(cont.) Response to interpellation 2022/23:166 on the deductible in health insurance
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
The debate concerns the waiting period deduction in the sickness insurance and its impact on sickness absence. M argues that the waiting period deduction is important to counter unnecessary short-term absence and that the government has chosen to investigate the issue through a letter investigation in the Government Offices 1 2 3. M emphasizes that the sickness insurance should provide financial security but also counter unnecessarily long sick leaves 1 3. S argues that Sweden is the only Nordic country with a waiting period deduction and double deductibles 4. S argues that people with low wages cannot afford to stay home sick and that rules should be more solidary 4. S asks whether it is reasonable that employees should work from home when they are sick 5.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Statsrådet Anna Tenje (M)
Mr. Speaker! It is pleasant to be back in the chamber after a short break. One gets a bit carried away in the debate. I therefore intend for us to take a small look back.
For decades, there has been a deductible in the sickness insurance in order to counteract unjustifiably high short-term absence. It is important to remember that it was reintroduced in the 1990s after having been practically removed entirely in 1987. It was observed that the sickness absence rates for the unjustifiably high short-term absence increased at a rapid pace. At the end of the 80s, a full 5.5 percent of the proportion of employees were absent due to sickness.
In connection with the crisis at the beginning of the 1990s, major changes were made to the sickness insurance. The replacement levels were lowered, and the employer's sickness pay responsibility was introduced in 1992. In April 1993, the waiting day (karensdagen) was also introduced. Thereafter, the sickness rates for short-term sickness absence fell to 2.5 percent.
No evaluation has been made yet. There is also a lack of knowledge on how the care deduction affects different groups in the labor market. For the government, it has been important to review the care deduction. But in connection with this, we have chosen to link it more closely to the Government Offices' other work to ensure that the sickness insurance is designed in such a way that it contributes to counteracting sickness absence.
The sickness insurance shall, of course, provide financial security to those who, due to illness, cannot work. The focus shall be on rehabilitation, and the design shall counteract unnecessarily many and long sick leaves. This also applies to the part of the insurance that concerns countering unnecessarily high short-term absences.
The interpellator asked why it was chosen to shut down the ongoing investigation and move the work over to a working group within the Government Offices. At a change of government, it is no strangeness at all.
When the Social Democrats took over after the Alliance government, I find it difficult to imagine that they kept all the investigations that were underway in exactly the same way they were. I can imagine that they changed some investigation directives. Perhaps they de facto shut down one or another investigation. They may also have converted some from being an SOU to becoming a letter investigation at the Government Offices. I do not think that is strange. It would be strange if everything were as it always has been despite a change of government having occurred.
Our government has a high level of ambition when it comes to tackling many different issues, not least organized crime, the shootings, and the major problem of exclusion. But we are also keen to look further into this issue. Therefore, we have chosen instead to place this in a letter investigation and link it more closely to our own work in the Government Offices, in order to also evaluate and look closer at those parts.
Åsa Eriksson (S)
Mr. Speaker! Thank you, Minister, for the efforts to answer my questions! I really appreciate that.
I agree that it is not at all strange that things happen during a change of government. What is strange is that the Minister stood in the rostrum on December 13 and said that the Karen investigation was important and that it was important that we waited for its conclusions. But enough about that.
Mr. Speaker! In the Minister's first response, the Minister emphasizes the importance of the fact that different professional groups have different circumstances when it comes to being affected by illness at work. I truly agree with that. For those of us who work here in the Riksdag, the risk of being exposed to infection is completely different compared to someone who, for example, cares for children at a preschool. It is clear that it is unfair.
But we hear the fears from, for example, the parties in the labor market regarding a huge issue of boundary-setting if we are to have different rules for different professional groups. I have also received the Swedish Public Employment Service's response to the decommissioned Karens Commission. They strongly advise against giving different professional groups different rules and have a number of reasons why it would be unfortunate.
Mr. Speaker! It is unfair that the choice of profession can lead to different wages. But it is also unfair that one is punished if they are exposed to infection and have a greater risk of becoming ill and thus also suffer a quarantine deduction. I want to quote LO's equality barometer for 2021. There we can read, among other things: "To the question of why the respondents nevertheless chose to go to work, many answer that this is the case or that it will be financially difficult to be home sick and lose income. For people with the lowest wages, this answer is particularly marked." People with low-wage jobs therefore cannot afford to be home when they are sick.
Mr. Speaker! The purpose of the commission of inquiry that we Social Democrats appointed was for the rules to become more solidary and distributionally accurate, as well as to counteract the risks of sick leave.
We hear the Minister repeatedly speak about the importance of a deductible to avoid unnecessary short-term absence. It makes me wonder what distinguishes us Swedes from the inhabitants of the other Nordic countries. The Minister is certainly well aware that Sweden is the only country in the Nordic region that has a waiting period in the health insurance systems.
If the Minister for Health has missed it, I can point to the RUT report that I ordered and which arrived yesterday. There, the setups between the Nordic systems are compared. It appears there that Sweden stands out in one further way. Sweden is not only the only country that has a waiting period deduction. It is also the only country that has a deductible in the sickness benefit, which is a maximum of 80 percent of the salary. It does not exist in the other countries. We therefore have a double deductible in our sickness insurance system.
I would like to hear why the Minister believes that double deductibles are needed in Sweden but not in our neighboring countries. Does the Minister mean that Swedes are lazier or cheat more? Why were double deductibles needed? Has the Minister succeeded in finding any research study that confirms that Swedes would exploit the system and report sick out of pure laziness if there were no waiting period?
Statsrådet Anna Tenje (M)
Mr. Speaker! I now return to the first question, which I received before we took a short break, regarding the investigation directive that the interpellator had not managed to find. I understand that. It is a public document, but it was not first on the Ministry of Social Affairs' website. I have it here, in any case, and the interpellator will receive it in hand as soon as we are finished with the interpellation debate. One advantage of the break was that I had the opportunity to delve into this and to print it out.
I actually share the interpellator's or the labor market's partners' concern regarding the issue of boundary setting. Naturally, this can become complicated and difficult when it comes to which professions could be assumed to be covered by an exemption. But it is precisely this that the working group must look at and come to a conclusion on and then flesh out, that is, how such a model could look. I do not intend to precede that investigation either.
So back to the rostrum on December 13 - I had the fine privilege of being invited to the Social Insurance Committee last week when we examined this issue. I want to be clear once again that I have great respect for this rostrum and this plenary hall. I should not have said that everything would be as it has always been. I was clear in saying that the investigation directive could be subject to change. But I was not clear that we could also imagine moving it from an SOU investigation to a letter investigation. There I went too far, and I should not have said it from this rostrum. I regret that, of course.
But regardless, we can still state that we now have a letter investigation. We are in complete agreement that we should look more into these issues. It has been important from the government's side to do so, and we will also do that. Now we wait and see what the investigation concludes, and it is presented on December 15. After that, there will, of course, be continued debate.
I also want to be clear in saying that the parties in the labor market already have the possibility today to agree to waive the karens deduction. That has been chosen to be done in one case, as far as I have found, and it concerns the rescue services. Otherwise, the parties have not chosen to reach an agreement with one another to remove the karens deduction.
When it comes to the other studies or comparisons with the other Nordic countries, I can think that it is certainly interesting to follow and look at. I swear that Norway at least has a somewhat higher short-term absence than Sweden has, if it is the case that one does not have any quarantine deduction.
I just came from a debate at Forum Jämställdhet in Malmö last week which concerned both equal pensions and equal parental leave. After very many comparisons with the other Nordic countries, most of it boiled down to the fact that we have quite different systems. We have different systems for most things, both for the wage formation process and the labor market parties, but above all, we have it for the parental leave and for the pensions. It is likely also in this case that we do not have completely comparable systems.
But I often draw and very gladly learn lessons from other countries and good examples. There is, therefore, nothing preventing the working group from looking at that matter in the letter-by-letter investigation that will now be worked out henceforth.
Åsa Eriksson (S)
Mr. Speaker! Thank you, Minister! I really appreciate that the Minister is trying to give clear answers to the questions. More ministers should do that. It is very good!
And so I want to ask the question: Is it reasonable to demand that sick employees should work, but from home? In much, this is what the Minister's answer about the working group is about, namely to look at certain occupational groups that do not have the possibility to work from home, while others do. Then I read between the lines that if one has the possibility to work from home, one shall therefore work when one is sick.
We have a high sickness absence in Sweden. It is estimated at 46 percent; even higher for women. Two million people report that they have worked even though they have been sick for at least two days during 2021. In an email to the disbanded Karensutredningen, Arbetsgivarverket states that they do not consider the question of where the work is performed to be relevant for the assessment of the right to sick pay or for the construction of the karens deduction. They argue instead that if an employee cannot perform work due to illness, the employee should not work. And that does seem reasonable.
Mr. Speaker! A secure sickness insurance should be available to everyone. We contribute to it when we work, and we should all be able to receive the compensation we are entitled to when the ability to work fails for various reasons. Working when one is ill can cause the state of illness to be prolonged or injuries to be aggravated, and that would be very unfortunate. There is also a risk that stress increases and thus mental ill-health and long-term sick leave. I would therefore like to ask the Minister: Does the Minister think that people should work from home when they are ill?
Statsrådet Anna Tenje (M)
Mr. Speaker! I would like to once again thank the interpellor for us having this discussion and raising this debate. We have discussed the issue several times previously in the chamber, but above all, we have done so in the committee.
I now look forward to the work that will be carried out in the working group, and I will gratefully receive its results by December 15, 2023, at the latest. I also believe it is very good that a parliamentary group will be appointed. An invitation will be sent out to all Riksdag parties to appoint a representative who can sit in the parliamentary reference group to provide wise input but also to be able to work with this issue continuously and influence the work as it progresses.
I think it is good that one does not read between the lines, but rather listens to what is said and what is written. I want to be clear in saying that I have not suggested that one should go to work or that one should work from home when one is ill. I think we should have a sickness insurance that applies, and when one is ill and needs to take part of it, it should be in place. I also think we should have a system that counteracts long-term sick leaves so that people are not hidden and forgotten in the statistics again. There must be a clear rehabilitation responsibility, from the employer's, Försäkringskassan's, and the health and medical care's side, but also for the individual themselves so that one returns to work as soon as possible and that we do not have long sick leaves.
In the same way, I think it is good that one has a deductible when it comes to the system where the sickness benefit deduction exists. I think it has been clearly shown that it increases when one removes it. But I am willing to look at this issue and would gladly compare it with other countries. Should it, against all odds, be the case that I am wrong – it can actually be so that one is wrong – I am willing to reconsider my decisions.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.