Advanced

Essays on Sickness Insurance, Absence Certification and Social Norms

Dackehag, Margareta LU (2007)
Abstract (Swedish)
Popular Abstract in Swedish

Avhandlingen består av ett inledande kapitel och tre essäer, som studerar sjukpenningförsäkringen, sociala normer och sjukskrivning.



Den första essän, Group-Specific Social Norms and Economic Incentives in a General Welfare System, behandlar interaktionen mellan ekonomiska och sociala drivkrafter i ett generellt bidragssystem. Vi anknyter resultaten till sjukpenningförsäkringen. Modellen i Lindbeck, Nyberg & Weibull (1999) modifieras genom att populationen delas in i två grupper, som styrs av gruppspecifika sociala arbetsnormer. Gruppernas beteende studeras i såväl separata system som ett gemensamt system. Vi finner att grupptillhörighet spelar roll för bidragsnivån och... (More)
Popular Abstract in Swedish

Avhandlingen består av ett inledande kapitel och tre essäer, som studerar sjukpenningförsäkringen, sociala normer och sjukskrivning.



Den första essän, Group-Specific Social Norms and Economic Incentives in a General Welfare System, behandlar interaktionen mellan ekonomiska och sociala drivkrafter i ett generellt bidragssystem. Vi anknyter resultaten till sjukpenningförsäkringen. Modellen i Lindbeck, Nyberg & Weibull (1999) modifieras genom att populationen delas in i två grupper, som styrs av gruppspecifika sociala arbetsnormer. Gruppernas beteende studeras i såväl separata system som ett gemensamt system. Vi finner att grupptillhörighet spelar roll för bidragsnivån och skattesatsen i systemet samt för andelen bidragstagare i populationen. Vidare observeras i ett first-best-scenario att en begränsning av andel bidragstagare i utbyte mot en mer generös bidragsnivå kan vara optimal. Beträffande den sociala normen, finner vi en tvetydig effekt på bidragsnivån i first-best-fallet, medan den innebär en bidragsökning i ett second-best-scenario.



I den andra essän, Sickness Absence Certification, undersöker vi sjukskrivningsprocessen under antagandet att läkaren kan utfärda så kallade sjukintyg utan att verifiera att arbetstagaren har en nedsatt arbetsförmåga på grund av sjukdom. Läkare med olika strikt sjukskrivningspraxis interagerar med arbetstagare som skiljer sig från varandra vad gäller arbetsmotivation. Beroende på vilken eller vilka läkartyper som är tillgängliga för sjukskrivning och de därtill knutna förväntningarna på behandling i termer av sjukskrivning och bedömning av arbetsförmåga blir ?mindre motiverade? arbetstagare sjukskrivna oavsett arbetsförmåga, medan ?motiverade? arbetstagare sjukskrivs under förutsättning att en nedsatt arbetsförmåga har observerats av läkaren. Vi betraktar även olika policyinstrument som försäkringsgivaren kan använda i de fall felaktigt bruk av försäkringssystemet bedöms föreligga och diskuterar instrumentens konsekvenser för den samhälleliga välfärden. I detta sammanhang tar vi hänsyn till ?matchningen? mellan arbetstagare och läkare, liksom ?matchningen? mellan arbetsstatus och arbetsförmåga.



I tredje essän, Occupational Physicians and General Practitioners ? Implications for Sickness Absence Certification, jämför vi företagsläkarens och allmänläkarens sjukskrivningspraxis med varandra. Medan den senare antas anpassa praxis till arbetstagarens preferenser, kan det vara så att den förre intar en restriktiv hållning vad gäller sjukskrivning, på grund av påverkan från kunden, det vill säga företaget. Till skillnad från företagsläkarens bedömning av arbetstagarens arbetsförmåga, kännetecknas allmänläkarens bedömning av bristande precision. Detta innebär att sjukskrivning sker i alltför många fall. Både ?mindre motiverade? och ?motiverade? arbetstagare föredrar läkare med anpassningsbar sjukskrivningspraxis, vilket resulterar i olika behandling av arbetstagarna med avseende på sjukskrivning, givet att de senare har möjlighet att knyta förväntningar om en viss behandling till enskilda läkare. Däremot föredrar ?motiverade? arbetstagare också korrekt information om arbetsförmågan, vilket för med sig en risk för ?ofrivillig? sjukfrånvaro då allmänläkare utför sjukskrivningar. (Less)
Abstract
The thesis consists of an introductory chapter and three essays, considering sickness insurance, social norms and absence certification.



The first essay, Group-Specific Social Norms and Economic Incentives in a General Welfare System, investigates the interaction between economic incentives and social influences in a general welfare system. We relate the results to sickness insurance. The model in Lindbeck, Nyberg & Weibull (1999) is modified by dividing the population into two groups, which are governed by group-specific social work norms. The behaviour of the two groups is studied in separate welfare systems as well as a shared system. We find that group affiliation matters for the generosity of the welfare policy,... (More)
The thesis consists of an introductory chapter and three essays, considering sickness insurance, social norms and absence certification.



The first essay, Group-Specific Social Norms and Economic Incentives in a General Welfare System, investigates the interaction between economic incentives and social influences in a general welfare system. We relate the results to sickness insurance. The model in Lindbeck, Nyberg & Weibull (1999) is modified by dividing the population into two groups, which are governed by group-specific social work norms. The behaviour of the two groups is studied in separate welfare systems as well as a shared system. We find that group affiliation matters for the generosity of the welfare policy, in terms of tax rate and transfer level, and for the share of transfer recipients. Furthermore, in a first-best scenario, it is observed that a restriction on the recipient share in exchange for a generous transfer may be optimal. Regarding the social norm, we find an ambiguous effect on the optimal welfare policy in a first-best scenario, whereas it implies a transfer increase in a second-best scenario.



In the second essay, Sickness Absence Certification, we model sickness absence certification by assuming that the physician may certify absence for a worker without verifying that his ability to work is impaired due to sickness. Physicians with ?strict? as well as ?lax? sick-listing routines interact with workers who differ in their motivation for work. Depending on the physician type, or types, available and the expectations thereof, ?less motivated? workers are sick-listed regardless of working ability, while ?motivated? workers are sick-listed conditional on the observation of health-related ability impairment. We consider various policy instruments that the insurer may employ against a perceived misuse of the insurance and discuss their welfare implications, taking into account the match between worker and physician as well as the match between labour activity and working ability.



The third essay, Occupational Physicians and General Practitioners ? Implications for Sickness Absence Certification, compares the certification practices of the occupational physician with those of the general practitioner. Whereas the latter adjusts his practices to the preferences of the worker, the former may have a restrictive attitude towards sick-listing, due to the client?s, that is the firm?s, influence. In contrast to the occupational physician's assessment of working ability, the general practitioner's assessment is imprecise, which implies an over-certification of sick-leave claims. Both ?less motivated? and ?motivated? workers prefer physicians with adjustable practices, resulting in different treatments of the workers regarding absence certification, provided that workers are able to attach expectations about treatment to individual physicians. However, ?motivated? workers also prefer correct information about ability, implying a risk of ?involuntary? sickness absence when general practitioners certify absence. (Less)
Please use this url to cite or link to this publication:
author
opponent
  • associate professor Jelovac, Izabela, GATE, Centre Léon Bérard, Lyon
organization
publishing date
type
Thesis
publication status
published
subject
keywords
economic theory, econometrics, Economics, occupational physician, general practitioner, physician behaviour, working ability, sickness absence certification, sickness absence, sickness insurance, social insurance, incentives, social norms, Social policy, welfare, economic systems, economic policy, Nationalekonomi, ekonometri, ekonomisk teori, ekonomiska system, ekonomisk politik, Social economics, Social ekonomi
pages
110 pages
publisher
Department of Economics, Lund Universtiy
defense location
EC3:210 Holger Crafoords Ekonomicentrum Tycho Brahes väg 1 Lund
defense date
2007-11-15 13:15
ISSN
0460-0029
language
English
LU publication?
yes
id
21d10412-6acc-4e8f-be75-6c7febb2289e (old id 599108)
date added to LUP
2007-11-13 07:30:27
date last changed
2016-09-19 08:44:58
@phdthesis{21d10412-6acc-4e8f-be75-6c7febb2289e,
  abstract     = {The thesis consists of an introductory chapter and three essays, considering sickness insurance, social norms and absence certification.<br/><br>
<br/><br>
The first essay, Group-Specific Social Norms and Economic Incentives in a General Welfare System, investigates the interaction between economic incentives and social influences in a general welfare system. We relate the results to sickness insurance. The model in Lindbeck, Nyberg &amp; Weibull (1999) is modified by dividing the population into two groups, which are governed by group-specific social work norms. The behaviour of the two groups is studied in separate welfare systems as well as a shared system. We find that group affiliation matters for the generosity of the welfare policy, in terms of tax rate and transfer level, and for the share of transfer recipients. Furthermore, in a first-best scenario, it is observed that a restriction on the recipient share in exchange for a generous transfer may be optimal. Regarding the social norm, we find an ambiguous effect on the optimal welfare policy in a first-best scenario, whereas it implies a transfer increase in a second-best scenario.<br/><br>
<br/><br>
In the second essay, Sickness Absence Certification, we model sickness absence certification by assuming that the physician may certify absence for a worker without verifying that his ability to work is impaired due to sickness. Physicians with ?strict? as well as ?lax? sick-listing routines interact with workers who differ in their motivation for work. Depending on the physician type, or types, available and the expectations thereof, ?less motivated? workers are sick-listed regardless of working ability, while ?motivated? workers are sick-listed conditional on the observation of health-related ability impairment. We consider various policy instruments that the insurer may employ against a perceived misuse of the insurance and discuss their welfare implications, taking into account the match between worker and physician as well as the match between labour activity and working ability.<br/><br>
<br/><br>
The third essay, Occupational Physicians and General Practitioners ? Implications for Sickness Absence Certification, compares the certification practices of the occupational physician with those of the general practitioner. Whereas the latter adjusts his practices to the preferences of the worker, the former may have a restrictive attitude towards sick-listing, due to the client?s, that is the firm?s, influence. In contrast to the occupational physician's assessment of working ability, the general practitioner's assessment is imprecise, which implies an over-certification of sick-leave claims. Both ?less motivated? and ?motivated? workers prefer physicians with adjustable practices, resulting in different treatments of the workers regarding absence certification, provided that workers are able to attach expectations about treatment to individual physicians. However, ?motivated? workers also prefer correct information about ability, implying a risk of ?involuntary? sickness absence when general practitioners certify absence.},
  author       = {Dackehag, Margareta},
  issn         = {0460-0029},
  keyword      = {economic theory,econometrics,Economics,occupational physician,general practitioner,physician behaviour,working ability,sickness absence certification,sickness absence,sickness insurance,social insurance,incentives,social norms,Social policy,welfare,economic systems,economic policy,Nationalekonomi,ekonometri,ekonomisk teori,ekonomiska system,ekonomisk politik,Social economics,Social ekonomi},
  language     = {eng},
  pages        = {110},
  publisher    = {Department of Economics, Lund Universtiy},
  school       = {Lund University},
  title        = {Essays on Sickness Insurance, Absence Certification and Social Norms},
  year         = {2007},
}