Influence of local structural factors on physicians' sick-listing practice: a population-based study
2005 (English)In: European Journal of Public Health, ISSN 1101-1262, Vol. 15, no 5, 470-4 p.Article in journal (Refereed) Published
Background: Physicians have a central role as gatekeepers to the social security system, includingsick-listing. Variation in physicians’ sick-listing practices has been demonstrated in several studies. Theobjective of this study was to determine whether local structural factors affect sick-listing practice.Methods: A total of 57 563 consecutive sick-listing certificates, issued during 4 months in 1995 and2 months in 1996, were collected from the local branches of the National Social Insurance Office ineight Swedish counties. County code, local community population size and presence of a hospital in thearea were used as indicators of local structural factors. Length of the sick-listing certificates and of thesick-listing episodes were used as outcome variables. Results: After ajustment for the influence of categoryof issuing physician, patients’ age, sex and diagnosis (‘case mix’), and type of certificate there was alarge variation of the length of the sick-listing certificates and of the sick-listing episodes betweencounties, between communities of various size and between communities with or without a hospitalin the area. All these factors were independently and significantly correlated to the length of thecertificate and of the sick-listing episode. Conclusions: The results support the hypothesis that physicians’sick-listing practice is influenced by local structural factors.
Place, publisher, year, edition, pages
2005. Vol. 15, no 5, 470-4 p.
epidemiology, sick-leave, sick-listing, sickness certification practice, structural factors, Sweden
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:uu:diva-90767DOI: 10.1093/eurpub/cki029PubMedID: 16126748OAI: oai:DiVA.org:uu-90767DiVA: diva2:163236