Health insurance is one of the foundations of Swedish welfare, and a security for citizens that are unable to work due sick leave. Today, citizens on sick leave have to work and be active in their contact with administrative officers at the Social Insurance Agency, in what is named bureaucratic co-creation, to get their case processed and to receive health insurance benefits. These are the findings in Johan Kaluza’s doctoral dissertation “The workload of citizens on sick leave: Working citizens encounter a customer-oriented bureaucracy”.
The dissertation is based on a study of Sweden’s Social Insurance Agency. Theoretically, it takes its departure in the literature on working consumers and customer-oriented bureaucracies. The following paradox constitutes the basis of this dissertation: in order to qualify for health insurance, the citizen’s ability to work must be limited while it is presupposes that his/her can work within the system, in order to gain access to it. In explaining how this paradox is managed, the aim of this dissertation is to map out and explain the practices that working citizens and customer-oriented bureaucrats carry out when putting health insurance into practice. This results in the assertion that work consists of eight practices divided up into two themes; support practices and control practices. On the basis of practice theory, it is then discussed how these practices interact and what occurs when the interaction fails. The dissertation also identifies the strategies correction, pressure, and taking over, which actors use when interaction between practices fails.
This dissertation contributes with new knowledge developing the concept of working citizens, and by mapping out the work done when putting public services into practice. This work is partly stimulated by citizens’ worries about doing something wrong. Caseworkers use citizens’ work to ease their own working situation by means of what is designated, in the dissertation, as bureaucratic co-creation. Development of this concept makes up the dissertation’s next key research contribution. Through this concept, the theory of customer-oriented bureaucracies is further developed. The concept also creates a basis for a critical discussion on the concept of co-creation in service research, which presupposes that citizens are freely able to influence the outcome of the processing of their case. The dissertation shows, however, that co-creation for citizens consists exclusively of routine work and control practices.
Johan Kaluza conducted his doctoral studies at CTF, Service Research Center at Karlstad University, and defended his doctoral dissertation in Business Administration at Karlstad Business School. The data was collected within the framework of a project which examines unnecessary demand at the Swedish Social Insurance Agency and the Swedish Tax Agency. The project was a collaboration between CTF, the Swedish Social Insurance Inspectorate and the Swedish Tax Agency.
