We examine the impact of a policy reform that gave public sector workers in one municipality extended rights to self-declare sickness absence. To identify the effect of bypassing the physician as an absence certifier we contrast the development of sickness absence in the reform municipality with sickness absence in similar municipalities. We use a standard difference–in–difference comparison and the synthetic control method to quantify the effect of the reform.

We find that the reform reduced sickness absence by more than 20%. The fall in sickness absence was largest for (relatively) young workers. It is the incidence of absence spells that declines, not their length.