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An increase in sick leave has been registered by both the National Insurance Administration and by the Confederation of Norwegian Business and Industry. In 1988, expenditure on sick leave was NOK 20.7 billion. The same year the National Insurance Institution found that the average length of each sick leave was 49 days. An arrangement for notification of sick leave was enforced in order to strengthen follow up of persons in receipt of sick pay who had been off work for more than eight weeks. Our survey in Skedsmo shows that this arrangement is not commonly known among the public. In view of the increasing public consciousness about national insurance in general, the doctors who are required to submit notification of sick leave are of the opinion that this arrangement is a useful venture. It is difficult to conclude, however, that this arrangement has been of any benefit to the individual patient. The national insurance office has registered a decrease in expenditure on sick leave, but the work load of officials in the administration has increased.
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A study of sick leave from work during pregnancy has been performed from data collected by Social Security's consulting doctors in 1985. The proportion of sick leave of a duration of less than six months during pregnancy may be estimated to be 18.6% of all the reasons for sick leave for all women aged less than fifty years, and so represents the second highest reason for sick leave after mental diseases. A socio-professional inequality exists with regard to sick leave during pregnancy: the estimated frequency of sick leave for pregnancy is thirteen times higher in workers than in managers, and seven times higher in employees.
In 1988 the National Insurance Administration in Norway introduced a compulsory sickness certificate to be issued by the doctor after eight weeks of incapacity of work (sickness certificate II). The form contains 25 specified items to be filled in by the doctor. We registered and analysed the sickness certificates received by the local National Insurance offices in five municipalities during the last three months of 1988 (n = 735). The patients included a slight majority of males. 1/3 of the patients were younger than 30 years old and 2/3 younger than 50. 1/4 of the items had not been filled in by the doctors. The most frequent diagnostic groups were musculo-skeletal/connective tissue diseases (46.4%), mental disorders (11.2%), and complications related to pregnancy and birth (9.6%). Sickness certificate II included a five-level prognosis scheme. 68.3% of the patients were allocated to prognosis A, i.e. full recovery as a result of medical treatment only. Few doctors noted that cooperation with other health and social welfare personnel was desirable. The level of unemployment was reported as being higher in patients who were certified sick for greater than or equal to 8 weeks than in the general population of the countries included in the study. The extra costs of introducing sickness certificate II are estimated to equal one day's sickness allowance for each of the 735 patients.
The literature indicates a high percentage of sick leave during pregnancy in the past 10 years. In the Nordic countries 30-50 percent of pregnant women on the labour market are on sick leave during pregnancy. There is no indication that the increased frequency is due to decreased health amongst pregnant women, but it may be a consequence of an increase in working women. Pregnancy means additional strain to the double tasks that many working women experience. A few references indicate that sick leave is most common among women working full time and women, who have previously given birth. Sick leave may cover up for increasingly poor working environments or social problems, but may also reflect changes in standards, legislation or role performance. It is advisable to follow pregnant women on sick leave closely in order to avoid expulsion from the labour market. Pregnancy-related sick leave seems to be multifactorial, which should lead to caution concerning conclusions on the relative influence of different factors on sick leave during pregnancy.
Average number of sick leave hours per month taken by smoking and nonsmoking employees of Missouri's Department of Health were examined. During a 20-month period 97 smokers took 5.3 hours per month sick leave, whereas 309 nonsmokers took 4.3 hours, a 23% difference. Excess sick leave was taken by smokers regardless of their sex, marital status, or age group. Smokers who were male, unmarried, or older took 22% to 38% more sick leave than their nonsmoking counterparts. It was estimated that for excess sick leave only, the smokers cost the department $11,931 per year. Using total cost figures developed by Weiss yielded an estimated excess cost of $510,802 per year.
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.
A study of cigarette smoking and sick leave was conducted at a large petrochemical complex in Shanghai, China in 1988. Among a random sample of 1856 men the smoking prevalence was 80% with the highest rate (84%) occurring in the age group 25-34 years. Only 53% of smokers and 76% of nonsmokers said they believed smoking was harmful to health and knowledge of which diseases were associated with smoking was poor. Retrospective data were also collected on sick leave in 1986 and 1987. In 1986 13% of men took sick leave and in 1987 12%; the mean duration of sick leave was 3 days per year. In 1986 the odds ratios (OR) for taking sick leave were 2.37 for heavy smokers and 1.45 for light smokers compared to unity for nonsmokers; the corresponding OR for 1987 were 1.70 and 1.28 for heavy and light smokers compared with nonsmokers. Smoking was positively associated with sick leave even after adjustment for age, consumption of alcohol and exposure to chemicals; OR = 1.56 (95% confidence interval (Cl): 1.06-2.31) in 1986 and OR = 1.32 (95% Cl: 0.90-1.95) in 1987. Demonstration of this association even in a young population with low sick leave rates illustrates yet again the adverse effects of smoking on health and the urgent need to reduce the very high prevalence of smoking in China.
Sick leave, traditionally, has been for employees alone--a dissatisfying arrangement when the sick person is a family member, not the professional. But one hospital rewrote its rule, extending sick leave to include time off if a spouse or dependent child is ill. The staff likes the hospital's acknowledgment that professionals have important family obligations. Administrators like the high rate at which it's retaining valued personnel.
Experience has shown that doctors tend to be overgenerous when awarding sick leave. Quite rightly their first consideration is their patient, but frequently too little thought is given to the overall effect that excessive absence because of illness may have have on the patient, on the company in which he works, and on the country as a whole. Economically, these effects may be profound. A tempered industrial viewpoint is put forward and South African law regarding sick leave is outlined. A plea is made to doctors to safeguard their sick leave notes, prescription pads or letterhead paper, to award sick leave on merit, giving legible sick leave notes containing the necessary information, and to the profession not to overlook the wider aspects of the matter.
The epidemiology of sick leave was studied in the city of Malmö, Sweden, (230,000 inhabitants). Every current and completed sick-leave episode during the year of 1985 was collected for 124,411 persons aged 16 to 65, who were registered with the National Health insurance scheme in 1985. Absence rate, absence incidence, absence prevalence and absence duration were analyzed in relation to age, sex, marital status, nationality, income and place of residence. Absence rate (mean value) in the total population was 25.5 days with a median of three days. The absence rate increased by age. High absence rates were seen for females, single people and some immigrant groups. This was even true for residential areas characterized by a higher proportion of single-person households and households on social welfare, of unemployed and people with a low income and a foreign background. The absence rate gives limited information as to the epidemiology of sick leave. Through adding absence incidence, absence prevalence and absence duration it was possible to get a more comprehensive picture of the phenomenon. Sex-differences in absence rate for instance were mainly explained by differences in absence incidence and prevalence, while differences in absence rate regarding nationality were explained by differences in absence duration. This is an important step towards a better understanding of the factors behind sick leave.
The aim of the study was to search for bivariate associations between on the one hand samples of background, job-related and well-being characteristics, and on the other hand longitudinally recorded sick-leave in individuals with repeated short-term sick-leave. Out of altogether 123 subjects included, 113 self-rated their well-being at the onset of, and 88 also after, a supportive programme. The well-being rating covered experience of treatment by other people, reservation, loneliness, inferiority, tension, vulnerability, guilt, security and indolence. Socio-demographic and job-related characteristics and attitudes were registered and declared at the initial contact. Correlations between these separate sets of independent variables, and sick-leave occasions and days in each of the two years following the contact were computed. There was an almost complete lack of covariation between background variables and sick-leave. Neither did job-related characteristics correlate. Only an expressed wish for a job change was vaguely associated with more absence days, but not with more spells. In striking contrast, a convincing consistent longitudinal pattern between self-rated well-being and sick-leave behaviour emerged. The poorer the well-being, the greater the subsequent sick-leave. Yet, a major part of the sick-leave variance remained unexplained. Accordingly, other etiological factors may still interact with well-being in the comprehensive setting behind the sick-leave behaviour.(ABSTRACT TRUNCATED AT 250 WORDS)
The paper addresses the problem of sick leave in the hotel industry. It was hypothesized that there would be a tendency for granted sick leaves to include weekends, thus imposing an additional financial burden on the hotel in question. A total of 401 medical certificates from a large city hotel were reviewed. According to these certificates one third of the patients regained their health between Sunday and Monday. Of the patients with "short" sick leaves (less than a fortnight), 40% recovered between Sunday and Monday. The average duration of the sick leave for this group was 1.3 days longer than that of the patients whose sick leaves ended on other days of the week. The results are discussed in terms of the ambiguous position of the medical practitioner.
In order to illustrate the conditions involved in sick-leave during pregnancy, 593 consecutive parturient women received a questionnaire on the day after delivery. 48% of the pregnant women were certified as sick and 16% were admitted to hospital during pregnancy. The most common reasons for sick-leave were threatening abortion (19%), haemorrhage (18%) and threatening premature delivery (15%). The duration of sick-leave averaged 15 weeks as compared with 7.3 weeks in Denmark as a whole. In the subgroup of textile workers, 71% considered that the work was physically stressing and 70% were certified sick. Compared with all of the other occupationally active women, textile workers were more frequently certified sick, considered that their work was more physically stressing and had more frequently required sick-leave but were more rarely admitted to hospital. Similarly, textile workers had a greater risk for sick-leave on account of threatening abortion, pelvic loosening or pain in the locomotor system.
This paper addresses physicians' tendency to allot standardized, "rounded off" sick leave. Of the 401 sick leaves reviewed, 64.3% lasted for one or two weeks, one or two months, or to the end of the week or month. The patients' presumed wish for an extended leave, and the practitioners' strained work situation were examined as possible influential factors. A scrutiny of general practitioners' and company practitioners' working conditions, and employees' current inclination to work, does not support these ideas. Dialogue between physician and patient should be improved and we also suggest a change to "vaguer" durations of sick leave.
A survey questionnaire was administered to employees of a public health agency regarding their involvement with smoking and other life-style behavior. Responses were analyzed and combined with sick leave data to determine the use of sick leave among employees who currently smoke, those who never smoked, and those who formerly smoked. Current smokers took significantly more sick leave than those who have never smoked ("nonsmokers") or former smokers. Using an analysis of variance model, only smoking status, education level, and sex, among selected demographic variables, were significantly related to the amount of sick leave taken. Current smokers took excess sick leave (amounting to nearly $40,000) as compared with nonsmokers and ex-smokers combined over a 21-month period. This study also characterizes the relationship between smoking status and selected life-style behavior. Smokers were less active, less likely to use seat belts, less likely to believe that smoking is related to health, and more likely to be heavier and to eat a poor diet than their nonsmoking or former smoking counterparts. We make suggestions regarding the reduction of smoking and other deleterious behavior as a means of controlling costs and reducing employee morbidity.