Response to interpellation 2022/23:67 on absolute time limits in the health insurance
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
I believe that the sickness insurance should provide economic security and that long sick leaves must be prevented through clear check-in points 1. M wants to strengthen the rehabilitation chain and argues that time limits signal urgency with interventions to get people back to work 2. M emphasizes that employers, Försäkringskassan, the health and medical care, and Arbetsförmedlingen must take their responsibility 3. M argues that the government will closely monitor the development of sickness absence 4 and that clear time limits must exist to signal urgency since research shows that it becomes harder to return the longer people are away 4. S believes that absolute time limits are counterproductive because they make people sicker 5. S emphasizes that the sickness insurance is an income insurance where one should be able to rely on receiving compensation and the right interventions in case of illness 6.
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)
Madam Speaker! Åsa Eriksson has asked me whether I will contribute to the government reintroducing absolute time limits in the sickness insurance.
The government has taken over the responsibility for a country that is in the midst of several parallel crises. One of these crises is the recession that Sweden is now facing or is in. At the same time, many people and companies are being subjected to dramatic cost increases as a result of high inflation and extreme prices for energy and fuel.
A prerequisite for meeting this challenge is to ensure that as many people as possible are available to the labor market and strive to get a job and become self-sufficient. Work creates prosperity and counteracts individuals' poverty.
The sickness insurance shall provide financial security for those who cannot work due to reduced work capacity. People who cannot work shall receive sickness benefit. Those on sick leave shall participate in rehabilitation in order to be able to return to work, and the implemented policy must be designed to prevent and counteract long-term sick leaves, among other things through clearly defined assessment points.
I can state that Försäkringskassan, in its latest expenditure forecast, assesses that the economic development will likely lead to a dampened development of sick leave during the next one to two years. After that, Försäkringskassan sees that the most likely development is that sick leave increases again. Försäkringskassan believes that if history provides a lesson, such an increase could also become very substantial.
The government will follow the development of sickness absence and the previous government's recently implemented changes in the sickness insurance to ensure that the changes do not result in unnecessarily long sick leaves and that those who cannot work due to illness have financial security. Long-term sick leaves are harmful, both for the person who is on sick leave and, in the long run, for society as a whole. Therefore, it is important to stimulate drivers to return to work and to focus on strengthening the rehabilitation chain.
Åsa Eriksson (S)
Madam Speaker! I thank the Minister very much for the answer. I think it is very exciting to debate the health insurance with the Minister and look forward to this evening.
I was very pleased by the following in the Minister's response: "The sickness insurance shall provide financial security for those who cannot work due to reduced capacity for work. People who cannot work shall receive sickness benefit. Those on sick leave shall participate in rehabilitation in order to be able to return to work." How incredibly good it is to hear those sentences! It is exactly what we Social Democrats also think. If the Minister stands by that, we will be able to cooperate very well during this parliamentary term to further strengthen and improve the sickness insurance even more, so that people who lack capacity for work due to illness can truly receive the compensation they are entitled to. This was very good. Who knows - perhaps the Minister has been influenced by our first interpellation debate.
Madam Speaker! I am, however, a bit concerned by the end of the Minister's response: "Therefore, it is important to stimulate drivers for returning to work as well as to focus on strengthening the rehabilitation chain." We all want people to return to work as soon as possible - absolutely. But this part about strengthening the rehabilitation chain sounds a bit ominous to me. What does the Minister mean by that?
The Moderates campaigned on reintroducing the absolute time limits in the rehab chain. Is this what the Minister means by "stimulating drivers to return to work as well as focusing on strengthening the rehabilitation chain"? If so, we are really not in agreement.
Madam Speaker! It takes different amounts of time for sick people to be rehabilitated and regain their ability to work. Therefore, absolute time limits in the sickness insurance are somewhat counterproductive. One does not become healthier by being kicked out of the sickness insurance. The worry that it should happen makes people even sicker and makes it take longer to regain the ability to work.
One of all the investigations that the Social Democratic-led government commissioned to strengthen the sickness insurance was the one led by Claes Jansson. In that, quite a few things are established, and I want to highlight two things in the investigation's summary. The requirement that existed previously, that the insured person after 180 days in the rehabilitation chain shall be able to have their work capacity assessed against work with the employer, is far too strict. Claes Jansson's investigation also established that the concept of "unreasonable" does not compensate sufficiently for the special reasons not being applicable after 365 days.
Therefore, Madam Speaker, our government implemented several changes to loosen the absolute time limits. People are individuals and need different amounts of time to be rehabilitated and regain their capacity to work. One should be able to receive the support and help that one needs without being kicked out of the sickness insurance.
Madam Speaker! Many people are now wondering what will happen to them the day they fall ill. They are terrified that the government and the State Council will not keep their election promise from the campaign to reintroduce the absolute time limits. For them, it may perhaps be a comfort that this right-conservative government has not directly made itself known for keeping what it has promised. Perhaps we can hope for that. But I still want to ask for safety's sake: Will the State Council contribute to the government reintroducing absolute time limits in the sickness insurance?
Statsrådet Anna Tenje (M)
Madam Speaker! One does not get healthier when one is hidden and forgotten in the statistics. We have also tested that in Sweden before.
The new exceptions in the rehabilitation chain that the previous government introduced are intended to provide more time for those on sick leave to be rehabilitated back to work with their own employer. As the interpellor mentioned, we have had an interpellation debate on this subject once before. At that time, I was clear that the government will monitor the development of these changes very closely. It is important that the rehabilitation work is as effective as possible and is initiated early in the case of illness, so that the return to work is not delayed.
The time limits in the sickness insurance exist to signal that there is urgency regarding interventions to get people back to work. Those who can start working again should receive support quickly. There is urgency for the employer, for Försäkringskassan, and for health and medical care, but it is obviously also urgent for the individual. What I want to emphasize is that the rehabilitation chain must be strengthened and that everyone involved—Försäkringskassan, health and medical care, the employer, and also the individual—must take their full responsibility with joint forces to implement the measures that may be needed for the individual to return to work again. That is what I think is important, and that is exactly why I want to further strengthen the rehabilitation chain. No one should be hidden and forgotten in the statistics again.
Åsa Eriksson (S)
Madam Speaker! This matter of "hidden and forgotten" is the Minister's standard phrasing. I have already learned that after only two interpellation debates. I can assure the Minister that neither I nor any other Social Democrat wants to hide and forget people in some kind of statistics, least of all in the health insurance. On the contrary, I have several times emphasized how important it is that people return to work as soon as possible and that they receive active rehabilitation measures so that this can happen. I hope that I will avoid hearing "hidden and forgotten" any more times. I hope that the Minister has more tools in his toolbox than trying to stick that label on us.
Madam Speaker! I will try a somewhat different angle on my question regarding the rehabilitation chain. In another debate, we have agreed that the growing mental ill-health, not least among women, is a threat to society and to the individual's living conditions. Here we have a gigantic task before us to ensure that we help people to better mental health. Psychiatric diagnoses have been the most common reason for sick leave since 2014. To counter a development where more and more people are signed off sick with psychiatric diagnoses and with ever longer periods of illness, the working conditions must be changed. We must ensure that we prevent stress-related ill-health so that it never arises, and the support for those who are nevertheless affected by mental ill-health must be improved. This is very important for us Social Democrats, and I hope that the Minister and I agree on that.
My colleague in the Council, Maria Malmer Stenergard, has submitted a motion to the Riksdag regarding an alternative rehabilitation chain for psychiatric diagnoses. I quote from Maria Malmer Stenergard's proposal: "It looks . different for mental illness. This becomes particularly clear when one weighs in the interaction of the psychosocial work environment with mental ill-health. A person who has been affected by exhaustion syndrome perhaps should not be signed off sick at home for a longer period at all. Many describe a situation where the pressure from the poor psychosocial work environment becomes too great and creates a severe stress reaction."
We therefore want to consider the need for a new track in the rehabilitation chain for mental diagnoses. This is because the time limits in the existing chain are actually better suited for 'traditional' medical conditions.
Madam Speaker! I would like to ask the Minister: Is this something that the government will proceed with during the current mandate period and then propose some kind of alternative track in the rehabilitation chain for mental diagnoses?
Statsrådet Anna Tenje (M)
Madam Speaker! This is definitely an important issue. Mental illness among those who are on sick leave is a very large and important issue. This applies in particular because very many women find themselves exactly here.
How, where and when we shall look further into the issue, I cannot answer today. I will take that with me. Minister Maria Malmer Stenergard usually has wise suggestions, but there is nothing being prepared in the Government Offices right now. I will simply have to come back to that question.
I believe we can both completely agree that more needs to be done to get people back from sick leave who are there due to mental ill health. But how, Madam President of the Council, do I return to that.
I understood that it was a bit of a sensitive issue to talk about hiding and forgetting. But if one is not to hide and forget people in the statistics, one must act and not let the months pass. That is exactly why it is so important that the time limits exist and that one strengthens the rehabilitation chain. Then more people will also take their responsibility in the process.
It is not only the individual who is to work here, but it is primarily the employer, Försäkringskassan and the health and medical care who, together with the individual, shall provide help and support so that people can return to work again.
Everyone needs to do their part during the sick leave process so that people can return to work. I forgot to mention that Arbetsförmedlingen also has a given place in the rehabilitation chain.
I want to return to the importance of this now that it is seen that sickness absence is expected to increase when the economy turns upwards again. Such an increase is judged to be able to become very substantial if one looks at how it has unfolded earlier in history.
It is very important that one now takes the time to analyze the previous government's changes and what consequences they have, so that one can rectify the negative consequences but perhaps also take advantage of the positive consequences that the changes have led to.
It is also about building a system that is a rehabilitation chain that corresponds to the reality we see today and the sick leaves we see today. This is especially relevant considering how many women today are in mental ill-health and a state of exclusion because they have not been rehabilitated back to work and feel that they can return.
Åsa Eriksson (S)
Madam Speaker! I choose to interpret the Minister's response regarding the proposal from Maria Malmer Stenergard as that one would need some alternative rehabilitation chain so that not everyone becomes healthy as quickly. That means that we will not have absolute time limits in the sickness insurance in the future, and for that, I thank you.
I also want to tell the Minister that we Social Democrats think that checkpoints are very good. It is really necessary to follow up that things are happening. It is about employers taking their responsibility, that the healthcare system provides rehabilitation measures, that Försäkringskassan and Arbetsförmedlingen cooperate, and so on.
But it does not help people to get well if they lose their compensation. Nor does the threat that it may happen matter because one has absolute time limits. It is an enormous difference.
We Social Democrats, during our eight years in government, implemented several improvements in the sickness insurance precisely to increase security for people. People should be given the opportunity to become healthy and regain work capacity so that they can work again and support themselves. Risk of poverty does not make a single person healthier. Those who become ill and lack work capacity should be able to rely on receiving compensation from the sickness insurance and the right interventions.
It is an income insurance. We pay into the insurance when we work. When we are sick, we are to receive from the insurance. It is not the case that someone pays for a home insurance and then suddenly accepts that one has to move into a tent if the house burns down. One pays into the insurance so that one knows there is a protection on the day one becomes ill and does not have work capacity.
It is something that we Social Democrats will continue to fight for. People should have security even during illness. They should be able to support themselves even during illness. I believe that we will continue to debate this issue even in the future.
Statsrådet Anna Tenje (M)
Madam President! I return to the promise that the government will follow the development of sickness absence very closely going forward. We will have to see if Försäkringskassan's forecast is correct and that it is expected to decrease now in the coming years and then again increase sharply.
We will also follow the previous government's recently implemented changes in the health insurance. We have not seen the full consequences of it yet. An investigation is underway. It will then be presented ahead. At that point, we will carefully analyze the consequences that the recently implemented change has had.
I return again to the fact that people must not be hidden and forgotten. Therefore, early measures must be put in place. Clear time limits must exist, and they must signal that it is urgent. We know that the research clearly says that the longer people risk being away, the more difficult it becomes to return.
That is why it is so important to work against the unjustifiably long sick leaves. Everyone involved in the process has a responsibility and must work together to get the individual back to work and get the individual back into a community.
Madam Speaker! I am quite convinced that the interpellor and I will be standing here again to debate this issue. It will be a so-called favorite in reprise. I thank you so very much for the debate tonight.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.