Cost-effectiveness
Managing Sickness Absence
Policies and practices in an international context
ABSTRACT:
In most countries, sickness absence, absence from work due to work incapacity, is a regular topic.
Although there are periods that absence rates are low, employers or Human Resource Management
(HRM) know they constantly have to pay attention to the subject. Also on societal level sickness
absence now and then evokes concern, in particular when absence rates are rising, public
expenditures are being cut, or when incidents with sickness certification evoke public discussions.
This paper firstly informs about cross-national patterns of sicknes absence rates. Subsequently, an
overview will be given of policies and measures applied to manage (hig) sickness absence.
AUTHOR:
Rienk Prins (r.prins@astri.nl)
Managing Sickness Absence
Policies and practices in an international context
Introduction
In most countries, sickness absence, absence from work due to work incapacity, is a regular topic.
Although there are periods that absence rates are low, employers or Human Resource Management
(HRM) know they constantly have to pay attention to the subject. Also on societal level sickness
absence now and then evokes concern, in particular when absence rates are rising, public
expenditures are being cut, or when incidents with sickness certification evoke public discussions.
This paper firstly informs about cross-national patterns of sicknes absence rates. Subsequently, an
overview will be given of policies and measures applied to manage (hig) sickness absence.
Some cross national figures
In several countries there are no reliable national figures on the level of sickness absence. National
statistics often show serious restrictions, as they, for instance, only cover the days sickness benefits
have been paid (disregarding waiting days, certification rules or wage payment periods). Moreover,
often data are lacking for the civil service
Also international statistics are very poor regarding their insight into sickness absence. The only
source with some basic similarity across EU countries is based on employee surveys.
Figure 1 and 2 provide the outcomes of the Working Conditions Surveys, held by the European
Foundation for the Improvement of Working and Living Conditions (Dublin). They reflect, for a
representative sample of employees, the reported annual number of days absence from work
due to sickness.
Figure 1 Sickness absence in ‘old’ EU countries (2001)
Sickness absence days in last 12 months (2001)
18
16
16
14
12 11 11
10
DAYS
10
8 8 9
8 8
8 7 7
5 6
6
4
4
3
2
0
GR IRL SP UK L I D P F DK A B SP FIN NL
COUNTRIES
Figure 2 Sickness absence in ‘new‘ EU countries (2002)
These data show that the level of sickness absence in the ‘’old’’ EU countries is on a higher level
than in the ‘’new’’ member states. Further it can be noted that the Netherlands and Slovenia,
according to these sources, have the highest sickness absence rates.
In the light of the figures presented it is not surprising that in some countries more attention is
paid to measures to reduce sickness absence than in others. The repertoire of measures may
be classified into three categories: employer-oriented measures, employee- oriented measures
and administrative-organizational measures.
Employer oriented measures
The past 10 years in several countries measures have been taken which focus on the costs,
responsibilities and behaviour of the employer. Some examples:
a. Introduction or increasement of the period of compulsory wage payment in the initial
stage of sickness absence (e.g. in the Netherlands this period has been extended to
two years);
b. Increased opportunities for the employer to have the legitimacy of absences be
checked during the wage payment period (e.g. Germany);
c. More focus on prevention, by extending the obligation for the employer to contract
Occupational Health Services (e.g. the Netherlands);
d. Introduction of ‘Return to Work Plans’, which the employer has to make and send to
the social insurance agency, showing his efforts and plans to stimulate work
resumption (e.g. Sweden).
Measures focussing on the employee
In many countries the types of measures to restrict sickness absence were not limited to the
employer. Also a variety on measures have been taken to affect the employee behaviour or his
financial responsabilities:
a. Introduction or increase of the number of waiting days, for which the employee does
not receive any compensation in case of sickness;
b. Reduction of benefit levels in order to increase differences between wage level and
sickness benefits (e.g. Sweden);
c. Restrictions to the social partners to top up benefits, even when agreed in collective
labour agreements (e.g. Sweden);
d. Programmes focussing on prevention in the work place and in private life, e.g. by
introducing Work Place Health Promotion programmes (e.g. Germany).
Administrative measures
The largest category of measures regards reforms in social insurance administration and
procedures related to sickness absence monitoring.
These measures can further be sub-divided into three categories:
a. Activation of social insurance agencies, by means of:
o More active monitoring of the sick listed employee during his/her sickness period,
and developing profiles for selecting insured for evaluation;
o Early intervention, by inviting the employee in an early stage of his/her work
incapacity period to come to the agency and consider wprk resumption measures;
b. Increased budgets for initiating additional measures:
o Return to Work subsidies, which should stimulate the employer and employee to try
work resumption under – temporary or permanently - adapted conditions (tasks, hours,
etc.);
o Earlier medical treatment: budgets to acquiry medical or rehabilitative treatment in
order to avoid ‘waiting lists’ in health care;
c. Reorganization of medical services and role of medical experts, e.g.:
o Development of guidelines for the evaluation of work incapacity due to complex
conditions (e.g. psychosomatic complaints);
o Less reliance on information from the family doctor, and increased use of
services of independent medical experts.
Discussion topics
In the light of the experiences gathered in various countries four discussion statements have
been formulated on sickness absence policies:
1. The sick worker’s supervisor should have active role in sickness absence policy.
2. Regular contact between sick employee and organization is crucial for work resumption.
3. In most organizations adequate statistics on sickness absence are missing.
4. Family doctors and medical specialist doctors should know more about work and working
conditions of their patients.