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Changing Swedish sickness insurance: Policies, institutions and outcomes
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Government.
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis is to contribute to welfare state theorising by analysing changing risk protection in Swedish sickness insurance and demonstrate how the understanding of such, and its implications, can be enhanced by strategic methodological choices. When analysing formal policy change in the compulsory sickness insurance system, it is concluded that the Swedish system fulfils almost every aspect of a so called social democratic welfare state, and no institutional shift can be discerned over time. When instead studying the interaction between compulsory and occupational benefits, and when investigating differences between diverse groups on the labour market and changes over time, it is demonstrated that there has been an institutional shift in the Swedish system. The balance in regulation between state and collective agreements has moved substantially in the direction of the latter. In terms of the basis for entitlements, a shift from citizenship/residence and labour force participation towards occupational categories has occurred. Considering the replacement levels of the public system, there has also been a shift towards inadequate benefits due to a low ceiling. Such findings emphasise the importance of including occupational systems, and of not treating the population as a homogenous mass, when studying risk protection. When focusing the analysis on how a system functions in practice rather than in theory as is usually done, and thus focusing on non-take-up of occupational benefits, it is shown that a large group of individuals are missing out on the benefit to which they have a right due to their occupational category. Such a fact has implications in terms of risk protection. The most obvious implication of high levels of non-take-up of occupational insurance is reduced individual income security for the affected groups. As the non-take-up is unevenly distributed among groups, such results also indicate that the traditional stratification in the system is strengthened but also that new groups of individuals are worse off than others, thus causing a new basis for stratification within the system.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. , p. 65
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences, ISSN 1652-9030 ; 175
Keywords [en]
Sickness insurance, disability pension, Sweden, occupational welfare, policy change, stratification, social policy analysis, non-take-up
National Category
Political Science (excluding Public Administration Studies and Globalisation Studies)
Research subject
Political Science
Identifiers
URN: urn:nbn:se:uu:diva-397628ISBN: 978-91-513-0823-4 (print)OAI: oai:DiVA.org:uu-397628DiVA, id: diva2:1372198
Public defence
2020-01-10, Brusewitzsalen, Östra Ågatan 19, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2019-12-18 Created: 2019-11-22 Last updated: 2020-01-13
List of papers
1. Policy instruments and the politics of the welfare state: Policy change in Swedish sickness insurance 1955–2017
Open this publication in new window or tab >>Policy instruments and the politics of the welfare state: Policy change in Swedish sickness insurance 1955–2017
(English)Manuscript (preprint) (Other academic)
Abstract [en]

The aim of this paper is to explore how changes in welfare systems can come about, in order to increase our understanding of the connection between policy instruments and party politics. The empirical strategy has been to analyse the case of compulsory Swedish sickness insurance that was introduced in 1955 (replacing the old voluntary state subsidised system) and examine every policy change made during periods of expansion and retrenchment. Three questions are addressed: First, by which policy instruments have changes been made? Secondly, when in government do political parties differ in their direction of change and, of primary interest, do they use different policy instruments in reforming Swedish sickness insurance? Thirdly, how has the Swedish sickness insurance model evolved over time? I demonstrate how twelve different policy instruments have been used to change Swedish sickness insurance. Since conventional indicators in comparative studies of benefit generosity are only based on a subset of these policy instruments – above all replacement rate, maximum duration, waiting days and qualification period, this implies that potentially important modes of change traditionally are excluded. This is particularly true concerning eligibility/qualifying conditions, where conventional indicators only catch a fraction of the ways in which schemes can develop over time. I also show that the Era of Austerity has been more about expansions than cutbacks. Moreover, political parties in government tend to change benefit generosity by using different kinds of policy instruments. The more precise analysis of policy instruments generates hypotheses about the connection between policy instruments and party politics and unveils how the Swedish model of sickness insurance has evolved over time.

Keywords
policy change, policy instruments, ‘new politics’ of the welfare state, ‘old politics’ of the welfare state, power resources approach, sickness insurance, Sweden
National Category
Political Science (excluding Public Administration Studies and Globalisation Studies)
Research subject
Political Science
Identifiers
urn:nbn:se:uu:diva-397565 (URN)
Available from: 2019-11-21 Created: 2019-11-21 Last updated: 2019-11-22
2. Stratification in Changing Swedish Sickness Insurance
Open this publication in new window or tab >>Stratification in Changing Swedish Sickness Insurance
2015 (English)In: European Journal of Social Security, ISSN 1388-2627, Vol. 17, no 4, p. 453-480Article in journal (Refereed) Published
Abstract [en]

This paper proposes an analytical approach to capturing gradual institutional change in mature welfare states. The approach takes account of both public and occupational provisions of income security and investigates differences between diverse groups in the labour market, various income levels within such groups, as well as changes over time. The analytical approach is then applied to the empirical case of the Swedish sickness insurance, on which new data covering the last 30 years have been collected. The results show that sickness insurance as a whole still offers generous replacement rates but that there has been an institutional shift in the provision of income protection. The earlier system of universal public provision that was closely related to former income has developed into a system where this is the case only for certain groups in the labour market while the rest are dependent on collectively negotiated solutions. Accordingly, the traditional Swedish institutional model in which an encompassing public system promotes equality of status has been transformed over time. In the absence of an adequate analytical approach this is a fact that has not been fully recognised in earlier welfare state research.

Place, publisher, year, edition, pages
Mortsel, Belgium: Intersentia, 2015
Keywords
occupational welfare; sickness insurance; social policy analysis; stratification; Sweden
National Category
Political Science
Research subject
Political Science
Identifiers
urn:nbn:se:uu:diva-273825 (URN)10.1177/138826271501700404 (DOI)
Available from: 2016-01-18 Created: 2016-01-18 Last updated: 2019-11-22Bibliographically approved
3. Insured but without benefits: Non-take-up in Swedish occupational sickness insurance
Open this publication in new window or tab >>Insured but without benefits: Non-take-up in Swedish occupational sickness insurance
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Swedish sickness insurance has been undergoing a transformation away from an encompassing public welfare system towards a greater dependency on collectively negotiated occupational plans. With the increased importance of occupational insurance, the ability to secure the take-up of such benefits is increasing in importance. This study uses longitudinal, individual administrative data to investigate the take-up of occupational benefits within the public sector in Sweden, particularly during disability pension spells. It is argued that the non-take-up of benefits is a key aspect of the growing stratification in income protection in the Swedish society. Detailed administrative data allow the identification of both an eligible population and eligible non-claimants in Swedish occupational sickness insurance, meaning that common problems in the field of non-take-up, such as misreporting, recall and measurement errors in survey data, are avoided. Analysing Swedish occupational sickness insurance offers new insights into the literature on non-take-up, where focus traditionally has been on means-tested benefits, primarily in Anglo-Saxon countries and Germany. The non-take-up rate is found to be close to 17 percent of every spell of disability pension between 2007 and 2014. Low-income earners, young persons, men and individuals diagnosed with mental and behavioural disorders or injuries, poisoning and certain other consequences of external causes, have a higher non-take-up of occupational benefits, causing a new basis for the stratification of income protection. The non-take-up of occupational benefits has consequences for the extent to which and for whom we can expect occupational insurance to complement public insurance. Future research should not assume that occupational systems work as well in practice as they do in theory.

Keywords
non-take-up, occupational welfare, sickness insurance, disability pension, Sweden
National Category
Political Science (excluding Public Administration Studies and Globalisation Studies)
Research subject
Political Science
Identifiers
urn:nbn:se:uu:diva-397566 (URN)
Available from: 2019-11-21 Created: 2019-11-21 Last updated: 2019-11-22

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Citation style
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