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Martín-Román ÁL, Moral A, Pinillos-Franco S. Are women breaking the glass ceiling? A gendered analysis of the duration of sick leave in Spain. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2024; 24:107-134. [PMID: 37095293 PMCID: PMC10124936 DOI: 10.1007/s10754-023-09351-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 03/17/2023] [Indexed: 05/03/2023]
Abstract
We study the gender gap in the duration of sick leave in Spain by splitting this duration into two types of days - those which are related to biological characteristics and those derived from behavioral reasons. Using the Statistics of Accidents at Work for 2011-2019, we found that women presented longer standard durations (i.e., purely attached to physiological reasons) compared to men. However, when estimating individuals' efficiency as the ratio between actual and standard durations, we found that women were more inefficient at lower levels of income, whereas in case of men, this occurred at higher levels of income. These results were reinforced when considering that men and women do not recover from the same injury at the same rate. Women were more efficient than men across all the compensation distribution, especially at higher income levels.
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Affiliation(s)
- Ángel L Martín-Román
- Dpto. Análisis Económico, Facultad de Ciencias Sociales Jurídicas Y de La Comunicación, Universidad de Valladolid, Plaza Universidad, 40005, Segovia, Spain.
| | - Alfonso Moral
- Dpto. Análisis Económico, Facultad de Ciencias Sociales Jurídicas Y de La Comunicación, Universidad de Valladolid, Plaza Universidad, 40005, Segovia, Spain
| | - Sara Pinillos-Franco
- Dpto. Análisis Económico, Facultad de Ciencias Económicas Y Empresariales, Universidad Autónoma de Madrid, Calle Francisco Tomás Y Valiente 5, 28049, Madrid, Spain
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Salonen L, Hartikainen E, Solovieva S, Viikari-Juntura E, Leinonen T. Contribution of compositional changes in the workforce to sickness absence trends in Finland. SSM Popul Health 2023; 24:101525. [PMID: 37808232 PMCID: PMC10550613 DOI: 10.1016/j.ssmph.2023.101525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/23/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023] Open
Abstract
In this study, we assessed whether the long-term decrease in sickness absences in Finland is explained by observed and unobserved compositional changes in the workforce. Utilizing register-based panel data on Finnish wage earners aged 30-62, we examined the annual onset of compensated sickness absence (granted after 10 weekdays) in the period 2005-2016. We applied random effects models adjusting for changes in the observed sociodemographic and occupational characteristics of the study population. We also applied fixed effects models, with corrections of the estimates for cohort ageing, to additionally account for the unobserved time-invariant characteristics of the study population over the years. Of the observed characteristics, increasing educational level partly explained the decreasing trend in sickness absences, and the further contribution of the occupational class was weak. Additionally, accounting for unobserved individual characteristics further explained the decreasing trend in sickness absences among those aged 30-47 years and led to a reverse increasing trend among those aged 48-62 years irrespective of sex and employment sector. Particularly for those over 47 years old, the decrease in sickness absences appeared to be more strongly influenced by compositional changes in characteristics that are established before fully entering the labour market - such as educational level as well as unmeasured individual characteristics that remain unchanged after childhood and early adulthood - than in the work environment or other factors contributing at working age. Sickness absence trends fluctuated during economic cycles, which did not appear to be explained by immediate changes in the observed or unobserved characteristics. Different mechanisms are likely to explain long-term sickness absence trends and trends around economic cycles. Attempts to improve work ability and labour market inclusion in long-term should rely more on increasing educational levels among the workforce and on interventions carried out early during the life course.
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Affiliation(s)
- Laura Salonen
- Finnish Institute of Occupational Health, 00032, Helsinki, Finland
| | - Elli Hartikainen
- Finnish Institute of Occupational Health, 00032, Helsinki, Finland
| | | | | | - Taina Leinonen
- Finnish Institute of Occupational Health, 00032, Helsinki, Finland
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Reini K, Saarela J. Birth order and sickness absence: Register-based evidence from Finland. PLoS One 2023; 18:e0280532. [PMID: 36649355 PMCID: PMC9844843 DOI: 10.1371/journal.pone.0280532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/29/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND In working ages, sickness absence is strongly related to persons' health condition. We studied how birth order was associated with receipt of sickness allowance, distinguishing between mental disorders, musculoskeletal disorders and injuries. METHODS A follow-up study based on the entire Finnish population was conducted for sibling groups born 1969-1982, in which each sibling was observed from age 35 years in the period 2004-2018. Focus was on within-family variation in first-time sickness allowance receipt. RESULTS Results of stratified Cox regressions revealed that each increase in birth order was associated with a slightly higher risk of sickness absence from any cause. For mental disorders, associations were stronger; the hazard ratio as compared to first borns was 1.03 (95% CI: 0.98-1.08) of second borns, 1.10 (0.99-1.22) of third borns, and 1.52 (1.25-1.85) of fourth or higher borns. Corresponding numbers for musculoskeletal disorders were 1.12 (1.07-1.17), 1.19 (1.09-1.30) and 1.15 (0.96-1.38), and for injuries 1.06 (1.01-1.12), 1.09 (1.21-1.14) and 0.96 (0.77-1.20), respectively. CONCLUSIONS Birth order effects were generally stronger for women than men, and to some extent influenced by educational level, occupation, income, and family composition. Possible latent mechanisms behind the associations may relate to within-family dynamics at childhood.
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Affiliation(s)
- Kaarina Reini
- Demography Unit, Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland
- * E-mail:
| | - Jan Saarela
- Demography Unit, Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland
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Karlsson EA, Sandqvist JL, Seing I, Ståhl C. Exploring Interactions in the Sickness Insurance System in Terms of Power and Trust. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:483-493. [PMID: 34935082 PMCID: PMC9576653 DOI: 10.1007/s10926-021-10017-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
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.
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Affiliation(s)
- Elin A Karlsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Jan L Sandqvist
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Ida Seing
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Christian Ståhl
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
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Blomgren J, Laaksonen M, Perhoniemi R. Changes in Unemployment Affect Sickness Absence and Disability Retirement Rates: A Municipality-Level Panel Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126359. [PMID: 34208260 PMCID: PMC8296176 DOI: 10.3390/ijerph18126359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 11/25/2022]
Abstract
To enhance understanding of the interplay between unemployment and sickness absence and disability retirement, the aim of this study was to examine how changes in area-level unemployment rates are associated with changes in sickness absence and disability retirement rates in a longitudinal setting. Municipality-level time-series data were collected on unemployment, sickness absence, disability retirement and covariates from databases for Finnish municipalities for years 2003–2017 (n = 4425 municipality–year observations). Fixed effects panel regression models were used to analyse how changes in unemployment rates predict changes in sickness absence and disability retirement rates when comparing consecutive years. The results showed that when examining yearly cross-sections, a higher level of unemployment in the municipality was associated with higher sickness absence and disability retirement rates. However, longitudinal assessment of consecutive years with panel regression models showed that a one percentage point increase in the municipality-level unemployment rate was associated with a decrease both in the sickness absence rate (−1.3%, p < 0.001) and in the disability retirement rate (−2.1%, p = 0.011), adjusted for simultaneous changes in demographic and socio-economic covariates, morbidity and economic situation of the municipality. The results indicate that unemployment and disability benefits partly act as substitutes for each other. Unemployment and disability rates should be assessed together to reach a more complete understanding of the level of non-employment overall and in different areas.
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Affiliation(s)
- Jenni Blomgren
- The Social Insurance Institution of Finland, Nordenskiöldinkatu 12, 00250 Helsinki, Finland;
- Correspondence:
| | - Mikko Laaksonen
- Finnish Centre for Pensions, Tukkutorinkuja 5, 00580 Helsinki, Finland;
| | - Riku Perhoniemi
- The Social Insurance Institution of Finland, Nordenskiöldinkatu 12, 00250 Helsinki, Finland;
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Blomgren J, Perhoniemi R. Increase in sickness absence due to mental disorders in Finland: trends by gender, age and diagnostic group in 2005-2019. Scand J Public Health 2021; 50:318-322. [PMID: 33615899 PMCID: PMC9096587 DOI: 10.1177/1403494821993705] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Mental disorders are among the key public health challenges and cause a significant share of sickness absence. The aim of this study was to examine gender and age-specific trends in sickness absence in Finland among non-retired persons aged 16-67 years during 2005-2019 by main diagnostic groups. Special focus was put on the development of sickness absence due to mental and behavioural disorders. METHODS Data on compensated sickness allowance days were retrieved from the database of the Social Insurance Institution of Finland, and data on the non-retired population aged 16-67 years from the database of Statistics Finland for years 2005-2019. Yearly age-standardised sickness absence rates (yearly sickness absence days per each person in the population at risk) according to diagnostic group were calculated for women and men in age groups 16-34, 35-49 and 50-67 years. RESULTS A steep increase in sickness absence due to mental disorders was observed between 2016 and 2019 in all age groups among both genders, but the increase was more prominent among women. The age group 16-34 years also showed a longer-term gradual increase. In all examined gender and age groups, the increase was mainly a consequence of an increase in sickness absence due to depression and anxiety disorders. CONCLUSIONS Increase in sickness absence due to mental disorders is an early sign of threats to work ability and productivity of the working-age population. Several factors may simultaneously drive the development. The specific reasons for the recent trend need to be studied.
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Affiliation(s)
- Jenni Blomgren
- Research Unit, The Social Insurance Institution of Finland (Kela), Helsinki, Finland
| | - Riku Perhoniemi
- Research Unit, The Social Insurance Institution of Finland (Kela), Helsinki, Finland
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Turunen J, Karhula K, Ropponen A, Koskinen A, Hakola T, Puttonen S, Hämäläinen K, Pehkonen J, Härmä M. The effects of using participatory working time scheduling software on sickness absence: A difference-in-differences study. Int J Nurs Stud 2020; 112:103716. [DOI: 10.1016/j.ijnurstu.2020.103716] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 01/18/2023]
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Employment Vulnerability of People With Severe Mental Illness. Health Policy 2020; 125:269-275. [PMID: 33422335 DOI: 10.1016/j.healthpol.2020.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 10/05/2020] [Accepted: 10/18/2020] [Indexed: 11/22/2022]
Abstract
Using French longitudinal register data, we compare the evolution of employment rates of persons with severe chronic mental illness, before and after the first medico-administrative recognition of the illness by the Statutory Health Insurance (SHI), with that of people without recognised mental illness. The study focuses on persons of working age having a work history before recognition. Our empirical approach relies on a double difference method with coarsened exact matching. Before illness recognition subjects had lower employment rates than those without mental illness but relatively high, reflecting their initial employment attachment. Results indicate that employment rates decrease sharply after recognition. A large employment rate gap between persons with and without severe mental illness develops during the four years following recognition. We examine whether the magnitude of the decrease is sensitive to the macroeconomic context. Findings show that the decline in employment rates was significantly more pronounced during the Great Recession compared with the pre-crisis period, amongst women. As a conclusion, this study points out that implementing coordinated early health and labour policies in the phase of the entry into the chronic-illness insurance scheme of the SHI might play a key role in preventing the detrimental effects of illness on economic and social conditions of persons with severe mental illnesses.
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How Are Patients Accessing Primary Care Within the Patient-Centered Medical Home? Results From the Veterans Health Administration. J Ambul Care Manage 2019; 41:194-203. [PMID: 29847406 DOI: 10.1097/jac.0000000000000241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The patient-centered medical home (PCMH) expands access by providing care same-day, by phone, and after hours; however, little is known about which patients seek these services. We examined the association of patient, clinical, and local economic characteristics with the self-reported use of 5 routine and nonroutine ways to access primary care within the Veterans Health Administration. We identified sets of characteristics, including gender- and age-specific, racial and ethnic, and socioeconomic differences of how veterans report seeking primary care. As the PCMH model develops, it will be important to further understand the differential demand for these services to optimize patient-centered access.
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Kausto J, Verbeek JH, Ruotsalainen JH, Halonen JI, Virta LJ, Kankaanpää E. Self-certification versus physician certification of sick leave for reducing sickness absence and associated costs. Cochrane Database Syst Rev 2019; 5:CD013098. [PMID: 31087323 PMCID: PMC6514432 DOI: 10.1002/14651858.cd013098.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND From the societal and employers' perspectives, sickness absence has a large economic impact. Internationally, there is variation in sickness certification practices. However, in most countries a physician's certificate of illness or reduced work ability is needed at some point of sickness absence. In many countries, there is a time period of varying length called the 'self-certification period' at the beginning of sickness absence. During that time a worker is not obliged to provide his or her employer a medical certificate and it is usually enough that the employee notifies his or her supervisor when taken ill. Self-certification can be introduced at organisational, regional, or national level. OBJECTIVES To evaluate the effects of introducing, abolishing, or changing the period of self-certification of sickness absence on: the total or average duration (number of sickness absence days) of short-term sickness absence periods; the frequency of short-term sickness absence periods; the associated costs (of sickness absence and (occupational) health care); and social climate, supervisor involvement, and workload or presenteeism (see Figure 1). SEARCH METHODS We conducted a systematic literature search to identify all potentially eligible published and unpublished studies. We adapted the search strategy developed for MEDLINE for use in the other electronic databases. We also searched for unpublished trials on ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP). We used Google Scholar for exploratory searches. SELECTION CRITERIA We considered randomised controlled trials (RCTs), controlled before-after (CBA) studies, and interrupted time-series (ITS) studies for inclusion. We included studies carried out with individual employees or insured workers. We also included studies in which participants were addressed at the aggregate level of organisations, companies, municipalities, healthcare settings, or general populations. We included studies evaluating the effects of introducing, abolishing, or changing the period of self-certification of sickness absence. DATA COLLECTION AND ANALYSIS We conducted a systematic literature search up to 14 June 2018. We calculated missing data from other data reported by the authors. We intended to perform a random-effects meta-analysis, but the studies were too different to enable meta-analysis. MAIN RESULTS We screened 6091 records for inclusion. Five studies fulfilled our inclusion criteria: one is an RCT and four are CBA studies. One study from Sweden changed the period of self-certification in 1985 in two districts for all insured inhabitants. Three studies from Norway conducted between 2001 and 2014 changed the period of self-certification in municipalities for all or part of the workers. One study from 1969 introduced self-certification for all manual workers of an oil refinery in the UK.Longer compared to shorter self-certificationfor reducing sickness absence in workersOutcome: average duration of sickness absence periodsExtending the period of self-certification from one week to two weeks produced a higher mean duration of sickness absence periods: mean difference in change values between the intervention and control group (MDchange) was 0.67 days/period up to 29 days (95% confidence interval (95% CI) 0.55 to 0.79; 1 RCT; low-certainty evidence).The introduction of self-certification for a maximum of three days produced a lower mean duration of sickness absence up to three days (MDchange -0.32 days/period, 95% CI -0.39 to -0.25; 1 CBA study; very low-certainty evidence). The authors of a different study reported that prolonging self-certification from ≤ 3 days to ≤ 365 days did not lead to a change, but they did not provide numerical data (very low-certainty evidence). OUTCOME number of sickness absence periods per workerExtending the period of self-certification from one week to two weeks resulted in no difference in the number of sickness absence periods in one RCT, but the authors did not report numerical data (low-certainty evidence).The introduction of self-certification for a maximum of three days produced a higher mean number of sickness absence periods lasting up to three days (MDchange 0.48 periods, 95% CI 0.33 to 0.63) in one CBA study (very low-certainty evidence).Extending the period of self-certification from three days to up to a year decreased the number of periods in one CBA study, but the authors did not report data (very low-certainty evidence). OUTCOME average lost work time per 100 person-yearsExtending the period of self-certification from one week to two weeks resulted in an inferred increase in lost work time in one RCT (very low-certainty evidence).Extending the period of self-certification (introduction of self-certification for a maximum of three days (from zero to three days) and from three days to five days, respectively) resulted in more work time lost due to sickness absence periods lasting up to three days in two CBA studies that could not be pooled (MDchange 0.54 days/person-year, 95% CI 0.47 to 0.61; and MDchange 1.38 days/person-year, 95% CI 1.16 to 1.60; very low-certainty evidence).Extending the period of self-certification from three days up to 50 days led to 0.65 days less lost work time in one CBA study, based on absence periods lasting between four and 16 days. Extending the period of self-certification from three days up to 365 days resulted in less work time lost due to sickness absence periods longer than 16 days (MDchange -2.84 days, 95% CI -3.35 to -2.33; 1 CBA study; very low-certainty evidence). OUTCOME costs of sickness absence and physician certificationOne RCT reported that the higher costs of sickness absence benefits incurred by extending the period of self-certification far outweighed the possible reduction in costs of fewer physician appointments by almost six to one (low-certainty evidence).In summary, we found very low-certainty evidence that introducing self-certification of sickness absence or prolonging the self-certification period has inconsistent effects on the mean number of sickness absence days, the number of sickness absence periods, and on lost work time due to sickness absence periods. AUTHORS' CONCLUSIONS There is low- to very low-certainty evidence of inconsistent effects of changing the period of self-certification on the duration or frequency of short-term sickness absence periods or the amount of work time lost due to sickness absence. Because the evidence is of low or very low certainty, more and better studies are needed.
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Affiliation(s)
- Johanna Kausto
- Finnish Institute of Occupational HealthP.O. Box 40TYÖTERVEYSLAITOSFinlandFI‐00032
| | - Jos H Verbeek
- Finnish Institute of Occupational HealthCochrane Work Review GroupTYÖTERVEYSLAITOSFinlandFI‐70032
| | - Jani H Ruotsalainen
- Finnish Institute of Occupational HealthCochrane Work Review GroupTYÖTERVEYSLAITOSFinlandFI‐70032
| | - Jaana I Halonen
- Finnish Institute of Occupational HealthP.O. Box 40TYÖTERVEYSLAITOSFinlandFI‐00032
| | - Lauri J Virta
- Social Insurance Institution of Finland (Kela)TurkuFinland
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Biscardo CA, Bucciol A, Pertile P. Job sick leave: Detecting opportunistic behavior. HEALTH ECONOMICS 2019; 28:373-386. [PMID: 30562844 DOI: 10.1002/hec.3850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 09/26/2018] [Accepted: 10/23/2018] [Indexed: 06/09/2023]
Abstract
We utilize a large administrative dataset of sickness leave in Italy (a) to investigate whether private firms are more effective than the public insurer in choosing who to monitor and (b) to study the correlation between potentially opportunistic behavior and the observable characteristics of the employee. We find that private employers are more likely to select into monitoring employees who are fit for work despite being on sick leave, if the public insurer is not supported by any data-driven tool. However, the use of a scoring mechanism, based on past records, allows the public insurer to be as effective as the employer. This result suggests that the application of machine learning to appropriate databases may improve the targeting of public monitoring to detect opportunistic behavior. Concerning the association between observable characteristics and potentially opportunistic behavior, we find that males, employees younger than 50, those on short leaves, or without a history of illness are more likely to be found fit for work.
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Affiliation(s)
| | | | - Paolo Pertile
- Department of Economics, University of Verona, Verona, Italy
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Baert S, van der Klaauw B, van Lomwel G. The effectiveness of medical and vocational interventions for reducing sick leave of self-employed workers. HEALTH ECONOMICS 2018; 27:e139-e152. [PMID: 28833846 DOI: 10.1002/hec.3578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 06/16/2017] [Accepted: 07/19/2017] [Indexed: 06/07/2023]
Abstract
We investigate whether interventions by (a) medical doctors and (b) occupational specialists are effective in reducing sick leave durations among self-employed workers. Therefore, we exploit unique administrative data comprising all sick leave claims by self-employed workers insured with a major Dutch private insurer between January 2009 and March 2014. We estimate a multivariate duration model dealing with nonrandom selection into the two intervention types by controlling for observable and unobservable claimant characteristics. We find adverse treatment effects for both interventions, irrespective of whether they are started early or (middle) late in the sickness spell.
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Affiliation(s)
- Stijn Baert
- Ghent University, Ghent, Belgium
- University of Antwerp, Antwerp, Belgium
- Université catholique de Louvain, Louvain-la-Neuve, Belgium
- Institute for the Study of Labor (IZA), Bonn, Germany
| | - Bas van der Klaauw
- VU University Amsterdam, Amsterdam, The Netherlands
- Tinbergen Institute, Amsterdam, The Netherlands
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13
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Martín-Román Á, Moral A. A methodological proposal to evaluate the cost of duration moral hazard in workplace accident insurance. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:1181-1198. [PMID: 28224308 DOI: 10.1007/s10198-017-0878-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 02/10/2017] [Indexed: 06/06/2023]
Abstract
The cost of duration moral hazard in workplace accident insurance has been amply explored by North-American scholars. Given the current context of financial constraints in public accounts, and particularly in the Social Security system, we feel that the issue merits inquiry in the case of Spain. The present research posits a methodological proposal using the econometric technique of stochastic frontiers, which allows us to break down the duration of work-related leave into what we term "economic days" and "medical days". Our calculations indicate that during the 9-year period spanning 2005-2013, the cost of sick leave amongst full-time salaried workers amounted to 6920 million Euros (in constant 2011 Euros). Of this total, and bearing in mind that "economic days" are those attributable to duration moral hazard, over 3000 million Euros might be linked to workplace absenteeism. It is on this figure where economic policy measures might prove more effective.
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Affiliation(s)
- Ángel Martín-Román
- Department of Economic Analysis, Facultad de Ciencias Sociales, Jurídicas y de la Comunicación, University of Valladolid, Plaza del Alto de los Leones, 1, 40001, Segovia, Spain.
| | - Alfonso Moral
- Department of Economic Analysis, Facultad de Ciencias Sociales, Jurídicas y de la Comunicación, University of Valladolid, Plaza del Alto de los Leones, 1, 40001, Segovia, Spain
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Sumanen H, Pietiläinen O, Mänty M. Self-Certified Sickness Absence among Young Municipal Employees-Changes from 2002 to 2016 and Occupational Class Differences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14101131. [PMID: 28954443 PMCID: PMC5664632 DOI: 10.3390/ijerph14101131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 09/17/2017] [Accepted: 09/23/2017] [Indexed: 11/23/2022]
Abstract
We examined changes in self-certified, one-to-three day sickness absence (SA) among young employees from 2002 to 2016 and the magnitude of occupational class differences during that period. All 18–34-year-old employees of the City of Helsinki, Finland were included (2002–2016, n = ~11,725 per year). Employer’s personnel and SA registers were used. Occupational class was categorized to four groups. Changes in self-certified SA from 2002 to 2016 were analyzed with Joinpoint regression and the magnitudes of occupational class differences were estimated with the relative index of inequality (RII). Most of the trends first increased and turned to decrease in 2007/2010. Managers and professionals had the least amount of SA, but steadily increasing trends were observed among men. Self-certified SA followed only partially the typical socioeconomic gradient, as routine non-manuals had the highest levels of SA. The magnitude of occupational class differences in self-certified SA was stable during the study period only among women. Self-certified SA and occupational class differences have increased in recent years among men in the lower occupational classes. Socioeconomic differences exist in self-certified SA among young employees, but gradient is only partial. Overall, high amounts of self-certified SA especially in the lower occupational classes require further studies and preventive measures.
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Affiliation(s)
- Hilla Sumanen
- Department of Public Health, University of Helsinki, P.O. Box 20 (Tukholmankatu 8B), FIN-00014 Helsinki, Finland.
- Department of Health Care and Emergency Care, South-Eastern Finland University of Applied Sciences, FIN-48220 Kotka, Finland.
| | - Olli Pietiläinen
- Department of Public Health, University of Helsinki, P.O. Box 20 (Tukholmankatu 8B), FIN-00014 Helsinki, Finland.
| | - Minna Mänty
- Department of Public Health, University of Helsinki, P.O. Box 20 (Tukholmankatu 8B), FIN-00014 Helsinki, Finland.
- Department of Research, Development and Innovation, Laurea University of Applied Sciences, FIN-01300 Vantaa, Finland.
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15
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Pekkala J, Blomgren J, Pietiläinen O, Lahelma E, Rahkonen O. Occupational class differences in long sickness absence: a register-based study of 2.1 million Finnish women and men in 1996-2013. BMJ Open 2017; 7:e014325. [PMID: 28729307 PMCID: PMC5642757 DOI: 10.1136/bmjopen-2016-014325] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Sickness absence is consistently higher in lower occupational classes, but attempts to analyse changes over time in socioeconomic differences are scarce. We examined trends in medically certified sickness absence by occupational class in Finland from 1996 to 2013 and assessed the magnitude and changes in absolute and relative occupational class differences. DESIGN Population-based, repeated cross-sectional study. SETTING A 70% random sample of Finns aged between 25 and 63 years in the years 1996-2013. PARTICIPANTS The study focused on 25- to 63 year-old female (n between 572 246 and 690 925) and male (n between 525 698 and 644 425) upper and lower non-manual and manual workers. Disability and old age pensioners, students, the unemployed, entrepreneurs and farmers were excluded. The analyses covered 2 160 084 persons, that is, 77% of the random sample.For primary and secondary outcome measures, we examined yearly prevalence of over 10 working days long sickness absence by occupational class. The Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) were used to assess the magnitude and changes in occupational class differences. RESULTS Compared with mid-1990s, sickness absence prevalence was slightly lower in 2013 in all occupational classes except for female lower non-manual workers. Hierarchical occupational class differences in sickness absence were found. Absolute differences (SII) peaked in 2005 in both women (0.12, 95% CI 0.12 to 0.13) and men (0.15, 95% CI 0.14 to 0.15) but reached the previous level in women by 2009 and decreased modestly in men until 2013. Relative differences narrowed over time (p<0.001) but levelled off by 2013. CONCLUSIONS Sickness absence prevalence is currently slightly lower in almost all occupational classes than in the mid-1990s, but occupational class differences have remained large. Ill health and poor working conditions especially in the lower occupational classes should be targeted in order to reduce sickness absence and to achieve longer working lives.
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Affiliation(s)
- Johanna Pekkala
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jenni Blomgren
- The Social Insurance Institution of Finland, Helsinki, Finland
| | - Olli Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Aaviksoo E, Kiivet RA. Influence of the sickness benefit reform on sickness absence. Health Policy 2016; 120:1070-8. [PMID: 27498065 DOI: 10.1016/j.healthpol.2016.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 07/15/2016] [Accepted: 07/19/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To analyse short-term changes in sick-leave use after the implementation of sick-pay cut policy in Estonia on July 1, 2009. METHODS The study is based on all sick-leave episodes of 20-64-year-old employees registered by the Estonian Health Insurance Fund in 2008 and 2011, which covers 227,981 persons in 2008 and 152,102 persons in 2011. Population- and absentee-level sickness absence measures were used to describe sickness absence. Multiple logistic regression analysis was performed to explore associations between sick-pay cut and sickness absence measures. RESULTS The main impact of the reform was that the total number of sick-leave episodes and sick-listed persons decreased by one third. The number of sick leave episodes lasting 4-20days decreased by half whereas the change in shorter and longer episodes was negligible. Chances of recurrent sick-leave lowered significantly. The mean duration of sick-leave episodes lengthened in a positive correlation with age. CONCLUSION At the population level sickness absence decreased after the sick-pay cut, which was one of the goals of the reform. The sickness absence of absentees with long-lasting illnesses did not change, but people with shorter illnesses adapted their sickness absence behaviour. It indicates that health outcomes of people whose absence has decreased due to policy changes need to be followed.
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Affiliation(s)
- Evelyn Aaviksoo
- University of Tartu, Department of Public Health, Ravila 19, 50411 Tartu, Estonia.
| | - Raul Allan Kiivet
- University of Tartu, Department of Public Health, Ravila 19, 50411 Tartu, Estonia.
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17
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Oke A, Braithwaite P, Antai D. Sickness Absence and Precarious Employment: A Comparative Cross-National Study of Denmark, Finland, Sweden, and Norway. THE INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE 2016; 7:125-47. [PMID: 27393320 PMCID: PMC6818083 DOI: 10.15171/ijoem.2016.713] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 05/18/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Precarious employment is a major social determinant of health and health inequalities with effects beyond the health of workers. OBJECTIVE To investigate the association between precarious employment and sickness absence in 4 Nordic countries, Denmark, Finland, Norway, and Sweden. METHODS Logistic regression analyses were conducted separately for each country on data from 4186 respondents aged 15-65 years in Denmark, Finland, Norway, and Sweden derived from the 2010 European Working Conditions Survey. Sickness absence was based on self-reports and defined as absence of seven or more day per year. Precarious employment was operationalized as a multidimensional construct of indicators. Analyses were also conducted separately for men and women. RESULTS The prevalence of sickness absence was lowest in Sweden (18%), and highest in Finland (28%). 3 precarious employment indicators were positively associated with sickness absence; the pattern being largely similar in the total sample. In the sex-disaggregated sample, 5 precarious employment indicators increased the likelihood of sickness absence; the pattern was heterogeneous, with women generally having significantly higher odds of sickness absence than men. "Low household income" and "sickness presenteeism" were strong predictors of sickness absence among both sexes in most of the 4 studied countries. Sickness absence varied between the Nordic countries in the sex-disaggregated analyses. CONCLUSION Precarious employment indicators predicted sickness absence in the Nordic countries. Findings emphasize the need to prioritize informed and monitored collective bargaining for all workers, increase working time flexibility, and improving work conditions.
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Affiliation(s)
- A Oke
- Division of Global Health and Inequalities, The Angels Trust - Nigeria, Abuja, Nigeria.
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