The market for paid sick leave

In many countries, general practitioners (GPs) are assigned the task of controlling the validity of their own patients’ insurance claims. At the same time, they operate in a market where patients are customers free to choose their GP. Are these roles compatible? Can we trust that the gatekeeping decisions are untainted by private economic interests? Based on administrative registers from Norway with records on sick pay certification and GP-patient relationships, we present evidence to the contrary: GPs are more lenient gatekeepers the more competitive is the physician market, and a reputation for lenient gatekeeping increases the demand for their services.     

Prescription of temporary sick leave to pregnant women in the absence of legal provisions]

Swiss legislation doesn't provide any maternity leave for pregnant women before the day of delivery. A retrospective study of 550 women who had just delivered, showed that in the absence of such provisions, 48.9% of women who worked during their pregnancy had been given temporary sick leaves by their physician on one or more occasion. The decision of giving such sick leave depends primarily on whether or not the woman presents obstetrical risks and is not systematic. The frequency of sick leaves increases also with job load. Finally, the attitude of each woman, related to her personal characteristics, her degree of satisfaction at work and her job security, are other deciding factors for prescribing sick leave.     

Setting trouble-free policies for parental and sick leave

Parental and sick leave are medical staff benefits that can lead to all kinds of problems. This article offers specific guidance for heading off the most common and difficult problems, focusing particularly on ways to provide fair benefits to employees who need them without inviting unnecessary absences and policy abuse. It reviews typical medical practice sick leave policies as well as four creative strategies for encouraging and rewarding excellent attendance and deterring abuse. In addition, this article suggests ways to structure a parental leave policy that will not only be fair to employees but also help the practice fulfill its legal obligations.     

病假条网上淘？

近日，网络上热传一则名为“史上最悍然的淘宝商品”的帖子，这个最悍然商品其实就是北京同仁医院的病假条，每张标价80元。发帖人还注明，同学的家长是北京同仁医院的大夫，绝对保真，且数量有限，欲买从速。     

Supraspinatus tendon affection and sick leave

Rotator cuff disease, among others damage of the supraspinatus tendon mainly caused by work overload, is a common problem in the population resulting in a high incidence of sick leaves. In the present survey we sought to compare the need for sick leaves in relation to different stages of supraspinatus tendon affection and in relation to five different groups of workers. Our study counted with the participation of patients who were diagnosed with this condition. The individuals were grouped according to stages of the disease (tendonitis, partial rupture, total rupture) and according to the biomechanical aspects of their occupation (general services, civil construction, domestic workers, farm workers and security guard services). Statistical analysis was performed using Pearson's chi-square test, dependence analysis and exact test. Results revealed that 62 (55%) of the individuals were on sick leave. The highest rates of sick leaves according to Pearson's test occurred in the groups general services (38.71%) and farm workers (22.58%). According to the dependence analysis, tendonitis (p<0.05) was the most frequent reason for sick leaves and, according to Pearson's test, farm work seems to keep the individual for a longer space of time unfit for duty (p=0.02).     

Measuring sick leave: a comparison of self-reported data on sick leave and data from company records

The objective of this study was to compare sick leave data obtained from questionnaires with data from company records. During a period of 12 months, questionnaires were completed monthly for 6 months and then at 9 and 12 months. The sensitivity and specificity of questionnaires for detecting an episode of sick leave were determined, using the company records as a reference standard. In addition, the duration of sick leave episodes reported in the two data sets was compared. In this analysis, company records were not assumed to be superior, and agreement was assessed with intraclass correlation coefficients (ICCs). The sensitivity of questionnaires for detecting an episode of sick leave was 55% (95% CI = 0.50-0.60) and the specificity 83% (95% CI = 0.72-0.94). The ICC for all episodes was 0.58 (95% CI = 0.47-0.67). The only satisfactory ICC (0.87; 95% CI = 0.74-0.93) was found for the questionnaires at 9 and 12 months. No large systematic differences were found between the duration of episodes reported in the two data sets. In conclusion, in our study, the sensitivity of questionnaires for detecting an episode of sick leave was very low. Furthermore, when episodes were recalled, there was little agreement on the duration of the episode between questionnaire data and data in the company records. Based on these results and considering the risk of missing questionnaires, data on sick leave gathered from company records are clearly preferable as an outcome measure in research.     

Experiences within the process of sick leave

The aim of this study was to explore what individuals who have been on sick leave experienced as important in the process of returning to work, moving to long-term sick leave, or receiving a disability pension. Grounded Theory was used for interpreting interviews with 15 people who had been on sick leave four years previously. In the results four ideal types were crystallized which are presented in the form of vignettes. The ideal types were discussed focusing on occupational life using the Model of Human Occupation and the theories of Sense of Coherence and Status Passage. The study provided a deeper understanding of people's experiences during the process of their sick leave. Valuable predictors for re-entry into work or disability retirement were: individual mental resources; clear or unclear diagnosis; how long had been spent in the sick-leave process; and personal belief in an ability to work in the future. The interventions and support given by professionals and the social environment, the balance and sense of coherence in life, and participation in the sick leave process were also important. The idealtypes found could be helpful to professionals working in this field in deepening their understanding of the clients.     

Experiences within the process of sick leave

The aim of this study was to explore what individuals who have been on sick leave experienced as important in the process of returning to work, moving to long-term sick leave, or receiving a disability pension. Grounded Theory was used for interpreting interviews with 15 people who had been on sick leave four years previously. In the results four ideal types were crystallized which are presented in the form of vignettes. The ideal types were discussed focusing on occupational life using the Model of Human Occupation and the theories of Sense of Coherence and Status Passage. The study provided a deeper understanding of people's experiences during the process of their sick leave. Valuable predictors for re-entry into work or disability retirement were: individual mental resources; clear or unclear diagnosis; how long had been spent in the sick-leave process; and personal belief in an ability to work in the future. The interventions and support given by professionals and the social environment, the balance and sense of coherence in life, and participation in the sick leave process were also important. The idealtypes found could be helpful to professionals working in this field in deepening their understanding of the clients.     

Validation of sick leave measures: self-reported sick leave and sickness benefit data from a Danish national register compared to multiple workplace-registered sick leave spells in a Danish municipality

ABSTRACT: BACKGROUND: Previous validation studies of sick leave measures have focused on self-reports. Register-based sick leave data are considered to be valid; however methodological problems may be associated with such data. A Danish national register on sickness benefit (DREAM) has been widely used in sick leave research. On the basis of sick leave records from 3,554 and 2,311 eldercare workers in 14 different workplaces, the aim of this study was to: 1) validate registered sickness benefit data from DREAM against workplace-registered sick leave spells of at least 15 days; 2) validate self-reported sick leave days during one year against workplace-registered sick leave. METHODS: Agreement between workplace-registered sick leave and DREAM-registered sickness benefit was reported as sensitivities, specificities and positive predictive values. A receiver-operating characteristic curve and a Bland-Altman plot were used to study the concordance with sick leave duration of the first spell. By means of an analysis of agreement between self-reported and workplace-registered sick leave sensitivity and specificity was calculated. Ninety-five percent confidence intervals (95% CI) were used. RESULTS: The probability that registered DREAM data on sickness benefit agrees with workplace-registered sick leave of at least 15 days was 96.7% (95% CI: 95.6-97.6). Specificity was close to 100% (95% CI: 98.3-100). The registered DREAM data on sickness benefit overestimated the duration of sick leave spells by an average of 1.4 (SD: 3.9) weeks. Separate analysis on pregnancy-related sick leave revealed a maximum sensitivity of 20% (95% CI: 4.3-48.1).The sensitivity of self-reporting at least one or at least 56 sick leave day/s was 94.5 (95% CI: 93.4 -- 95.5) % and 58.5 (95% CI: 51.1 -- 65.6) % respectively. The corresponding specificities were 85.3 (95% CI: 81.4 -- 88.6) % and 98.9 (95% CI: 98.3 -- 99.3) %. CONCLUSIONS: The DREAM register offered valid measures of sick leave spells of at least 15 days among eldercare employees. Pregnancy-related sick leave should be excluded in studies planning to use DREAM data on sickness benefit. Self-reported sick leave became more imprecise when number of absence days increased, but the sensitivity and specificity were acceptable for lengths not exceeding one week.     

Job sick leave: Detecting opportunistic behavior

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.     

Sickness presence,sick leave and adjustment latitude

Objectives

Previous research on the association between adjustment latitude (defined as the opportunity to adjust work efforts in case of illness) and sickness absence and sickness presence has produced inconsistent results. In particular, low adjustment latitude has been identified as both a risk factor and a deterrent of sick leave. The present study uses an alternative analytical strategy with the aim of joining these results together.

Material and Methods

Using a cross-sectional design, a random sample of employees covered by the Upper Austrian Sickness Fund (N = 930) was analyzed. Logistic and ordinary least square (OLS) regression models were used to examine the association between adjustment latitude and days of sickness absence, sickness presence, and an estimator for the individual sickness absence and sickness presence propensity.

Results

A high level of adjustment latitude was found to be associated with a reduced number of days of sickness absence and sickness presence, but an elevated propensity for sickness absence.

Conclusions

Employees with high adjustment latitude experience fewer days of health complaints associated with lower rates of sick leave and sickness presence compared to those with low adjustment latitude. In case of illness, however, high adjustment latitude is associated with a higher probability of taking sick leave rather than sickness presence.     

Reducing sick leave costs by shortening waiting periods for elective surgery

Some sick leave of patients waiting for elective surgery could be avoided if these patients were treated with less delay. One way of achieving this is to give priority to patients on sick leave. Problems of fairness that such a policy would raise might be solved by assuring that part of the production gains stemming from avoided sick leave were used to increase treatment capacity to benefit all patients, including those not on sick leave. Another way to reduce sick leave due to waiting time is to increase supply temporarily and reduce treatment backlog without changing priorities among patient groups. If treatment thresholds are unaffected, such a temporary increase in supply will relieve all later patients of some of their waiting and render a production gain that may exceed marginal costs. If treatment thresholds are lowered as a result of waiting time's being reduced, there will still be production gains in patients benefiting by the temporary increase in supply, but in this situation the gains may cover only part of marginal costs.     

Generalizability of a prediction rule for sick leave due to shoulder pain

OBJECTIVES: Recently, a rule was developed to predict sick leave related to shoulder pain during a period of 6 months after patients have consulted a general practitioner for a new episode of shoulder pain. The objective was to evaluate the generalizability of this prediction rule by testing it in two other populations of workers who had gone for a consultation in primary care for a new episode of shoulder pain. METHODS: The prediction rule was derived in a prognostic cohort study (N=350). The outcome was sick leave related to shoulder pain during 6 months following the first consultation. The rule was tested on merged control groups from three trials on shoulder pain (N=128). In addition to this population, a recently conducted study on musculoskeletal disorders (N=224) was used to validate the prediction rule. The generalizability of the prediction rule was tested by studying calibration and discrimination in the validation cohorts. RESULTS: The prediction rule showed reasonable calibration in both validation cohorts. The discriminative ability, with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.70 in the derivation cohort was stable in the cohort of the musculoskeletal disorder study (AUC 0.71). In the control groups of the three randomized controlled trials of a Dutch shoulder study, the discriminative ability decreased to an AUC of 0.66. CONCLUSIONS: The prediction rule for sick leave related to shoulder pain in a 6-month period following the first consultation in primary care showed adequate generalizability to another population of workers with shoulder pain participating in an observational cohort study. In the control groups of the three randomized controlled trials the prediction rule performed less well.