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This thesis describes and analyses the transformation of the Swedish sickness insurance and the specific character of the modern sickness insurance system. It deals with the capacity or the sickness insurance to create social integration and cohesion.

The emergence of various voluntary sickness insurance societies at the end of the 19th century was a counter-movement and a reaction against market society and laissez-faire. In the first half of the 20th century the sickness insurance societies became increasingly regulated, state-subsidized and bureaucratized. After preparatory parliamentary committee work in the 1940s the National Sickness Insurance was introduced in 1955. This political reform process its agents and contradictions are studied in detail.

Several theoretical perspectives are used to explain the transformation of the sickness insurance: approaches that emphasize the "logic of industrialism", power resources, constitutional factors and state autonomy.

The analysis of the modern sickness insurance is organized with the help of three concepts: bureaucracy, efficiency and legitimacy. The bureaucratic character is evident. The volume and differentiation of tasks have increased. The number of employed has grown with new experts and specialized professionals. The formal hierarchy has been extended and power become more centralized.

Two aspects of efficiency are emphasized. Individual efficiency includes the scope and generosity of sickness benefits. Societal efficiency encompasses control mechanisms for sickness-related absence and administrative costs. It is argued that the development of the sickness insurance has implied expansion of individual efficiency at the expense of societal efficiency.

In terms of legitimacy the period from the 1960s until the mid-1970s the majority of the political parties, labour market organizations and the public opinion was in favour of expanding the sickness insurance. However, in recent years a shift towards more critical views of the bureaucratic form of insurance and the high level of sickness-related absence has occured.

In conclusion it is argued that the Swedish national sickness insurance programme is well integrated in the economic and wage labour systems (system integration). Increasing sickness-related absence and costs are, however, seen as signs of growing system disintegration. But on the whole the sickness insurance has been capable of creating social cohesion as all social classes are included in the same insurance programme with similar conditions for all. The system has until now enjoyed relatively wide-range support from a majority of social groups and organized interests.