Exploring Interactions in the Sickness Insurance System in Terms of Power and Trust

Purpose Activation policies and efforts to reduce sick leave rates has influenced sickness insurance systems in Western countries, which has led to social security being more connected with work and attempts to expose malingering among the sickness absent. The aim of this study was to explore how power and trust are expressed by clients and stakeholders within the Swedish sickness insurance system. Methods This was a longitudinal qualitative study based on semi structured interviews and case files from 31 clients on sick leave in Sweden. Data was analyzed using a thematic analysis. Results The main theme ‘Acts of power and distrust’ illustrates how stakeholders’ express suspicions towards each other, and how clients need to demonstrate desire and efforts to return to work which other stakeholders verified. Conclusions The clients desire to prove themselves able to contribute to society was prominent in this study and power relations need to be acknowledged, in particular between client and the SIA. Further, to preserve citizens trust in the system, the system needs to demonstrate trust also in the clients.

Social validity of work ability evaluations and official decisions within the sickness insurance system: A client perspective

BACKGROUND: Studies of the social validity of work ability evaluations are rare, although the concept can provide valuable information about the acceptability, comprehensibility and importance of procedures. OBJECTIVE: The aim of this study was to explore clients’ perceptions of social validity of work ability evaluations and the following official decisions concerning sickness benefits within the Swedish sickness insurance system. METHODS: This was a longitudinal qualitative study based on interviews with 30 clients on sick leave, analyzed through deductive content analysis. RESULTS: Clients’ understanding of the evaluation was dependent on whether the specific tests were perceived as clearly related to the clients’ situation and what information they received. For a fair description of their work ability, clients state that the strict structure in the evaluation is not relevant to everyone. CONCLUSION: The work ability evaluations indicate low acceptability due to lack of individual adaptation, the comprehensibility varied depending on the applicability of the evaluation and information provided, while the dimension ‘importance’ indicated as higher degree of social validity. The official decision about sickness benefits however was considered unrelated to the evaluation results, lacking solid arguments and sometimes contradictory to other stakeholders’ recommendations indicating poor social validity.

Graded Work, the Activation of Sick-Listed Workers and Employer Participation in Continental Europe

There is an increasing emphasis on activating workers on sick leave and on using their residual work capacity. This article compares activation via graded-work schemes in Germany, Austria, Switzerland and the Netherlands, with a focus on the role of employers. The analysis of literature sources and survey data reveals an ongoing reform activity, as well as great diversity in terms of employer obligations and incentives in the countries studied. These differences are very consequential for the intensity of employer efforts to activate sick-listed workers, even when comparing countries that otherwise share many institutional features. The distinction between public and privatised systems of sickness insurance, on the contrary, seems to be less relevant for the question of employer participation in activation. The findings are consistent with the expectation that less comprehensive employer participation is correlated with stronger selectivity in activation efforts. Depending on the prevailing approach in the individual countries and on developments to date, policy-makers are confronted with different challenges and priorities.

Ubezpieczenia społeczne doktorantów szkół doktorskich

The reform of the doctoral student education system, resulting in a departure from conducting third degree studies in favour of doctoral schools, resulted in changes in the field of social security law. The status of a doctoral student receiving a doctoral scholarship has become independent grounds for compulsory retirement, disability and accident insurance. At the same time, it is the basis for voluntary sickness insurance. The author criticises the granting of doctoral students the right to acquire cover under this type of insurance. Their actual situation when receiving a doctoral scholarship is far different from the situation of other persons (grounds) covered by sickness insurance. The author also discusses the issue of coincidences of grounds for social insurance of doctoral students. The legislator categorised the collection of a doctoral scholarship in the group of absolute grounds for insurance. Unfortunately, it omitted in the regulation of Art. 9 sec. 1a of the Act on Social Insurance System a reference to the basis of the contributions on the received scholarship, which in extreme cases may lead to a significant extension of the doctoral student’s social insurance obligation.

PERHITUNGAN PREMI DENGAN PENERAPAN DEDUCTIBLE PADA MODEL AKTUARIA UNTUK SICKNESS INSURANCE PERTANGGUNGAN SATU TAHUN

Health insurance is an insurance product that provides benefits if the insured is exposed to the risk of an accident or illness and causes loss of income, thus requiring costs. The most important benefit in this study from sickness insurance is the reimbursement of medical expenses. The design of determining premiums by applying deductibles (flat deductibles) is seen as one of the insurance policy policies that meet the principles of determining premiums. The actuarial aspects considered in the health insurance model in this study for the calculation of premiums relating to the type of insurance benefits with expense reimbursement for a period of one year coverage, with due regard to the type of work. The purpose of this study is to see the applied of deductible to the premiums that must be paid to insurance companies that provide benefits for claims submitted. The policy of applying deductibles certainly makes the amount of reimbursement change.

Assessment of the competitive environment of the health insurance market

The main purpose of this investigation is to distinguish the problematic tendencies of the health insurance market development in Ukraine and the competitive positions of the leading insurance companies on it. Accordingly, the issues of complex analysis of key indicators of the insurers’ competitiveness, and the issues of establishing the factors that determine the level of competition in the market become very urgent. The first 30 insurers out of 50 were taken for the study, and they received about 90% of insurance premiums for voluntary health insurance in Ukraine in 2017. The authors have made the assessment of the competitive environment of the health insurance market of Ukraine using the concentration index and the indicator of market competition, which resulted in defining the advantages and disadvantages of their application. Taking into account that the abovementioned indicators for assessing the competition in the insurance market can provide only approximate results, which indicates the inadequacy of the conclusions about the effectiveness of business processes management on it, the authors offered a scientific methodological approach to assessing the market environment with the use of an integrated indicator of the voluntary health insurance market competitiveness. Herewith, such an integrated indicator is calculated in terms of three segments of the market: sickness insurance; voluntary medical insurance (continuous health insurance); medical expenses insurance, simultaneously taking into account the behavior of two indicators – concentration and market competition. As a result of the research, it was found that the highest level of market concentration is typical for sickness insurance and it indicates a high monopoly in the market in terms of this segment. Thus, the integrated indicator allows to make a comprehensive investigation of market behavior of the market participants and to reveal the problematic tendencies of its competitive environment.