[Insurance medicine training--a cost-effective initiative].

A training program in insurance medicine for younger physicians in clinical practice is presented. The program is individualized, problem-based and oriented towards clinical practice. Physicians participate in the program for two or five working days--depending on the level of clinical competence--and the following items are stressed: case reports with clinical insurance medicine aspects, knowledge of ordinary work places among the general population, training in early rehabilitation, and awareness of the process of certification for sick leave. During the past three years 73 physicians at all levels of clinical competence, mostly in the specialties general practice and occupational health, have passed the training program. There are many positive spin-off effects of the training, as well as substantial reductions in the rate of physician certification for sick leave and for early retirement pensions in the region. In 1999 the average level of sick-leave utilization was two days less than the national average, a reduction in relative terms by about 50% from 1996, when the regional level was 20% higher than the national level. In addition, during the period 1996-1999 the number of appeals of decisions of the Regional Social Insurance Office has been reduced from 33% to 6% of all decisions in which physician certificates for sick leave played a role. A nation-wide introduction of such a training program might possibly reduce the state expenditure for sick-leave insurance by 3 billion SEK on a yearly basis (about 10% of the current sick-leave related expenditure).