Social Insurance Agency - A Report With High Productivity And Quality

Transcription

1 ISF Report 2014:24 Productivity and quality at the Swedish Social Insurance Agency Swedish Social Insurance Inspectorate Stockholm 2014 Inspektionen för socialförsäkringen Authors: Magnus Medelberg (project manager), Martin Söder and Jonas Thelander 1

2 Summary The Swedish Social Insurance Inspectorate (Inspektionen för socialförsäkringen, ISF) is an independent supervisory agency for the Swedish social insurance system. The objectives of the agency are to strengthen compliance with legislation and other statutes, and to improve the efficiency of the social insurance system through system supervision and efficiency analysis and evaluation. The ISF s work is mainly conducted on a project basis and is commissioned by the Government or initiated autonomously by the agency. This report has been initiated by the agency. Background, methods and objectives In this report productivity, processing times and quality in the case handling at the Swedish Social Insurance Agency s (henceforth referred to as the Agency) local insurance centres (LFC) was studied. The analyses are based on data from the year 2012 regarding three disability benefits: Disability Allowance, Care Allowance and Assistance Compensation. All 45 LFCs which were processing the disability benefits in 2012 are included in the study. Two general questions were posed: 1. Is there a correlation between productivity, processing times and quality? Do units (LFCs) with high productivity and short processing times have an inferior quality of decision making? 2. If some units can combine short processing times and high productivity with high quality, what characterises them? 2

3 In this study several analyses of the LFC s case handling are performed and considered together: Analysis of the results of LFCs regarding productivity, processing times and different quality measures. Analysis of background data about the LFCs, their staff composition and results from employee surveys. Analysis of external factors such as the socio-economic structure of those who had applied for the benefits. A review of case files has also been conducted. Three LFCs were selected based on their good results regarding productivity, processing times and available quality measures. Cases handled at these three LFCs were compared with cases handled at the other 42 LFCs (the control group). All in all, more than 600 case files were reviewed. Interviews were performed with managers and controllers at the four regional centres in charge of the LFCs as well as with managers and case workers at the three LFCs that were selected for a more in-depth case study based on their aboveaverage results. Findings Higher productivity and shorter processing times do not taint quality The quantitative analyses do not support the thesis that LFCs with high productivity and short processing times are of inferior quality regarding investigations and decisions compared to other LFCs. Several different ways of measuring productivity, processing times and quality were tested. In most cases, no correlation at all was observed. The only significant correlation was that LFCs with higher productivity had, on average, a lower percentage of amended decisions in the Agency s internal reassessment units, which instead can be seen as an indicator of higher quality decisions among the most productive LFCs. 3

4 Furthermore, neither the study of case files nor the interviews indicated that LFCs with high productivity and short processing times produced lower quality decisions. On the other hand, several interviewees saw it as natural that successful LFCs should be able to manage to balance different objectives against each other. Many factors forming part of the explanation as to why some LFCs have better results than others Why some LFCs in general have better results than others is a complex question. Much of the explanation for the differences between the LFCs can probably be attributed to factors that are not easily measured and quantified. Interviewees mention many different, and sometimes interdependent, factors such as management, staff composition and good collaboration between the professionals in the administration process. A pervading theme in the interviews is a sort of positive spiral where success breeds success: LFCs who have reached a high level of performance are in a better position to work efficiently. Interviewed officials and managers at the three LFCs with good results also mentioned some common points in organization and work procedures among these three LFCs: e.g. that administrative officials start processing cases as soon as possible after an application has been received at the LFC, and close (informal) collaboration between different professional roles at the LFC such as administrative officials, insurance specialists and medical insurance advisors (FMR). Several quantitative analyses have also been performed. The only really powerful correlation found is between good results and administrative official content. It seems obvious that the staff will be more satisfied when conditions to do a good job and achieve good results are in place. The interviewees also emphasized that good results in themselves can make employees more satisfied. On the other hand, the quantitative analyses wholly or partly contradicted two factors associated with inferior results that have been mentioned in several interviews. Having a higher proportion of newly recruited administrative officials did not correlate with inferior results. And although larger LFCs on average are slightly more productive, there seem to be no clear correlation between LFC size and results. 4

5 Finally, external factors also seem to be part of the explanation for the difference in results between LFCs. Both differences in local conditions such as the LFC s collaboration (or lack thereof) with municipalities, health care providers and assistance providers, and differences in socio-economic factors such as the level of education or income among the applicants have been analysed. As an example of the latter, LFCs where the clients on average have a higher income also have shorter processing times. The differences in rejection rates between LFCs need to be investigated further Another result from the study was that there are substantial differences in rejection rates between different LFCs. For example, the approval rate for assistance compensation varies between 17 and 68 percent. The differences are of the same magnitude for the other disability benefits studied. These variations are difficult to explain even for the Agency, and it is of major importance to ensure that these differences in assessment level between different LFCs are analysed further. Importance of considering the role of approval rates when customer satisfaction is used as measure of success An interesting observation made in this study is the powerful correlation between the level of approved cases and the results from the client survey: LFCs with a high level of approved cases on average receive higher client ratings. The correlation is not surprising. Earlier studies have showed large differences in client satisfaction, depending on whether the client has been granted the benefit or not. It is important that the Agency takes this correlation into consideration when working with management and following up. This does not only concern the benefits studied in this report. The Agency has highlighted the objective that increasing client confidence in the Agency should become the overriding goal in the business plan for There is a potential conflict between correct decisions and client satisfaction, or at least between stable insurance assessment levels and the clients desire to be granted the benefits applied for. Generous assessment levels, even if they are within the limits of applicable laws and regulations, can also have a major impact on insurance costs. 5

6 6