Office Level Variation in Benefit Duration for Service Users Receiving Work Assessment Allowance: A Norwegian Longitudinal Multilevel Register Study

Abstract

Purpose: Long-term work disability is a key predictor of permanent disability and poses a significant challenge to public health, impacting both individuals and society. This study investigates the duration of Work Assessment Allowance (WAA) benefit across seven local Norwegian Labour and Welfare Administration (NAV) offices within a shared housing and labour marked region in Norway (Nord-Jæren). Methods: Using individual-level data covering the period 2015-2019 (n= 8,582), this study examines the association between local NAV office affiliation and WAA duration using generalized linear model regression analysis adjusted for a range of relevant individual level factors. Results: Two of the seven offices, specifically the smallest and largest NAV offices, exhibited significantly longer WAA durations compared to the medium size reference office. Individuals at these offices had 4.10 and 1.52 months longer average WAA duration, respectively, holding all other variables at their means (both p < 0.001). Moreover, the number of activation programs granted were significantly associated with WAA duration (p < 0.001). Conclusion: While residual confounding cannot be rule out, these findings suggest that local NAV offices significantly influence the duration of WAA benefit, and that there are unwarranted variations in service users’ outcomes. By understanding and addressing these variations, policy and practice adjustments can be informed to promote greater efficiency, quality, and equity in public service delivery.