Affiliations: [a] Department of Health and Rehabilitation, Institute of Neuroscience and Physiology at University of Gothenburg, Gothenburg, Sweden
| [b] Department of Political Science, University of Gothenburg, Gothenburg, Sweden
Correspondence:
[*]
Address for correspondence: Kristina Holmgren, PhD, Institute of Neuroscience and Physiology/Occupational Therapy, Sahlgrenska Academy, University of Gothenburg, Box 453, 405 30 Gothenburg, Sweden. Tel.: +4631 786 5726; Fax: +46 31 786 5723; E-mail: kristina.holmgren@neuro.gu.se.
Abstract: BACKGROUND: From a public health perspective among the working population, it is very important that confidence in the welfare system is high, ensuring the citizens economic security and protecting them from economic stress when falling ill. OBJECTIVE: The aim of this study was to explore how people with experience of health insurance perceive their confidence in the Swedish Social Insurance Agency (SSIA). METHODS: Eight focus groups (n = 41) were conducted and each group met on one occasion. RESULTS: The participants described a systemic change in the work of the SSIA where the rule-of-law was disregarded, with arbitrary assessment, and no transparency. The reception by the SSIA shaped the image of the SSIA. The participants described vulnerability in relation to the SSIA. They felt mistrusted, which left a feeling of impotence that worsened their health. Experiencing vulnerability left a strong impression and affected the participants’ confidence negatively. CONCLUSIONS: The following has to be acknowledged to prevent clients from experiencing impaired health, promote return-to-work possibilities, and to push public confidence in the institution in a more positive direction: Politicians and public administrators need to clarify the regulations. The decision-making process needs to be transparent and just. The entire procedure, including continuity as well as a personal, nice reception, has to be ensured.
Keywords: Public health, sick-leave, procedural justice, welfare institutions
