Response to interpellation 2023/24:602 on the significance of medical certificates in sickness benefit cases
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 importance of the medical certificate in sickness benefit cases and how the investigation's proposals should be implemented. M emphasizes that the medical certificate is central to ensuring legally secure assessments and that the sickness insurance should provide financial compensation in case of illness 1 2. M argues that the investigator did not provide any sharp legislative proposals and that the views of the referral bodies are now being analyzed to ensure a solid preparation 1 3. S considers that the proposals are not political but should be implemented quickly to save time, money, and facilitate things for both doctors and those on sick leave 4 5. S asks when the changes will occur 4 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! Åsa Eriksson has asked me what measures I and the government intend to take in light of the proposals in the investigation on the significance of medical certificates in sickness benefit cases.
One purpose of the Inquiry into the significance of the medical certificate in sickness benefit cases (S 2022:06) was to investigate whether the assessment of the reduction in work capacity by the prescribing physician needs to be given greater weight in sickness benefit cases.
The medical certificate and the doctor's assessment are of great importance for Försäkringskassan's investigation and assessment of sickness benefit cases. Unjustified sick leaves entail large social costs and have negative consequences for the individual. At the same time, people who have reduced work capacity due to illness shall receive sickness benefit and be given support to return to work. Therefore, it is very important both for the individual and for society as a whole that the work of the health and medical care and Försäkringskassan with sick leave is performed with high quality, and in that work, the medical certificate is a central part.
The investigation's report Right Conditions for Sick Leave (SOU 2023:48) has recently been subject to consultation. The investigator chose not to submit any sharp legislative proposals in their report. Therefore, there are no such proposals to take a position on. The results of the consultation are currently being analyzed within the Government Offices and by me at the Ministry of Social Affairs. I truly look forward to seeing the compilation of the views that have been submitted.
Åsa Eriksson (S)
Madam Speaker! We are in complete agreement, Minister, on how important it is to have a secure and legally sound sickness insurance. We both know that the medical certificate is very important, just as the Minister clarified in his answer. It is important for the individual, it is important for Försäkringskassan, and it is important for the employer so that one can assess work capacity and so that one can take the correct measures so that everyone who can work also works as soon as possible.
To clarify the whole matter, I can say that the medical certificate has several different purposes. It is intended to confirm the individual's right to sick pay and serve as a basis for the employer's decision when assessing whether the employee is entitled to sick pay at the beginning of the illness. It confirms the individual's right to be absent from work and shows which work tasks one cannot perform when one has reduced work capacity due to illness. But it can also be a guidance for the employer regarding whether it is possible to adapt work tasks so that the person in question can continue to work, but with something else, despite having reduced work capacity—that is important. The medical certificate also obviously provides Försäkringskassan with a basis for its assessments.
Madam Speaker! I believe we have all heard people testify about their difficulties and their reduced capacity to work, and about how this causes great difficulties for both issuing doctors and Försäkringskassan. Vast amounts of hours are spent bouncing certificates back and forth. Doctors are uncertain about how they should design the certificates and which boxes should be ticked, despite efforts having been made to simplify.
We welcome that an inquiry was appointed to review this. We also welcome the proposals. For our part, we think it is a bit strange. Just as the Minister says, no constitutional changes are needed. It should be possible to implement the proposals quite quickly, yet we have still not heard anything from the government. That was why, Madam Speaker, I wrote this interpellation.
Thousands of people on sick leave and the majority of the medical profession are actually waiting for changes to occur so that things become simpler. I wonder: When can all those on sick leave and all the doctors issuing sick leave look forward to the proposed changes being implemented?
Statsrådet Anna Tenje (M)
Madam Speaker! For me, the most important thing is that the sickness insurance should provide compensation for loss of income during illness and rehabilitation. People should feel secure knowing that there is a sickness insurance that provides financial compensation when they become ill and cannot work. There is no doubt about that, and I believe we are very much in agreement on that.
The investigation into the significance of the medical certificate in sickness benefit cases was commissioned by the previous government. The government that is now in power definitely shares the view that the significance of the medical certificate in sickness benefit cases needed to be analyzed.
In the vast majority of cases, it is quite simple. The person who has become ill and is prevented from performing their work is signed off as sick with sickness allowance. But in the law, there are a number of different conditions that must be met for a person to be entitled to sickness allowance. A fundamental condition is that the capacity to work must be reduced by at least one quarter due to illness. It is therefore not enough that a person is ill for that person to be entitled to sickness allowance. The capacity to work must be reduced due to the illness. It is thus the reduced capacity to work that is central in the assessment. That is how it has been ever since the sickness allowance was introduced in Sweden.
In that assessment, the medical certificate plays a central role. In healthcare, there are experts and specialists in the medical profession who, based on the best possible empirical evidence and the current state of research, shall diagnose and, through care, treat patients with the goal that they shall become healthy.
The investigation into the significance of the medical certificate in sickness benefit cases was led by the special investigator Marina Tuutma, who is a specialist in general medicine, chairperson of the Swedish District Doctors Association, and second vice-chairperson of the Swedish Medical Association. She has assessed that it is not relevant to take measures to give the doctor's assessment of the reduction in work capacity even more weight in sickness benefit cases. But she has put forward a number of other proposals. It is precisely those proposals that have been out for consultation, which concluded in February. The compilation is now being carried out in the Government Offices.
Åsa Eriksson (S)
Madam Speaker! I was part of the parliamentary reference group for the investigation, together with representatives from all other parties in the Riksdag. I believe everyone shared the view that there was just no politics in the proposals that the investigator submitted. We – or at least I – probably believed that these were things that could be implemented quite quickly to save time and money and to accelerate the return to work for those on sick leave.
I choose to formulate the question as follows this time: Which of the proposals from the investigator does the Minister consider most urgent to implement?
Statsrådet Anna Tenje (M)
Madam Speaker! We have a fairly well-functioning system in Sweden. We have a specific investigator who receives a mandate with certain criteria. Sometimes the investigator is to submit legislative proposals, and sometimes the investigator is not to do so. In some cases, the investigator is free to do one or the other. In this case, the investigator has chosen not to submit any legislative proposals. Thus, it is not said that the investigator does not submit other proposals.
When we have received the proposals, it is customary in Sweden that we send them out for a referral process and that different referral bodies - these are experts, and it is usually also municipalities - get the opportunity to comment on the proposals. This is done so that one ends up in the right place. That is the fine thing about a preparation, which we do in Sweden. It is important that it has been prepared in a solid way when we enact laws or make major changes that affect very many people, which this would do.
One can have views on this. I often have views that the state's mills grind quite slowly. But now we chose to send out the proposals for consultation. We felt that they truly deserved it. We wanted to receive consultation views and other assessments that might come forward. The consultation period ended in February, and the compilation of the various proposals is currently underway.
I really look forward to taking part in the views. Just as the member believes, from what I have seen, it is not that there is politics or sensitive issues in this. This simply aims to improve the situation for those who are ill today. It is about them being able to get well, but it is also about being able to make legally sound and good assessments from both the doctor's perspective and the Försäkringskassan's perspective. This can then benefit both the individual and society as a whole.
But before I have seen the referral compilation and looked more closely at these issues, I do not intend to make any statements regarding which issue is most important or which issue I intend to move forward with first. One simply has to wait for the usual preparation.
Åsa Eriksson (S)
Madam Speaker! It is clear that we always want things to happen efficiently. Urgent changes should be implemented as soon as possible. I think it becomes even more urgent that these changes occur quickly if the government intends to proceed with the proposals from the investigation *Sjukförsäkringen i förändring*. In that case, it becomes even more important that everyone who is signed off on sick leave as quickly as possible receives the correct medical certificates, the correct support, and the correct help, so that they have time to regain their capacity for work and receive support and rehabilitation before the moderately-led government has reintroduced the stalemate.
When can we expect the proposals regarding the medical certificates to be implemented?
Statsrådet Anna Tenje (M)
Madam Speaker! I thank you again for a very interesting debate on a very important issue that the interpellator raises.
A well-functioning sick leave process with a focus on compensation for loss of income during illness and rehabilitation, as well as clear and correct measures, provides security, as has been said in today's debate, and is very important.
The referral process for Marina Tuutmas's report was, as mentioned, recently completed. The referral response is currently being analyzed in the Government Offices. I intend to return to this matter as soon as I can. I see no reason to delay or hesitate if we land on making any changes.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.