Anna stbom Senior advicer The Swedish Welfare system

Anna Östbom Senior advicer

The Swedish Welfare system City Hall Municipalities (290) • social care County Councils/regions (21) • health care The State • cash transfers (social insurance)

Rehabilitation guarantee 2009 -2012 agreement SALAR and Swedish Government - Evidence based medical treatment/rehabilitation to facilitate quick return to work - Concentrates on the most common diagnoses among people absent due to illness: o musculoskeletal pain o depression, anxiety disorders and stress - 1 billion Swedish kronor per year of which 100 million kronor to evaluation and research

Cognitive behavioral therapy (CBT) - Definition according to Socialstyrelsen CBT is a psychotherapeutic approach that aims to solve problems concerning dysfuntional emotions and behaviours through a goal-oriented, systematic procedure.

Multimodal Rehabilitation A broad-based, coordinated rehabilitation program which is based on the biopsychosocial model. The multimodal rehabilitation of patients with chronic pain conditions may include various combinations of physiotherapeutic, social, educational, psychological etc. interventions. The program inolves a multidisciplinary team which may consist of a doctor, physiotherapist, social worker, occupational therapist, psycohologist and nurse. (Report on: Methods of Treating Chronic Pain)

The national evaluation of the RG: Research design (Karolinska Institutet) Register study Survey study • Total population study • Population: Rehabilitation 2009 & 2010 • Data: Registers from county councils and SSIA • Outcome: Sickness absence • Comparisons: Matched reference group • Sample of health care units • Population: 12 county councils, 66 health care units, 2010 • Data: Questionnaires • Outcome: Health and working ability • Comparisons: Before/after rehabilitation (no reference group)

Evaulation 2009 and 2010 Karolinska Institutet There is no difference between the intervention group and reference group in changing sickness absence But the longer RG has existed the lower sickness absence after rehabilitation (all other factors being equal) working ability and health assessment was better six months after rehabilitation (EQ 5 D)

Numbers of rehabilitation 2009 and 2011 CBT 2009 CBT 2011 CBT/ 1000 inhabitant CBT/1000 inhabitant numbers age 16 -65 2009 25979 55167 4. 3 age 16 -65 2011 8. 99 MMR 2009 2011 Numbers 5934 MMR 2011 2009 MMR/ 1000 Numbers inahabitant 9238 age 16 -65 1. 0 MMR/1000 inhabitant age 16 -65 1. 51