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The European Journal of Public Health Advance Access originally published online on August 26, 2005
The European Journal of Public Health 2005 15(5):470-474; doi:10.1093/eurpub/cki029
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© The Author 2005. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Health Services Research

Influence of local structural factors on physicians' sick-listing practice: a population-based study

Britt E. Arrelöv1, Lars Borgquist2 and Kurt F. Svärdsudd1

1 Uppsala University, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology Section, Uppsala, Sweden
2 Linköping University, Faculty of Health Sciences, Department of Medicine and Care, Primary Care, Linköping, Sweden

Correspondence: Dr Britt Arrelöv, Department of Public Health and Caring Sciences, Family Medicine Section, Uppsala Science Park, 751 85 Uppsala, Sweden, tel: +46 18 611 34 26, fax: +46 18 51 16 57, e-mail: britt.arrelov{at}pubcare.uu.se

Background: Physicians have a central role as gatekeepers to the social security system, including sick-listing. Variation in physicians' sick-listing practices has been demonstrated in several studies. The objective of this study was to determine whether local structural factors affect sick-listing practice. Methods: A total of 57 563 consecutive sick-listing certificates, issued during 4 months in 1995 and 2 months in 1996, were collected from the local branches of the National Social Insurance Office in eight Swedish counties. County code, local community population size and presence of a hospital in the area were used as indicators of local structural factors. Length of the sick-listing certificates and of the sick-listing episodes were used as outcome variables. Results: After ajustment for the influence of category of issuing physician, patients' age, sex and diagnosis (‘case mix’), and type of certificate there was a large variation of the length of the sick-listing certificates and of the sick-listing episodes between counties, between communities of various size and between communities with or without a hospital in the area. All these factors were independently and significantly correlated to the length of the certificate and of the sick-listing episode. Conclusions: The results support the hypothesis that physicians' sick-listing practice is influenced by local structural factors.

Keywords: epidemiology, sick-leave, sick-listing, sickness certification practice, structural factors, Sweden


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