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Does variation in general practitioner (GP) practice matter for the length of sick leave? A multilevel analysis based on Norwegian GP-patient data


  • Aakvik, Arild
  • Holmås, Tor Helge
  • Kamrul Islam, M.


In Norway, as in many countries, the national insurance system is under economic stress from demographic change impacting on the pensions versus contributions balance, and an increasing number of disability and sickness benefit claimants. The general practitioner (GP) is responsible for assessing work capacity and issuing certificates for sick leave based on an evaluation of the patient. Although many studies have analyzed certified sickness absence and predictive factors, no studies assess its variation between patients, GPs or geographical areas within a multilevel framework. Using a rich Norwegian matched patient-GP data set and employing a multilevel random intercept model, the study attempts to disentangle patient, GP and municipality-level variation in the certified sickness absence length for Norwegian workers in 2003. We find that most observed patient and GP characteristics are significantly associated with the length of sick leave (LSL) and medical diagnosis is an important observed factor explaining certified sickness durations. However, 98% of the unexplained variation in the LSL is attributed to patient factors rather than influenced by variation in GP practice or differences in municipality-level characteristics. Our findings indicate that GPs practice variation does not matter much for the patients' LSL. Our results are compatible with a high degree of patient involvement in current general practice. Based on this understanding one may infer that GPs play an advocate role for their patients in Norway, where the patients' own wishes are important when decisions are made.

Suggested Citation

  • Aakvik, Arild & Holmås, Tor Helge & Kamrul Islam, M., 2010. "Does variation in general practitioner (GP) practice matter for the length of sick leave? A multilevel analysis based on Norwegian GP-patient data," Social Science & Medicine, Elsevier, vol. 70(10), pages 1590-1598, May.
  • Handle: RePEc:eee:socmed:v:70:y:2010:i:10:p:1590-1598

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    References listed on IDEAS

    1. Lusine Lusinyan & Leo Bonato, 2007. "Work Absence in Europe," IMF Staff Papers, Palgrave Macmillan, vol. 54(3), pages 475-538, July.
    2. Aakvik, Arild & Holmas, Tor Helge, 2006. "Access to primary health care and health outcomes: The relationships between GP characteristics and mortality rates," Journal of Health Economics, Elsevier, vol. 25(6), pages 1139-1153, November.
    3. Islam, M. Kamrul & Merlo, Juan & Kawachi, Ichiro & Lindstr m, Martin & Burstr m, Kristina & Gerdtham, Ulf-G., 2006. "Does it really matter where you live? A panel data multilevel analysis of Swedish municipality-level social capital on individual health-related quality of life," Health Economics, Policy and Law, Cambridge University Press, vol. 1(03), pages 209-235, July.
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    Cited by:

    1. Dyrstad, Karin & Halvorsen, Thomas & Hem, Karl-Gerhard & Rohde, Tarald, 2016. "Sick of waiting: Does waiting for elective treatment cause sickness absence?," Health Policy, Elsevier, vol. 120(12), pages 1383-1388.
    2. Alexander Ahammer, 2016. "How Physicians Affect Patients’ Employment Outcomes Through Deciding on Sick Leave Durations," Economics working papers 2016-05, Department of Economics, Johannes Kepler University Linz, Austria.
    3. Aakvik, Arild & Holmås, Tor Helge & Kjerstad, Egil, 2012. "Hospital Capacity, Waiting Times and Sick Leave Duration - an Empirical Analysis of a Norwegian Health Policy Reform," Working Papers in Economics 10/12, University of Bergen, Department of Economics.
    4. Aakvik, Arild & Holmås, Tor Helge & Kjerstad, Egil, 2015. "Prioritization and the elusive effect on welfare – A Norwegian health care reform revisited," Social Science & Medicine, Elsevier, vol. 128(C), pages 290-300.
    5. Lay-Yee, Roy & Scott, Alastair & Davis, Peter, 2013. "Patterns of family doctor decision making in practice context. What are the implications for medical practice variation and social disparities?," Social Science & Medicine, Elsevier, vol. 76(C), pages 47-56.


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