Changing Swedish sickness insurance : Policies, institutions and outcomes

Abstract: 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.