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Effects of Caseworker Screening on Employment and Health: Quasi-Experimental Evidence From the Swedish Sickness Insurance Program

Author

Listed:
  • Pathric Hägglund
  • Per Johansson
  • Kristian Persson

Abstract

This paper analyzes the effects of caseworker screening of doctors’ medical sick-leave certificates. The analysis uses data from people appealing caseworkers’ denial of their benefit claims. Caseworkers at four units made decisions on the appeals. The distribution of the cases to the four units was based on the appealing person’s birth date. One of the units was much stricter than the others (7.8% approved in contrast to 16.1% for the others). This allows us to use birth date as an instrument to estimate the effects of being denied sickness benefits. We find that the denial of sickness benefits, on average, has (i) positive effects on the labor-market outcomes and (ii) no negative effects on health outcomes. As the more liberal units deny sickness benefits for most screened medical certificates, we conclude that caseworker screening is very important in separating meritorious from non-meritorious claims. Doctors’ conflicting roles make it difficult for them to act in the best of interest of both their patients and society.

Suggested Citation

  • Pathric Hägglund & Per Johansson & Kristian Persson, 2026. "Effects of Caseworker Screening on Employment and Health: Quasi-Experimental Evidence From the Swedish Sickness Insurance Program," Evaluation Review, , vol. 50(1), pages 30-54, February.
    • Handle: RePEc:sae:evarev:v:50:y:2026:i:1:p:30-54
    DOI: 10.1177/0193841X251358288
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    References listed on IDEAS

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    1. Philip de Jong & Maarten Lindeboom & Bas van der Klaauw, 2011. "Screening Disability Insurance Applications," Journal of the European Economic Association, European Economic Association, vol. 9(1), pages 106-129, February.
    2. Bound, John, 1989. "The Health and Earnings of Rejected Disability Insurance Applicants," American Economic Review, American Economic Association, vol. 79(3), pages 482-503, June.
    3. Alexander Ahammer & Analisa Packham, 2022. "Disability Insurance Screening and Worker Outcomes," Upjohn Working Papers 22-375, W.E. Upjohn Institute for Employment Research.
    4. Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-255, March-Apr.
    5. Eric French & Jae Song, 2014. "The Effect of Disability Insurance Receipt on Labor Supply," American Economic Journal: Economic Policy, American Economic Association, vol. 6(2), pages 291-337, May.
    6. Mathilde Godard & Pierre Koning & Maarten Lindeboom, 2024. "Application and Award Responses to Stricter Screening in Disability Insurance," Journal of Human Resources, University of Wisconsin Press, vol. 59(5), pages 1353-1386.
    7. Nicole Maestas & Kathleen J. Mullen & Alexander Strand, 2013. "Does Disability Insurance Receipt Discourage Work? Using Examiner Assignment to Estimate Causal Effects of SSDI Receipt," American Economic Review, American Economic Association, vol. 103(5), pages 1797-1829, August.
    8. Simen Markussen & Knut Røed & Ragnhild C. Schreiner, 2018. "Can Compulsory Dialogues Nudge Sick†listed Workers Back to Work?," Economic Journal, Royal Economic Society, vol. 128(610), pages 1276-1303, May.
    9. Benedicte Carlsen & Jo Thori Lind & Karine Nyborg, 2020. "Why physicians are lousy gatekeepers: Sicklisting decisions when patients have private information on symptoms," Health Economics, John Wiley & Sons, Ltd., vol. 29(7), pages 778-789, July.
    10. Per Johansson & Lisa Laun & Mårten Palme, 2017. "Health, Work Capacity, and Retirement in Sweden," NBER Chapters, in: Social Security Programs and Retirement around the World: The Capacity to Work at Older Ages, pages 301-327, National Bureau of Economic Research, Inc.
    11. Ronald L. Wasserstein & Allen L. Schirm & Nicole A. Lazar, 2019. "Moving to a World Beyond “p," The American Statistician, Taylor & Francis Journals, vol. 73(S1), pages 1-19, March.
    12. David H. Autor & Mark G. Duggan, 2006. "The Growth in the Social Security Disability Rolls: A Fiscal Crisis Unfolding," Journal of Economic Perspectives, American Economic Association, vol. 20(3), pages 71-96, Summer.
    13. Eliason, Marcus & Johansson, Per & Nilsson, Martin, 2019. "Forward-looking moral hazard in social insurance," Labour Economics, Elsevier, vol. 60(C), pages 84-98.
    14. Liebert, Helge, 2019. "Does external medical review reduce disability insurance inflow?," Journal of Health Economics, Elsevier, vol. 64(C), pages 108-128.
    15. repec:hal:wpaper:hal-03714169 is not listed on IDEAS
    16. Per Johansson & Erica Lindahl, 2013. "Can sickness absence be affected by information meetings? Evidence from a social experiment," Empirical Economics, Springer, vol. 44(3), pages 1673-1695, June.
    17. Hartman, Laura & Hesselius, Patrik & Johansson, Per, 2013. "Effects of eligibility screening in the sickness insurance: Evidence from a field experiment," Labour Economics, Elsevier, vol. 20(C), pages 48-56.
    18. Hamish Low & Luigi Pistaferri, 2015. "Disability Insurance and the Dynamics of the Incentive Insurance Trade-Off," American Economic Review, American Economic Association, vol. 105(10), pages 2986-3029, October.
    19. Valentin Amrhein & Sander Greenland & Blake McShane, 2019. "Scientists rise up against statistical significance," Nature, Nature, vol. 567(7748), pages 305-307, March.
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