Vocational rehabilitation of unemployed sick-listed people in a Swedish rural area : An individual-level study based on social insurance data

Sammanfattning: The long trend of low unemployment and increasing economical growth in Sweden was broken in the early 1990’s. In a short time the rate of unemployment had risen from 1.3% in 1990 to 8.2% in 1993. A previous study made in Stockholm showed that among the long-term sick-listed 20% were unemployed. The sparsely populated areas in the furthermost northern counties of Sweden have had a high rate of unemployment and incapacity rates (sick days per insured and year) during many years. The primary aim of this study was therefore to investigate the unemployed long-term sick-listed and their vocational rehabilitation in a rural area of the county of Jämtland, Sweden. The study is based on a sample of 4 394 long-term sick-leave cases reported sick at all seven rural social insurance offices in Jämtland. Surprisingly, the study showed that the proportion of unemployed among the long-term sick-listed was lower in the rural area of Jämtland (15%) than in Stockholm (20%). However, as in Stockholm, the unemployed were over-represented among the long-term sick. This was especially true for men. Mental problems were more frequent among the unemployed (16%), than among the employed (6%), especially among the men. Unemployed people’s potential need for rehabilitation was not investigated to the same extent (15%) as employed people’s (37%). The unemployed had also to wait longer for a rehabilitation investigation to be drawn up by the social insurance office (168 days) compared with the employed (78 days). The study partly supports the hypothesis that the unemployed people are disregarded in vocational rehabilitation. A more important finding, however, was that vocational rehabilitation in general, regardless of employment status, seems beset with problems. Neither employers nor the social insurance offices seem to live up to the responsibilities that was given them according to the Rehabilitation Reform of 1992. For both employed and unemployed long-term sick-listed people with musculoskeletal problems, the time before start of vocational rehabilitation does not seem to be the determining factor that it so often is stated. However, when investigating all types of diagnoses the time before start of vocational rehabilitation does seem to be important. The results indicated that women had less chance than men in succeeding with their vocational rehabilitation. Women obtain more on-the-job training while men undergo vocational programmes containing education. Education has been shown to be an effective measure for successful vocational rehabilitation, so therefore it may be concluded that women are more or less unfairly treated with regards to vocational rehabilitation. The study also showed that an unemployed sick-listed person has much less chance of returning to the Labour Market after rehabilitation than an employed person. The short, limited and low-cost vocational rehabilitation that the unemployed are offered may not be adequate to sufficiently affect future sick-leave. They may need more individually adjusted measures. A multidisciplinary vocational rehabilitation programme, with work training and case management was shown, twelve months after the end of the programme, to be more effective regarding lowered benefit levels for unemployed sick-listed people, than a conventional rehabilitation programme.