[Assessing the quality of medical certificates II--useful criteria or unnecessary schedule?]

In Norway, doctors must provide the National Health Insurance (NIS) with a special medical certificate if a sick-leave exceeds eight weeks. The aim of this study was to evaluate this medical information in relation to the NIS criteria for further sickness benefits and the usefulness of the certificate in assessing the need for early rehabilitative and vocational initiatives.

2,237 consecutive eight-week medical certificates submitted to 21 NIS offices in the county of Hordaland in 1994 were independently evaluated by the NIS officer and the NIS medical consultant in a questionnaire survey.

Both evaluators found sufficient medical information in the vast majority of medical certificates, though in about 12% of the cases the medical criteria for further benefits were not sufficiently documented. In less than 10% of the cases, active rehabilitative or vocational measures were called for at this point in time. However, there was a rather low degree of consensus between the NIS officer and the medical consultant about in which cases supplementary information or active measures were warranted.

We conclude that the eight-week medical certificate usually contains enough medical information but is of limited use in assessing the need for active intervention by the NIS. Supplementary information from the absentee and the employer should be collected at an early stage of the sick leave.