Response to interpellation 2025/26:450 on the exception in the health insurance after day 180

Äldre- och socialförsäkringsministern Anna Tenje (M)

Good morning, Mr. Speaker! Jessica Rodén has asked me if the government intends to change or remove the exception in the sickness insurance after day 180 and what other concrete measures the government intends to take to give people the opportunity to return to work after illness.

Mr. Speaker! The Government has pursued an active policy and taken a number of measures in the area. During the mandate period, we have launched a battery of measures and legislative proposals but also several assignments to Försäkringskassan, Socialstyrelsen, Arbetsförmedlingen and Arbetsmiljöverket in order to prevent sick leave and promote return to work.

In November 2025, the government decided on the bill Work Trial with Maintained Sickness Benefit (prop. 2025/26:53). The legislative changes entered into force on March 1, 2026, and they mean that the person who has full sickness benefit can undergo work trial with their employer with maintained sickness benefit for a limited period, after agreement with the employer. The new provisions have lowered the thresholds for returning to work and also facilitate for the employer to support employees back to work.

It is important that all involved actors take responsibility, both individually and in cooperation, to prevent and shorten sick leaves. The employer's responsibility for a good working environment and management's commitment to workplace environment issues are central to reducing sickness absence. At the same time, more knowledge is needed regarding effective interventions for return to work.

In the research and innovation bill (prop. 2024/25:60), initiatives for research specifically regarding return to work were announced. Three new research centers have recently been formed, and they will contribute valuable knowledge for both the employer's and the healthcare's work with rehabilitation. The operationally-oriented support for the healthcare's work with sick leave and rehabilitation, which is currently being developed by Socialstyrelsen on behalf of the government, contributes to strengthening the healthcare's conditions for work with sick leave and rehabilitation.

The government has also strengthened the so-called workplace-oriented rehabilitation support, which aims to support employers who hire expert support to prevent sick leave and to facilitate return to work after illness. The support is being used to an increasing extent. Employers' plans for return to work are also increasing and are used to an increasing extent by Försäkringskassan as a basis in sickness benefit cases. Försäkringskassan's core operations were strengthened with 490 million SEK in the budget bill for 2025 (prop. 2024/25:1), which has enabled recruitment and development work.

The government's work and measures also yield results. It can be stated, Mr. Speaker, that sickness absence has decreased during 2025. The decrease is seen in both fewer initiated cases of sickness and in a higher proportion who leave the sickness benefit. During the year, there was a marked decrease in the number of cases of sickness with psychiatric diagnoses, which is very important. The previous increase in the number of long-term cases of sickness has largely leveled off, which is a break in trend compared to previous years.

Despite this development, challenges remain, especially with the longer periods of sick leave. We know that the probability of returning to work decreases the longer the sick leave lasts. That long periods of sick leave have accumulated over time is partly a consequence of the rule changes introduced in the sickness benefit during 2021 and 2022, including the exceptions at day 180 in the rehabilitation chain. Therefore, it is important that the government's work for strong support for returning to work continues for all involved in the sick leave process. No one, Mr. Speaker, shall be hidden and forgotten in the sickness insurance.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Jessica Rodén (S)

Mr. Speaker! Many thanks to the Minister for the opportunity to debate the issue today, and I thank you for the answer so far.

Mr. Speaker! The vast majority of people want to work. They want to go to work, feel needed, and be part of the community. But there are people who cannot endure the whole way through today's working life. It is precisely that stress-related mental ill-health and long sick leaves that we have seen increase for a period of time. When people become ill, the sickness insurance must provide real opportunities to return, not just test people away from their work. It was precisely for that reason that the Social Democratic government introduced the exception after day 180 in the sickness insurance.

The basic principle was simple. People who have the possibility of returning to their regular work should first be given reasonable conditions to complete their rehabilitation. People are not machines. An exhausted nursing assistant does not become healthy just because Försäkringskassan starts talking about normal work. A teacher who has hit a wall does not become healthy from economic anxiety, and a parent of a child with neuropsychiatric functional disabilities does not become less stressed by having to fight against the system.

The National Audit Office's report actually shows that the reform had positive effects – or has positive effects. Those whose work capacity was assessed with the support of the concept "overriding reasons" have had a greater opportunity to return to their work. That is important, and it shows that rehabilitation and security are connected.

But we also see that the rejections at day 180 are increasing again. I note that the Minister did not actually give me an answer to my question. Instead, there are enumerations of investments, strategies, and agency mandates. That is good, but people also need to be informed.

We need to work on several fronts simultaneously. Yes, we need research on stress-related ill health and exhaustion to understand why so many people break down in their working lives. We need to strengthen the systematic work environment work. We need more colleagues in the welfare sector so that nursing assistants, social secretaries, and teachers can manage to do their jobs without becoming ill themselves.

The truth is that people do not get sick in a vacuum. Försäkringskassan notes that stress-related mental ill-health accounts for an ever-increasing proportion of long-term sick leaves and that precisely the workload is a central cause, and therefore it is not enough to discuss control points in the sickness insurance.

We need to talk about working conditions, the work environment, and what the pressure in society looks like. I also note that the Minister, in their response, said that the longer sick leaves are partly a consequence of the rule changes regarding the exception at day 180. Therefore, it is reasonable to ask what the government and Sverigedemokraterna actually want to do with the exception. Do you intend to make the application stricter? Do you intend to limit the possibility of having work capacity assessed against regular work? Does the government stand behind the basic principle that people should be given a real opportunity to be rehabilitated back to their work?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Äldre- och socialförsäkringsministern Anna Tenje (M)

Mr. Speaker! I thank you again for the opportunity to debate these important issues. Member Rodén raises many aspects of this issue that I and all parties in the chamber definitely agree with.

My opening remarks were far too short to have time to go through all the reforms and improvements that have occurred during the mandate period. I have listed some, but I would particularly like to highlight an important piece of the puzzle in the work being done within Försäkringskassan in this area.

Försäkringskassan has, among other things, been tasked with following up on the employer's plan for return to work in order to strengthen the coordination of the important rehabilitation efforts. This is something that becomes extra important for people who are to receive help and support quickly to return, given that we know that if one is away for a longer period, the chance of actually returning to work decreases. Fast interventions and an active employer are important. That there is a plan, an adaptation, and a support means that we can avoid many sick leaves and additionally the unnecessarily long sick leaves. It is something that benefits the individual, the employer, and society as a whole.

Försäkringskassan and Arbetsmiljöverket have been tasked with developing their cooperation and supervision of the employer's work environment and rehabilitation responsibility to ensure that the work carried out by the employer actually involves taking responsibility. It should not just be beautiful, fine words on a piece of paper and in a plan, but one must get down to work and implement the measures.

Another assignment has been to provide more people with activity compensation with work-preparatory or work-life-oriented interventions as well as to develop indicators to follow up on the important work.

Arbetsförmedlingen and Försäkringskassan have been tasked with utilizing the work capacity of those on long-term sick leave. According to the agencies' joint report, Försäkringskassan is now working more structurally with the longer sick leaves and has introduced rehabilitation specialists, while Arbetsförmedlingen has strengthened its local employer work and its coordinated support. According to the agencies, this can accelerate rehabilitation and, above all, improve the support for those on long-term sick leave who already have established forms of cooperation and collaboration.

Försäkringskassan shall also ensure the implementation of social fund projects identified within the framework of the coordination associations' preparation structure. The grant for workplace-oriented rehabilitation support has not only been developed with allocated funds but has also been increased by 20 million kronor. The amount that can be paid out to employers has doubled.

Mr. Speaker! As I said earlier, we currently see a positive trend in the development of sickness absence. We know, however, that this can swing very quickly with major consequences as a result. From the government's side, we are following the issue very closely. This has a major impact on the individual and the employers, but also on society as a whole. Obviously, we are prepared to take various measures. But right now, there is nothing more advanced, but rather short-term measures. We are working on these issues and moving forward positions to get more people back to work, to strengthen the employers' responsibility, and to ensure that the plans are followed.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Jessica Rodén (S)

Mr. Speaker! The labor market has changed, and today we see completely different types of illnesses than before. Stress-related ill health and exhaustion account for an ever-increasing proportion of long-term sick leaves, primarily among women. Many of these people work in contact professions where the pace is high, recovery is small, and the workload is constant. It is about people who work with other people every day – in healthcare, in schools, and in care.

When working life changes, the view on rehabilitation and return to work must also change. However, the occupational injury insurance is still poorly adapted to today's working life and its patterns of illness and injury. Many of us are waiting for the government to move from words to action. The Minister has in a previous interpellation debate told a colleague that there are oceans of time left. We shall see what the government and the minister manage to present in this area. We wait with excitement!

The trade union Kommunal has long testified that there is too high a workload, too few colleagues, stress, and a lack of recovery – employees go home from work with the feeling of not having done enough. When welfare is pressured harder year after year, it is people who bear the consequences in their own bodies. It is no coincidence that it is primarily women in welfare professions who become signed off from work.

What is provoking is that the responsibility constantly falls on the one who has become ill. Women in welfare professions are worn out by too high a workload and stress. But when the rehabilitation fails, when the workplace adjustments do not materialize and when the people do not even receive the right support, it is still the person on sick leave who bears the consequences through rejections and economic insecurity. It is not the women in elderly care who have created the understaffing, and it is not the teachers who have created the high workload. But it is still they who pay the price when the sickness insurance is tightened.

There are many people who experience that they are judged against normal work before society has even done what is required for them to be able to have the opportunity to return to their usual work. The Swedish National Audit Office's review shows that contact with employers only occurred in approximately half of the audited cases before the exception was used. In a large proportion of the cases, Försäkringskassan had therefore not even had contact with the employer before people were assessed in the system. Case officers themselves describe that rehabilitation measures and cooperation with employers are deprioritized. How can people be able to return to their work faster if the rehabilitation and coordination do not work?

Since this is not the first time we have had this type of debate in this area and since the Minister has used these answers previously, I have asked the Riksdag's investigation service to examine what concrete effects the government's work has had regarding stress-related mental ill-health and long-term sick leaves. According to the report I received, it is not possible to see any effects.

The Minister also does not want to give me answers on what is intended regarding the exception that we are debating. We Social Democrats do not believe that people are rehabilitated faster by anxiety. We believe that safety and rehabilitation are linked. Again: What do the government and the Sweden Democrats intend to do with the exception? Is the intention to make the application stricter?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Äldre- och socialförsäkringsministern Anna Tenje (M)

Mr. Speaker! We are touching upon many different issues now. Thank God I am not only the Minister for Social Insurance but also the Minister for Seniors. Something I am passionate about is elderly care. We shall ensure that the elderly receive increased security and safety, that quality is strengthened, and that there is an improved situation regarding the supply of competence and the possibility of recruiting to these important professions.

It is closely linked to the other side of my portfolio. There, it is about reducing sick leaves and improving the working environment for not least nursing assistants and healthcare assistants, but also nurses. Municipalities and regions shall be attractive employers. These issues are very closely intertwined in my portfolio. We need to achieve an improved situation, not least within the public sector, where the sick leave rates are very high, especially among women. Among nursing assistants, they are generally twice as high as in other comparable industries.

We cannot have it this way. It is a major failure that no one in this chamber can absolve themselves from. We receive reports from Socialstyrelsen showing that it looks the same now in Swedish elderly care and the Swedish public sector as it did 20 years ago. It is a major failure that we have not succeeded in doing anything about the matter.

In the autumn and during the previous year, I therefore gathered representatives from SKR and leading municipalities and regions across Sweden and pointed out their responsibility to truly raise the issue and take the lead – not just set nice goals for how we should reduce sick leave rates within the public sector, but de facto develop action plans and work methodically and systematically with follow-up.

It is a matter of not only seeing where one can make a difference but also producing concrete examples that can be spread throughout all of Sweden, and several examples have been highlighted. I had Region Skåne present at a conference in the autumn. They spoke about the reduction of sick leaves within the public sector and could show a brilliant result of how they have worked. There are also several municipalities around the country that have succeeded with this.

What it is largely about is the leadership. The leadership within Swedish elderly care is under all criticism. As a unit manager, one usually has 50 employees under them. It is an unsustainable situation when one is to lead and manage such a complex operation.

That is exactly why it was so important for me to appoint the investigation into a leadership training within Swedish elderly care, which Acko Ankarberg Johansson will now lead. We would never dream of, for example, removing the important principal training within the world of schools and preschools, because that is a complex situation where it is difficult to lead and steer the operations. It is very important to develop a similar leadership training for the many skilled managers within Swedish elderly care, so that they can receive the right support and help, see and confirm their employees, work actively to prevent and preclude sick leaves, and above all work with maintaining and improving the work environment. I believe that it is the single most important issue that we can work on moving forward in the municipalities, so that more people can move from part-time to full-time and, not least, can prevent sick leaves.

I also want to highlight the investment that the government is now making with 25 million to Forte to establish and finance centers for return to work. I am passionate about women – it is primarily about women – receiving the right care and treatment, so that they can avoid being on sick leave.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Jessica Rodén (S)

Mr. Speaker! I actually believe that the Minister and I share the same fundamental goal that no human being should have to become ill or injured by their work and that no human being should have to be on sick leave longer than necessary. In that case, the entire chain must function.

We must build a working life where people do not get sick from their work. That is why the work environment is so important, particularly regarding nursing assistants, teachers, social secretaries, and other welfare workers, so that they can endure a full working life.

If people still become ill, the support needs to be provided early. Work adjustments, rehabilitation, and cooperation are needed. People must be given real opportunities to return to their work and not just be tested out of it. Many people experience today that they are judged against normally occurring jobs before society has even done what is required for them to be able to return to their regular work.

The Minister has not answered my question even once, despite the fact that I have asked the same question both in the submitted interpellation and now in my speeches. I am nevertheless giving Minister Tenje one last chance, Mr. Speaker.

What is it that the government and the Sweden Democrats actually want to do with the exception? Is the intention to make the application stricter? Will you limit the possibility of having one's work capacity assessed against one's regular work? Or does the government stand behind the basic principle that people should be given a real opportunity to be rehabilitated back to their work?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Äldre- och socialförsäkringsministern Anna Tenje (M)

Mr. Speaker! I do not quite know what the member is fishing for, given that I have given notice.

I have said that we are currently seeing a positive development regarding the development of sickness absence. We have worked with a number of different measures which we now hope will have an even greater effect going forward.

I have highlighted the importance of more knowledge, not least when it comes to the psychiatric diagnoses. We do not really know what provides a direct effect.

It is about the importance of ensuring that not least women in the public sector receive the right care and treatment so that they can avoid a sick leave at such an early stage as is only possible.

We have also highlighted, not least, the employer's responsibility. We know that the single most important part to reduce, shorten, and counteract unnecessarily long sick leaves is an active employer who shows support and commitment and definitely does the work behind the words in the action plan and furthermore establishes an action plan.

We are now seeing a positive trend, not least regarding the psychiatric diagnoses. But we know that it can change very quickly. That is exactly why it is so incredibly important to follow this issue very closely.

I believe it would be misconduct of office if a minister responsible for these issues were not prepared to take measures to counter and prevent sick leaves or, in that respect, improve the work of reducing sick leaves.

I have no other messages to give. We do not intend, do not think, and do not say anything else. We have no other messages to give than those that apply today and shall continue to apply. But we are following the issue very closely. I am ready to act if that should be required.

The interpellations debate was hereby concluded.

The speech at riksdagen.se, in Swedish (opens in a new tab)