Response to interpellation 2023/24:250 on the concept of the labor market in sickness and activity benefits
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
The debate concerned whether the right to sickness and activity compensation should be assessed against the same labor market concept as the sickness benefit. S argued that a stronger sickness insurance is an investment in human values and solidarity 1. S argued that today's regulatory framework means that work capacity is assessed against an imagined job that does not necessarily exist, which leads to rejections for persons with reduced work capacity 1 2. S also emphasized the importance of strengthening the sickness insurance to meet the increasing mental ill-health 3. M replied that the focus should be on rehabilitation and early interventions to avoid long-term sick leave 4 5. M argued that existing reforms must be evaluated before new decisions are made 5 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! Jessica Rodén has asked me how I view the proposal that the right to sickness and activity allowance should be tested against the same labor market concept that applies to the sickness benefit, and whether I intend to take any initiatives in this regard.
The investigation Sjukförsäkringen i förändring - en utvärdering (S 2022:07) is tasked with evaluating the changes in the sickness insurance regulations that have been implemented during 2020-2022. On February 9, 2023, the Government decided on additional directives which mean that the investigation may also submit necessary legislative proposals if the evaluation shows that sickness leaves are not concluded as intended but become unjustifiably long, or if other negative consequences for society or the individual arise (dir. 2023:20). The assignment shall be reported by March 1, 2024, at the latest.
On 1 September 2022, special provisions regarding sickness benefit for older persons of working age entered into force. The work capacity of insured persons who have at most five years left until they reach the age at which they can no longer receive sickness benefit and who have experience of such work as is normally found on the labor market shall, according to the provisions, be assessed in relation to these jobs. If other suitable work is available for the insured person, the work capacity shall be assessed against that. This rule change is covered by the mandate for the investigation Sjukförsäkringen i förändring - en utvärdering.
Försäkringskassan shall, according to the mandate in the agency's regulation letter for 2023, analyze the consequences of the provisions for older persons of working age in sickness benefit and sickness compensation that entered into force during 2022. The mandate shall be final reported to the Government Offices no later than June 14, 2024.
It is not relevant to have any further initiatives regarding the right to sickness or activity compensation before the investigations Sjukförsäkringen i förändring - en utvärdering and Försäkringskassan have reported on their assignments. At that point, the government can also take a position on the need for changes in the regulatory framework.
The sickness insurance shall provide economic security for those who cannot work due to reduced capacity for work. For the government, it is a priority that people should primarily return to the working life, and the focus shall be on rehabilitation and clear assessment points.
Jessica Rodén (S)
Madam Speaker! The last of all 18 interpellation debates today! He who waits for something good never waits for too long, do they?
Madam Speaker! To ensure a fair and inclusive welfare, we must focus on strengthening the sickness insurance. It is through a robust sickness insurance that we show that no one is left alone in the face of illness or disability and that we collectively bear the burden of life's trials.
Illness can affect anyone, at any time. Having a strong sickness insurance is not only a guarantee of economic security for the individual but also an expression of our collective sense of responsibility. An improved sickness insurance is an investment in strengthening our social safety net and giving people the opportunity to focus on recovery instead of on economic worries in difficult times. Illness or disability should never be a burden that affects different groups differently hard.
A stronger sickness insurance is, as has been said, an investment in our society's future. It is not just about economics but about human values, about showing solidarity and about showing consideration.
During the previous parliamentary term, entirely necessary reinforcements of the sickness benefit regulations were carried out, this so that more people can retain their sickness benefit in order to complete their care and treatment and then return to their regular work. But we need to do more! We also need to strengthen the sickness allowance.
The investigation into the sickness and activity allowance submitted the report *A sickness insurance with prevention, rehabilitation and security* in August 2021. In that report, several proposals for improvements were submitted, including the issue we are debating here today – that the right to sickness and activity allowance shall be assessed against the same labor market concept that applies to the sickness benefit. According to the investigation, this would reduce the risk of people remaining in the sickness benefit system despite there being no further measures to take so that these individuals can achieve improved work capacity.
Today's regulatory framework means that the insured person's capacity for work is assessed against work on the "labor market". "Labor market" includes adapted jobs, subsidized employment in the form of wage subsidies, development employment, security employment and specific new-start jobs, as well as fully sheltered employment at Samhall. If the insured is assessed to have a capacity for work in such a job, there is therefore no right to sickness benefit. However, no assessment is made as to whether such a job actually exists at the time of the decision. The assessment is therefore made against a hypothetical job that is adapted and which one believes should be able to exist, not what actually exists.
The Minister refers in her response to ongoing investigations that are to evaluate changes that have occurred and says that she therefore does not want to give any announcements in advance.
I would still wish that the Minister could give some kind of announcement - an announcement to all those who today receive a rejection of their application for sickness benefit with reference to the currently applicable concept of the labor market.
Does the Minister therefore consider it reasonable that people who are judged by their doctor to have no work capacity are denied the application with reference to a job that does not exist?
Statsrådet Anna Tenje (M)
Madam Speaker! I can begin by saying that I share the interpellant's initial description of our security system in large part. Our security system constitutes an important protection for those who work and are in the country in the event of just illness. In cases of illness, the focus should be on rapid interventions to avoid long-term sick leave and for a rapid return to work.
It is well established, Madam Speaker, that long-term sick leave leads to poorer health, well-being, and not least economy. Therefore, it is of the utmost importance that society's collective efforts are deployed as early as possible to avoid people falling into long-term exclusion that leads to poorer economy and makes it harder to get back. Not least, it can result in mental ill-health.
For the government, it is a priority that people primarily return to work. The focus shall then be on rehabilitation and clear checkpoints.
As I mentioned initially, the investigation *Sjukförsäkringen i förändring - en utvärdering* is tasked specifically with evaluating the changes in the health insurance regulations that we are talking about today and which were implemented in 2020-2022. Försäkringskassan also has a mandate to conduct a specific analysis of various proposals. Before that, it is simply not relevant to provide any announcements.
Even though these are the final shaking hours before the Riksdag closes for the year, we simply have to return when the analyses are done and the adequate calculations, I was about to say, but in any case the analyses and the basis are ready, so that it becomes correct and proper. I will definitely return to this, and we will surely have every reason to debate it in the chamber.
Jessica Rodén (S)
Madam Speaker! The mental ill-health among our young people is a major and growing problem. Every other 15-year-old experiences mental health issues. The proportion of children who receive a diagnosis of anxiety disorder or depression has tripled in recent years.
Mental health issues have lifelong and socio-economic consequences. Psychiatric conditions account for half of all sick leaves, and every second person involved in organized crime has had contact with psychiatry.
In the report From risk factors to health factors, TCO writes that mental ill-health is the most common cause of sick leave in all sectors within TCO. As risk factors, they mention high workload, lack of influence over work, and lack of support from the manager. Kommunal also testifies that stress-related issues are the cause of long-term sick leaves within the female-dominated occupations. Risk factors that Kommunal highlights are, similar to TCO, lack of influence but also understaffing, which leads to mental pressure and a feeling of inadequacy.
Madam Speaker! Sickness absence is higher among women than among men. It is higher for workers than for white-collar workers. Women are overrepresented in occupations with high demands but with low influence over working hours and how the work is to be performed, and such jobs are closely linked to health risks.
Mental ill-health is significant and has increased noticeably in recent years. Preventive health work, both within schools and in our workplaces, needs to be prioritized. Many policy areas are affected, and decisive action needs to be taken. But before we have addressed, among other things, mental ill-health in society, we need to strengthen the sickness insurance. No one, especially those who are ill or have reduced work capacity, becomes more employable by being made poorer.
Once again, I would like to ask the Minister if she considers it reasonable that people who are assessed by their doctor as having no capacity for work are denied their application with a reference to a job that does not exist.
Statsrådet Anna Tenje (M)
Madam Speaker! No, no one becomes more employable because they become poor. But it is definitely the case that with early interventions and when society works together to see individuals and help them back into work, it goes significantly faster.
It is also the case that long-term sick leave, sick notes, lead to increased mental ill-health, not least in the group that the interpellor mentions and then especially women. Precisely for that reason it is so important that early interventions are made and that employers, authorities and not least the regions together with the individual work to get the person back to work.
It is also a good practice, besides working together to get someone back to work, that one evaluates implemented reforms carefully and follows up on whether they have been successful and have served their purpose, but also whether there are reasons to correct or change any part in order to achieve a better result and get more people to be able to return to work.
I am sorry, but there will not be many more answers from my side. I will wait for the analyses and the work we have underway now, both the investigation and the supplementary directives but also Försäkringskassan's own analysis work, to see if it can be something that allows us to become even a little better and if we can strengthen our safety system even a little more and ensure that fewer people are left behind and that mental ill-health does not increase even further.
Jessica Rodén (S)
Madam Speaker! I want to devote my final contribution to highlighting the people who are rejected by reading out quotes from the website 116 times a day.
Annika writes: It is not enough that her life has been ruined. She is not even getting the compensation she is entitled to.
An anonymous woman writes: I didn't want to be sick, but I couldn't even get out of bed. She continues to write that she is a person who has always had high demands on herself both privately and in her professional life. Therefore, it took her a long time to accept that she had burnt herself out. She simply did not want to be sick. But when she could no longer get out of bed, she realized that she had no other choice than to take sick leave. She has undergone two different work ability assessments, both of which have confirmed exhaustion syndrome. Nevertheless, the caseworker considered her fully capable of working and she was given the choice between returning to her job or registering with Arbetsförmedlingen. After two days at work, she woke up with a high fever, and she fainted.
There are countless stories describing how people feel who have been rejected and referred to seek a job that does not exist.
Another woman tells that when she was completely bedridden, she was told that she should apply for a job that does not require her to stand up. But they never found that job.
Again: I finally want to ask the Minister whether it is reasonable that one's application for sickness benefit is rejected on the grounds that one should seek a job that does not exist.
I also want to wish everyone a Merry Christmas. Thank you for the debate!
Statsrådet Anna Tenje (M)
Madam Speaker! I would first like to wish both the Deputy Speaker and the members who have managed to stay here all evening, but above all also others who are present, a very Merry Christmas and a good end. After 18 interpellations, I understand that people are looking forward to both the Christmas break and a wonderful celebration.
Thank you also to the member for the interpellation, for a good debate, and for raising the question! As I have noted previously, there is an incredible amount going on in this issue as we have a large investigation underway. We have Försäkringskassan which is conducting its own analysis, and we also have others who have already looked into this question. Taken together, there will gradually be a massive amount of material for us to take a position on in order to strengthen our safety system and ensure that we have a sickness insurance that provides economic security for those who, for various reasons, cannot work and have reduced capacity for work. I believe the interpellor and I are very much in agreement on that.
When the proposals arrive, we will have to return and see if we are in agreement or if we have different views on the issue.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.