TY - JOUR
T1 - How equitable is vocational rehabilitation in Sweden? A review of evidence on the implementation of a national policy framework
AU - Burstrom, Bo
AU - Nylen, Lotta
AU - Clayton, Stephen
AU - Whitehead, Margaret
PY - 2010/6/7
Y1 - 2010/6/7
N2 - Purpose. Under the national framework law in Sweden, all eligible people should have equal chances of receiving vocational
rehabilitation. We aimed to review the evidence on (1) whether access to vocational rehabilitation is equitable in practice and
(2) whether the outcomes vary for different groups in the population.
Method. Systematic review of studies in Sweden that reported diagnostic or socio-demographic characteristics of people
offered or taking up rehabilitation programmes and outcomes of such programmes for different diagnostic and sociodemographic
groups. Searches of 11 relevant electronic databases, 15 organisational websites, citation searching and contact
with experts in the field, for the period 1990–2009.
Results. A total of 11 studies were included in the final review, six of which addressed review question (1) and seven
addressed review question (2). All the six observational studies of access reported biased selection into vocational
rehabilitation: greater likelihood for men, younger people, those with longer-term sick leave, those with lower income,
employed rather than unemployed people and those with musculoskeletal and mental disorders or alcohol abuse. Having had
a rehabilitation investigation also increased the likelihood of receiving vocational rehabilitation. Differential outcome of
rehabilitation was reported in seven studies: outcomes were better for men, younger people, employed individuals, those
with shorter sick leave and those with higher income. Selection into vocational rehabilitation was perceived as important for
successful outcomes, but success also depended on the state of the local labour market.
Conclusions. There is evidence of socio-demographic differences in access to and outcomes of vocational rehabilitation in
Sweden, even though the national framework law is meant to apply to everyone. Few studies have deliberately measured
differential access or outcomes, and there is a need for this kind of equity analysis of population-wide policies. Studies
evaluating the effects of vocational rehabilitation must consider selection into the programmes for adequate interpretation of
impact results.
Keywords: Social differentials, vocational rehabilitation, equity
AB - Purpose. Under the national framework law in Sweden, all eligible people should have equal chances of receiving vocational
rehabilitation. We aimed to review the evidence on (1) whether access to vocational rehabilitation is equitable in practice and
(2) whether the outcomes vary for different groups in the population.
Method. Systematic review of studies in Sweden that reported diagnostic or socio-demographic characteristics of people
offered or taking up rehabilitation programmes and outcomes of such programmes for different diagnostic and sociodemographic
groups. Searches of 11 relevant electronic databases, 15 organisational websites, citation searching and contact
with experts in the field, for the period 1990–2009.
Results. A total of 11 studies were included in the final review, six of which addressed review question (1) and seven
addressed review question (2). All the six observational studies of access reported biased selection into vocational
rehabilitation: greater likelihood for men, younger people, those with longer-term sick leave, those with lower income,
employed rather than unemployed people and those with musculoskeletal and mental disorders or alcohol abuse. Having had
a rehabilitation investigation also increased the likelihood of receiving vocational rehabilitation. Differential outcome of
rehabilitation was reported in seven studies: outcomes were better for men, younger people, employed individuals, those
with shorter sick leave and those with higher income. Selection into vocational rehabilitation was perceived as important for
successful outcomes, but success also depended on the state of the local labour market.
Conclusions. There is evidence of socio-demographic differences in access to and outcomes of vocational rehabilitation in
Sweden, even though the national framework law is meant to apply to everyone. Few studies have deliberately measured
differential access or outcomes, and there is a need for this kind of equity analysis of population-wide policies. Studies
evaluating the effects of vocational rehabilitation must consider selection into the programmes for adequate interpretation of
impact results.
Keywords: Social differentials, vocational rehabilitation, equity
U2 - 10.3109/09638288.2010.493596
DO - 10.3109/09638288.2010.493596
M3 - Article (journal)
SN - 1464-5165
VL - 33
SP - 453
EP - 466
JO - Disability and rehabilitation
JF - Disability and rehabilitation
IS - 6
ER -