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The European Journal of Public Health Advance Access published online on August 26, 2005
The European Journal of Public Health, 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.
Received April 9, 2003
Accepted June 21, 2004

Article

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

Britt E. Arrelöv 1*, Lars Borgquist 2, and Kurt F. Svärdsudd 1

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

* To whom correspondence should be addressed.
Britt E. Arrelöv, E-mail: britt.arrelov{at}pubcare.uu.se


  Abstract

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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