Effects on physicians' sick-listing practice of an administrative reform narrowing sick-listing benefits

To find out whether administrative changes regulating sick-listing benefits affect sick-listing practice among physicians in hospitals and primary health care.

New sick-listing cases from four social security offices in mid-Sweden.

A natural experiment design was used with a sample of newly started sick-listed cases collected 6 months before a sick-listing reform and a further sample taken 6 months after. The data were collected in a 1-year follow-up period in both samples.

Net days of sick-listing and percentage partial sick-listings. Compliance by doctors in providing information asked for in sickness certification forms.

Doctors filled in the forms more completely after the reform than they did before it. There was an inverse correlation between completeness of information and length of sick-listing. When potential confounding factors were taken into account, no change was seen in the proportion of partial sick-listing, in the mean number of net days of sick-listing or in the distribution of length of sick-listing periods. The proportion of all sick-listings made by general practitioners increased.

Administrative changes restricting sick-listing benefits did change some aspects of sick-listing practice but had no effect on length of sick-listing.