Hello Martin,

Interesting that the systems are so different despite our similarities.

As you probably know social workers have no power over the sick leave process. Doctors are in charge from the start. Here there is a lot of complaint in mass media debate (in conservative daily newspapers) that doctors are too liberal in writing sick leave certificates. One of the relatively new debates is that privatization of primary care particularly in the bigger cities have stimulated "over-certification" (a private health care centre - or a county based centre which is nowadays involved in competition with private centers for survival - might try to gain customers by being very liberal in sick leave certification.

I have not seen any relevant studies of the kind you are asking about. You might have a look at the webpage of IFAU.se which is the Swedish agency doing examinations of trends in  sick leave comparing different regions. At any rate international comparisons are interesting from this point of view

Thank you for this information Töres. I will take a look at IFAU.SE.

In Denmark, social workers at the municipal job centres decide about compensation for sick leave and can actually end the compensation, if an overall evaluation of medical and social information does not give a clear reason for inability to take care of present work with possible modifications (first 3 months) or any work with relevant modifications (after 3 months). The decision can be contested at a higher administrative unit. 

This is also discussed in media and elsewhere - both from the point of view you describe, and from the point of patients with few resources not being able to present relevant information and convince the social worker, although being disabled by disease - maybe even more so than your case....

In Italy sick leave compensation is handled by Italian National Welfare Institute (INPS) for non-work related diseases and by Italian National Work Accidents Insurance (INAIL) for work- related diseases.

Medical certifications indicating temporary inability are analized by the physicians of these Institutions, which  may provide medical examinations, both home-type or at the Institute.

Forensic physicians working at INAIL and INPS, after the medical examinations, may reduce the prognosis of the disease, and in some causes, terminate the status of temporary inability, readmitting the patient to work.

Design and implement a "before-and -After study with control". This should give you the strongest evidence of effect of doctors' involvement in social workers' visitation. Create two groups namely intervention and control groups. The former should have doctors accompany social workers on such home visits while the control will have no doctors during their home visits.  Both group visits should happen contemporaneously and at the end of a reasonable interlude, the outcome variable (new sickness absence cases) should be determined for both groups. Appropriate statistical test is then employed to compare both interventional and control groups outcomes. I guess this should answer your research question.

My comment was slightly misleading because certificates are indeed always issued by physicians in our country but the insurance system can disprove a certificate. This does not happen very often but of course when it happens it gives rise to conflicts and problems. Those working in the insurance system are not medically trained and only occasionally they are social workers