Sanctioning the sick: Do perceptions of activating the sick and diagnosis matter?

• Published in: Social policy & administration 2022-09, Vol.56 (5), p.726-741
• Main Authors: Bringsrud Fekjær, Silje, Børve Rasmussen, Erik, Terum, Lars Inge
• Format: Article
• Language: English
• Subjects: activation; behavioural conditionality; Compliance; disability; Health behavior; health problems; Medical diagnosis; Medicine; Perceptions; Propensity; Sanctions; sick role; subjective symptoms; vignette experiment; Welfare
• ISSN: 0144-5596; 1467-9515
• DOI: 10.1111/spol.12790

The recent inclusion of behavioural conditionality in health‐related benefit programmes raises questions about frontline workers' (FWs') discretionary use of sanctioning. Using an experimental vignette design in a survey of 824 FWs in the Norwegian Labour and Welfare Administration (NAV), we investigated whether FWs' perceptions of diagnosis and sick recipients' obligations affect their propensity to sanction for non‐compliance. We find that the recipients' diagnoses did not influence FWs' propensity to sanction for non‐compliance. Recipients with a symptom diagnosis (ME/CFS) were sanctioned to the same degree as those with a diagnosis based on objective medical evidence (Bekhterev's disease). However, FWs who generally found it difficult to impose activity requirements on recipients with health‐related problems were also less prone to enact sanctions. Our results support the notion of competing approaches to activating and sanctioning the sick. FWs who agree that it is difficult to activate the sick also tend to avoid sanctioning, whereas the propensity to sanction is more widespread among those who disagree that activating the sick is difficult.