Sick-listing - attitudes and doctors' practice : With special emphasis on sick-listing practice in primary health care

Abstract: The aim of this study was to describe attitudes and doctors' practice regarding the sick-listing process. Using a questionnaire distributed among newly sick-listed patients, their doctors,employers and officials at the National Health Insurance office it was found that the patients held a more positive view on the beneficial effects of sick-listing. This was more pronounced the worse they perceived their general health. They more often regarded their health problem as caused by their work and had a more positive view on thhealth effects of resting compared withthe other parties of the sick-listing process.In an audit survey among 53 GPs it was shown that for 9% of all patients seen sick-listing was considered. Out of these only 6% were not certified sick. The median length of sick-listing certified was 14 days. Female patients were more often partially sick-listed and female GPs sick-listed a larger fraction of their patients than male GPs. Risfactors for long certification periods were in fact associated with longer certification periods. Even in cases where the GP would not recommend sick-listing a certificate was issued in 87%.Using case vignettes to describe the sick-listing practice of doctors of different specialities it was found that GPs sick-listed more than orthopaedic surgeons and less than psychiatrists when acting on the same information. Female doctors sick-listed more than male doctors, irrespective of speciality and patient attitude. The mo important factor affecting sick-listing was the patient's attitude to sick-listing. Patients with the same symptoms wishing sick-listing were sick-listed to a greater extent than those who were reluctant.Evaluating the effects on physicians' sick-listing practice of an administrative reform narrowing sick-listing benefits a natural experiment design was used with a sample of newly started sick-listing ases collected 6 months before the reform and a new one 6 months after it. One of the aims of the reform was to make the doctors comply bett to the filling in of certificates and this was fulfilled but the aims to save money and increase the use of partial sick-listing was not.