Confidence in public institutions: A focus group study on views on the Swedish Social Insurance Agency.

BACKGROUND: From a public health perspective among the working population, it is very important that confidence in the welfare system is high, ensuring the citizens economic security and protecting them from economic stress when falling ill.

OBJECTIVE: The aim of this study was to explore how people with experience of health insurance perceive their confidence in the Swedish Social Insurance Agency (SSIA).

METHODS: Eight focus groups (n = 41) were conducted and each group met on one occasion.

RESULTS: The participants described a systemic change in the work of the SSIA where the rule-of-law was disregarded, with arbitrary assessment, and no transparency. The reception by the SSIA shaped the image of the SSIA. The participants described vulnerability in relation to the SSIA. They felt mistrusted, which left a feeling of impotence that worsened their health. Experiencing vulnerability left a strong impression and affected the participants' confidence negatively.

CONCLUSIONS: The following has to be acknowledged to prevent clients from experiencing impaired health, promote return-to-work possibilities, and to push public confidence in the institution in a more positive direction: Politicians and public administrators need to clarify the regulations. The decision-making process needs to be transparent and just. The entire procedure, including continuity as well as a personal, nice reception, has to be ensured.