Medicalization of sickness absence

Abstract

Objective: During the last decades, medical certificates have become the core administrative mechanism for a variety of redistributive policies within public administration. This article explores variations in sickness absence as a result of medicalization.

Methods: The study focuses on the meaning of illness and work disability over time among physicians and the officials in the national insurance offices who are responsible for deciding on matters of sickness absence. 230 casebooks (including medical certificates) are included in the study. The material covers two time periods: the end of the 1970s and the end of the 1990s.

Results: The findings indicate that over time officials and physicians have adopted a broader definition of illness and work disability. Different attention and meanings have been given to conditions and symptoms in the southern and northern parts of Sweden, resulting in a difference in diagnoses between the two regions.

Conclusions: The results indicate medicalization as one explanation for changing sickness figures and differences in the patterns of diagnoses, and the necessity of placing further emphasis on social insurance offices and their role in changing patterns of sickness absence.