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The medical doctors as gatekeepers in the sickness insurance?


  • Engström, Per

    () (Uppsala Center for Labor Studies)

  • Johansson, Per

    () (Uppsala Center for Labor Studies)


Based on a randomised experiment we estimate effects from notification to medical doctors of tighter monitoring of their medical certificates. Both time prescribed by the doctor certificates for sick leave (prescribed sick leave) and the impact on the length of the actual sickness absence (actual sick leave) is studied. We find no effect on the total number of prescribed sick leave days. We do, however, find an increase in both prescribed and actual sick leave with a 25 percent work inability. We also find that the notification letter causes an increase in actual sick leave (i.e. the number of reimbursed sick days). We discuss a number of potential explanations for this rather surprising result.

Suggested Citation

  • Engström, Per & Johansson, Per, 2009. "The medical doctors as gatekeepers in the sickness insurance?," Working Paper Series, Center for Labor Studies 2010:4, Uppsala University, Department of Economics.
  • Handle: RePEc:hhs:uulswp:2010_004

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    References listed on IDEAS

    1. Johansson, Per & Palme, Marten, 1996. "Do economic incentives affect work absence? Empirical evidence using Swedish micro data," Journal of Public Economics, Elsevier, vol. 59(2), pages 195-218, February.
    2. Johansson, Per & Palme, Mårten, 1998. "Assessing the effect of a compulsory sickness insurance on worker absenteeism," SSE/EFI Working Paper Series in Economics and Finance 287, Stockholm School of Economics.
    3. Johansson, Per & Palme, Marten, 2005. "Moral hazard and sickness insurance," Journal of Public Economics, Elsevier, vol. 89(9-10), pages 1879-1890, September.
    4. Lindbeck, Assar & Palme, Mårten & Persson, Mats, 2007. "Social Interaction and Sickness Absence," Working Paper Series 725, Research Institute of Industrial Economics.
    5. Magnus Henrekson & Mats Persson, 2004. "The Effects on Sick Leave of Changes in the Sickness Insurance System," Journal of Labor Economics, University of Chicago Press, vol. 22(1), pages 87-114, January.
    6. Hesselius, Patrik & Johansson, Per & Nilsson, Peter, 2009. "Sick of your colleagues' absence?," Working Paper Series 2009:2, IFAU - Institute for Evaluation of Labour Market and Education Policy.
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    Cited by:

    1. Avdic, Daniel & Johansson, Per, 2013. "Gender Differences in Preferences for Health-Related Absences from Work," IZA Discussion Papers 7480, Institute for the Study of Labor (IZA).
    2. Carlo Alberto Biscardo & Alessandro Bucciol & Paolo Pertile, 2015. "Who should monitor job sick leave?," Working Papers 18/2015, University of Verona, Department of Economics.
    3. Assar Lindbeck & Mårten Palme & Mats Persson, 2016. "Sickness Absence and Local Benefit Cultures," Scandinavian Journal of Economics, Wiley Blackwell, vol. 118(1), pages 49-78, January.

    More about this item


    monitoring; moral hazard; public social insurance;

    JEL classification:

    • C93 - Mathematical and Quantitative Methods - - Design of Experiments - - - Field Experiments
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • H55 - Public Economics - - National Government Expenditures and Related Policies - - - Social Security and Public Pensions
    • J22 - Labor and Demographic Economics - - Demand and Supply of Labor - - - Time Allocation and Labor Supply


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