Coordinating return-to-work stakeholders in a changing welfare system

Research on disability prevention and return to work (RTW) over the last decades has concluded that involving all relevant stakeholders in rehabilitation and disability prevention is important, and that the responsibilities of the stakeholders need to be coordinated. The coordination of RTW stakeholders is promoted by international institutions such as the European Union, and cooperative initiatives have been put into practice in several countries. In the Scandinavian countries, for instance, stakeholder cooperation in rehabilitation and RTW has been the subject of legislation and institutional reforms. Since the 1990s, Sweden has been creating structures for stakeholder cooperation. A more recent initiative is the creation of Coordination Associations (CAs), made up of four central stakeholders in the Swedish social security system: the Social Insurance Agency, the Public Employment Service, municipal social services and primary health care. The CAs act on a local level to coordinate services of participating stakeholders in order to restore or enhance the work ability of individuals and to facilitate their return to work. At the same time, the Swedish sickness insurance system has been undergoing some dramatic changes. Since 2006, a right-wing government has introduced new elements into the system, including a one-year time limit for sickness benefits and an end to temporary disability pensions. The changes aim to speed up the RTW process, promote activation and put pressure on rehabilitation providers and participants. In this presentation, Christian Stahl of Sweden's National Centre for Work and Rehabilitation will discuss the Coordination Associations, how people employed by the authorities and in health care perceive cooperative work and how recent policy changes affect their practice, as well as recent policy changes from an internationally comparative perspective.