Scandinavian Working Papers in Economics

Working Paper Series, Center for Labor Studies,
Uppsala University, Department of Economics

No 2010:4: The medical doctors as gatekeepers in the sickness insurance?

Per Engström () and Per Johansson ()
Additional contact information
Per Engström: Uppsala Center for Labor Studies, Postal: Department of Economics, Uppsala University, P.O. Box 513, SE-751 20 Uppsala, Sweden
Per Johansson: Uppsala Center for Labor Studies, Postal: Department of Economics, Uppsala University, P.O. Box 513, SE-751 20 Uppsala, Sweden

Abstract: Based on a randomised experiment we estimate effects from notification to medical doctors of tighter monitoring of their medical certificates. Both time prescribed by the doctor certificates for sick leave (prescribed sick leave) and the impact on the length of the actual sickness absence (actual sick leave) is studied. We find no effect on the total number of prescribed sick leave days. We do, however, find an increase in both prescribed and actual sick leave with a 25 percent work inability. We also find that the notification letter causes an increase in actual sick leave (i.e. the number of reimbursed sick days). We discuss a number of potential explanations for this rather surprising result.

Keywords: monitoring; moral hazard; public social insurance

JEL-codes: C93; H51; H55; J22

35 pages, June 1, 2009

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