sickness periods longer.Among the results from the interviews with social insurance officials can be mentioned that they had good knowledge about laws, but sometimes it was difficult to use their knowledge and methods due to lack of flexibility. They experienced feelings of loneliness and had great difficulty in making decisions. Co-operation with partners often did not work out - the officials did not demand so much of their co-actors.The results of the questionnaire directed towards the members of the board of social insurance and those who reported on the cases did not show statistically significant differences between the three counties. The members of the board had almost the same proposals for decision as those who reported on the cases. There were no significant differences between men and women in decision-making. As a whole the members of the board seemed to be skilled in their knowledge of how to use the social insurance legislation.The results of the interviews with persons on sick leave showed that those persons had difficulties in asking for help and support. They felt such loyalty to their employers that they did not ask for adjustments of working places when needed. At the same time they were disappointed that the employers were not sufficiently involved in making it possible to come back to work again. More than half of the respondents had not received enough support from the employers, the medical doctors or the social insurance officials. Most of them felt frustrated, with little or no hope for the future.The results of the questionnaire to persons on long-term sick leave showed that women took a greater responsibility for their own rehabilitation, while the employers showed an earlier interest in sick male employees than in sick female employees. The employers were also keener to adjust the working places for men than for women. Despite those factors, women more often met their employers than men did, and they also had a more positive attitude to social insurance officials and doctors than men had. People with longer education took greater responsibility for their rehabilitation than those with shorter education. Compared to older people, younger persons were more optimistic about their future health and work, and also expressed that work was not so stressful.