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Purpose  Activation policies and efforts to reduce sick leave rates has influenced sickness insurance systems in Western countries, which has led to social security being more connected with work and attempts to expose malingering among the sickness absent. The aim of this study was to explore how power and trust are expressed by clients and stakeholders within the Swedish sickness insurance system.  Methods  This was a longitudinal qualitative study based on semi structured interviews and case files from 31 clients on sick leave in Sweden. Data was analyzed using a thematic analysis.  Results  The main theme ‘Acts of power and distrust’ illustrates how stakeholders’ express suspicions towards each other, and how clients need to demonstrate desire and efforts to return to work which other stakeholders verified.  Conclusions  The clients desire to prove themselves able to contribute to society was prominent in this study and power relations need to be acknowledged, in particular between client and the SIA. Further, to preserve citizens trust in the system, the system needs to demonstrate trust also in the clients.

Exploring Interactions in the Sickness Insurance System in Terms of Power and Trust