Controlling sickness absence: A study of changes in the Danish sickness absence legislation since 1973
Introduction
In Denmark and in many other Western European countries sickness absence has become an issue of increased political concern during the last decade [1]. Sickness will normally impair working ability, and in Denmark already the guilds established in the 1890s health insurance funds to compensate members’ loss of income during periods of sickness. In high income countries today a person who is ill and unable to work receives income replacement from one or two sources; either from social funds based on contributions from employers and employees, Bismarckian system, or from tax revenue, Beveridge system [2]. The Beveridge system was developed as a part of the post war National Health Service system in the United Kingdom, and it was implemented in Denmark in the 1960s and 1970s.
Sickness absence is, however, a complex phenomenon, and the relation between ill health and sickness absence is not straightforward. All societies have two distributive systems, one based on work and one based on need, and there will always be a conflict between helping people in need without undermining the basic principle of distribution according to work [3]. To resolve this dilemma, the society must develop rules to determine the boundaries between the two systems, and these boundaries have to be invented and redesigned in face of changing social conditions [3]. To achieve an understanding of how this dilemma is being resolved in Denmark, we studied the sickness absence legislation during the past 30 years.
Section snippets
Method
The present sickness benefit scheme dates back to 1973. At that time the Danish labour market was divided into four main groups; white-collar/blue-collar workers, and workers in the private/public sector. White-collar workers are paid on a monthly basis, and they have since 1938 been covered by the White Collar Act, which among other things guaranteed full salary during a sickness absence spell of a certain length. Blue-collar workers were traditionally paid on a weekly basis and in general had
Sickness benefit rules
A Sickness Benefit Act was introduced in Denmark on 1st January 1973 covering wage earners, self-employed, and unemployed. The act was part of a broader social reform in the 1970s based on recommendations from a social reform commission [4]. An important principle was that all citizens should be entitled to economical help no matter what caused the loss of income.
Blue-collar workers in the private sector
The Sickness Benefit Act was a major improvement for blue-collar workers as all employees became entitled to sickness benefit in case
Discussion
This analysis shows two tendencies in the development of entitlement to sickness benefit in Denmark. On the one hand the system has implemented an intense degree of selectiveness. The maximum period of sickness benefit has changed from unlimited, to two years to one year. Follow-up evaluations were originally to be undertaken every third month, then every second month, and now every month in severe cases. A reintegration plan has further been added to be undertaken every sixth month and now
Conclusion
A Beveridge system of compensation for “incapacity to work due to disease” was implemented in Denmark in 1973. The act was from the beginning based on a broad concept of disease, but the implementation of this principle has undergone major changes over time reflected in more than 100 amendments to the act. In the 1970s and 1980s entitlement to sickness benefit depended in practice on medical diagnoses. A shift away from this practice started in the 1990s with an emphasis on “activation” and
Acknowledgement
This study was financially supported by the Danish Work Environment Fund and the Danish Research School of Public Health.
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