Absence from work – Estonia
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Absence from work has been a topical issue in Estonia due to changes in the health insurance benefit system in the framework of the labour law reform on 1 July 2009. The negative and positive outcomes of reducing the financing of sick leave have been discussed. A reduction in employees’ productivity and increase in the level of occupational injuries and diseases is expected. However, it is also hoped to reduce absence from work without a reason.
Definitions and aims of study
Absence from work is frequently discussed in terms of its costs. These costs were outlined in a report published by the European Foundation for the Improvement of Living and Working Conditions (Eurofound) in 1997: Preventing absenteeism in the workplace. Since that time – as many reports of the European Working Conditions Observatory (EWCO) and of the European Industrial Relations Observatory (EIRO) note – it has become an issue in many countries; one approach has been to try to reduce the costs by tightening rules on sick pay.
In addition to a focus on costs, sickness absence has been connected to wider debates on the quality of work in two main respects. Firstly, there is growing interest in well-being and health at work. Attention has thus turned to positive ways in which well-being can be promoted, with improved attendance being a possible consequence. Secondly, the concept of ‘presenteeism’ – meaning being present at work while feeling ill or being unable to work at normal capacity – has emerged. Presenteeism may mean that measured absence levels are low but also that there are hidden stresses and pressures on employees.
The purpose of this comparative study is to provide an overview of the extent of absence from work and policies for its management, and to place this overview in the context of wider debates on well-being and presenteeism. The report assesses the current picture in terms of the level of absence and how the problem is treated – purely in terms of cost or in relation to the quality of work. It also examines the effect of the economic recession on levels of absence and how the problem is viewed.
Absence is defined as non-attendance at work when attendance was scheduled or clearly expected. The specific focus is a period of absence lasting longer than three days; the comparative analysis seeks information on this level of absence but recognises that data may not always be available.
The study has two main themes: the extent and patterns of absence, together with any trends; and the means of control and policies towards absence.
Extent and patterns of absence
1. Broad patterns
Where data are sought on the extent of absence, please use if possible the definition given in the briefing note. If available data do not distinguish between absence lasting longer than three days and all absences, please provide the closest available figure.
(a) Please describe the main data sources for absence from work at national level. How are the data collected, and how is absence defined? Are the data broken down according to the length of absence? Which spells of absence are taken into consideration (e.g. three to 19 days and 20 days or more)?
Absence from work in Estonia is usually understood as missing work due to ill health or occupational injury or accident. Nevertheless, a unified definition of absence from work has not been established and data on absenteeism caused by any other reason are not collected.
Data on absenteeism related to ill health are gathered by the Estonian Health Insurance Fund (Haigekassa). The Health Insurance Fund collects the data and information on benefits related to sickness, care leave and work injury or accidents. Sickness benefits are paid to a person in the case of a disease or injury whereby the person is temporarily unable to do their usual job. Compensation for occupational accidents is paid to an insured person in the event of an illness or injury caused as a result of an occupational disease or an accident at work. The care benefit is paid for up to 14 days to persons caring for a sick child, and is paid for up to seven days to those caring for other family members.
The employer registers an employee’s temporary incapacity to work at the Health Insurance Fund, after which the temporary incapacity to work benefit is paid by the fund. Data in the Health Insurance Fund are not categorised according to the length of absence; however, two to eight days of absence from work is considered a short-term absence and 20 to 30 days is considered a long-term absence. No data are available on very short absences of less than two days.
(b) Please state the average overall current level of absence either in terms of % of working time lost or number of working days a year. What has been the trend over the past five years?
According to the Health Insurance Fund, in 2008, a total of 9,182,077 days of temporary incapacity to work was registered, with an average leave length of 15.3 days. This includes maternity benefits, which were paid for 131 days on average. The average length of sick benefits was 13.5 days, while care leave lasted 8.5 days on average and occupational accident benefit lasted 21.9 days. However, the actual length of absence from work is longer as the benefit was paid only from the second day of the leave, except in the case of maternity and care leave. For the total length of compensation for temporary incapacity to work, see Table 1 below.
| Reason for benefit | Number of compensated days a year | ||
|---|---|---|---|
| 2000 | 2007 | 2008 | |
| Illness* | 4,818,943 | 6,209,512 | 6,354,414 |
| Pregnancy or child birth | 1,065,871 | 1,676,152 | 1,742,286 |
| Occupational accident | 157,051 | 131,966 | 135,119 |
| Nursing a sick family member | 614,007 | 871,070 | 949,676 |
Note: * Since no benefit was paid for the first day of sick leave of an insured person, the number of work days actually lost due to temporary incapacity to work is somewhat higher; illness as the reason for benefit also includes data on occupational illness.
Source: Estonian Health Insurance Fund, 2000, 2007, 2008
The trends regarding temporary incapacity to work benefits and the number of days of absence from work are related to changes in the labour market. In times of economic growth, incomes and consequently temporary incapacity to work benefits and the number of persons covered by health insurance increased. These factors, together with increasing awareness of health issues, raised the number of days of absence from work. The length of sick leave varied between 12.7 days in 2004 and 12.2 days in 2007. With the economic recession, however, the number of sick leave periods started to decrease rapidly, while the length of leave for illness started to increase in 2008 – 13.5 days in 2008 compared with 18.8 days in the third quarter of 2009.
These developments were accompanied by changes in legislation – since 1 July 2009, the benefit for temporary incapacity for work is now paid from the fourth day of illness instead of the second day, leaving employees without benefit for the first three days and reducing the size of the benefit from 80% of the previous average wage to 70%. The trend data thus indicate that while people took sick leave more easily and for a shorter time period during economic growth, the need for sickness absence is now more carefully considered and taken only if the illness is more serious and likely to last for a longer duration.
(c) Please provide a breakdown of absence by gender. What has been the trend over the past five years?
According to a survey by the National Institute for Health Development (Tervise Arengu Instituut, TAI), the proportion of people with no absent days has decreased among both men and women – in 2002, 62.5% of men and 68.6% of women took no absent days, however by 2008 these proportions had declined significantly to 49.8% and 49.4% respectively (Table 2). The reasons for this trend are probably similar to those explaining the overall increase in the number of days absent.
| Number of days absent | Men | Women |
|---|---|---|
| None | 49.8 | 49.4 |
| 1–10 | 28.3 | 27.2 |
| 11–20 | 9.5 | 10.2 |
| 21–30 | 5.6 | 6.1 |
| >30 | 6.8 | 7.1 |
Note: Data refer to absence from work or school among the 16–64 year age group in the past 12 months.
Source: TAI, Health behaviour among the Estonian adult population, 2008
(d) Please provide a breakdown of absence by age groups (if possible, according to the following age groups: 15–29, 30–49 and 50+ years). What has been the trend over the past five years?
The trend has not changed over the period 2002–2008. Although the population has grown older, the dynamics in relation to absence from work due to illness in different age groups has overall remained the same. In general, older people tend to take longer leave (Table 3).
| Number of missing days | ||||||
|---|---|---|---|---|---|---|
| None | 1–10 | 11–20 | 21–30 | >30 | ||
| Men | 16–24 | 33.9 | 41.1 | 14.4 | 4.7 | 5.9 |
| 25–34 | 50.7 | 32.3 | 7.0 | 4.4 | 5.7 | |
| 35–44 | 51.4 | 27.1 | 10.1 | 5.3 | 6.1 | |
| 45–54 | 59.2 | 19.2 | 6.0 | 7.6 | 8.0 | |
| 55–64 | 54.2 | 20.0 | 10.3 | 6.1 | 9.1 | |
| Women | 16–24 | 30.5 | 32.3 | 18.6 | 7.4 | 6.1 |
| 25–34 | 51.5 | 28.5 | 10.0 | 6.8 | 3.2 | |
| 35–44 | 57.0 | 24.2 | 8.2 | 4.1 | 6.5 | |
| 45–54 | 50.7 | 22.2 | 8.8 | 7.4 | 11.0 | |
| 55–64 | 57.7 | 18.0 | 7.5 | 6.7 | 10.0 | |
Note: Data refer to absence from work or school in the past 12 months; some of the table rows do not add up to 100% because the figures are rounded.
Source: TAI, Health behaviour among the Estonian adult population, 2008
(e) Please provide any available estimates for the proportion of the total volume of absence a year due to short (3–19 days’ duration) spells and long-term absence (20 days or more). Have there been any changes in the prevalence of short-term and long-term levels of absence over the past five years.
According to a 2008 survey conducted by TAI, the highest proportion of absence from school or work is short-term: 27.2% of respondents have been absent from work or school for one to 10 days due to being ill in the last year. About 13% of respondents reported being absent from school or work for more than 20 days in the last 12 months. As noted earlier, according to the Health Insurance Fund, the average length of sick leave due to illness has increased in recent years, from 12.2 days in 2007 to 13.5 days in 2008 and 18.8 days in the third quarter of 2009; only absence from work is included in these figures. Thus, the proportion of people reporting long-term absence from school or work is probably also increasing.
(f) Please give the level of absence in small and medium-sized enterprises (SMEs) with fewer than 250 employees, compared with large organisations.
There are no comparative data on the level of absence in SMEs as compared with large companies.
(g) Please provide the latest figures on absence levels by activity sectors.
There is no available information on the absence figures according to sector of economic activity.
2. Causes of absence
(a) Please describe the main causes of absence as identified in national surveys. Are there differences according to gender, company size or sector of economic activity?
According to data from the Health Insurance Fund, in 2008, a total of 9,182,077 days of leave were compensated. Some 69% of these days were compensated for illness or injury, 19% for pregnancy or child birth, 2% for occupational accidents and 10% for caring for a sick family member.
According to data collected by the Health Insurance Fund in 2003, the most common reasons for sick leave were infectious influenza and respiratory diseases (34%), musculoskeletal and syndesmosis diseases (16%), and injuries and toxic illnesses (10%). There are no available data by company size or sector of economic activity. No more recent data have been collected.
(b) Please indicate the main occupational diseases and occupational injuries or accidents responsible for absence from work. Please identify and offer explanations for any changes that have occurred over the past five years.
According to the Labour Inspectorate (Tööinspektsioon), the main occupational diseases pertain to physical stress, for example carpal tunnel syndrome and occupational hearing loss. In total, 355 occupational diseases and work-related illnesses were registered and in many cases more than one disease was diagnosed in 2008. The majority of occupational diseases or work-related illnesses occur in the metalworking or mining industries. Occupational injuries or accidents mostly occur in the economic sectors of construction, public administration and defence, transport, and wholesale and retail trade.
The number of occupational diseases has decreased somewhat in the last five years although the change has not been remarkable. However, there are many reasons to believe that the number of occupational diseases is underestimated. For instance, a shortage of occupational health doctors and financial problems have led to a situation where only two hospitals are capable of diagnosing occupational diseases. Moreover, services provided by occupational health doctors are not financed by the Health Insurance Fund and the general attitude of employers towards diagnosing occupational diseases is rather poor.
According to the Labour Inspectorate, between 2004 and 2008 the number of occupational accidents increased gradually from 3,331 to 4,059, mostly due to the growing level of reported occupational accidents in the sectors of electricity, gas and water supply, construction, and hotels and restaurants. Quarterly data indicate a decrease in occupational accidents – from 1,072 in the second quarter of 2008 to 600 accidents in the same period for 2009.
This positive change may be explained by the economic recession and redundancies in sectors most at risk of occupational injuries or accidents. However, despite the declining numbers, it should be noted that, as in the case of occupational diseases, occupational accidents are also underreported. According to the 2007 Labour Force Survey data, a third (34%) of occupational accidents remain unregistered, mostly in the construction and manufacturing sectors.
3. Presenteeism
Please refer to the definition of presenteeism: ‘being present at work while feeling ill or being unable to work at normal capacity’. What data are available on its extent?
For example, a Dutch study asked employees, ‘during the last 12 months, did it happen that you went to work, even when you thought you should report sick?’ Almost two thirds of respondents replied in the affirmative. Please report on any data available in surveys of working conditions, presenting the wording of the questions used.
Presenteeism has not been studied in Estonia and no information is available in this regard. It is argued that, under new labour regulations, employees may continue to work when they are ill due to the new sick payment rules which would reduce their income significantly (see below).
Costs and policies
4. Costs of absence
Are there estimates or studies on costs of absence from work? Please provide available information on:
a) Figures for costs of absence from work for employers. Please summarise how the data are collected, how costs are compiled (what is included in the costs and concrete data) and measured (e.g. costs of absence as a percentage of company production or as a percentage of GDP for the whole country).
Most of the studies that have been conducted estimate the general impact that health has on the economy – that is, the costs of becoming ill. According to data from the Ministry of Social Affairs (Sotsiaalministeerium), the cost of absence because of ill health was 5.4% of gross domestic product (GDP) in Estonia in 2005. That estimation was derived by combining information from different registries. However, due to the use of different methodologies and data, the estimated cost of absence from work as a proportion of GDP for the whole country varies from 6% to 15% in different studies.
Another analysis by the Ministry of Social Affairs concluded that 0.5% of GDP was lost because of occupational injuries and accidents in Estonia in 2004; in other words, without these injuries or accidents, the GDP would have been higher. Information is based on combining different registry data and examining the loss in gross income in the case of occupational accidents.
b) Figures for costs of absence from work for the social security system. Please summarise how the data are collected, how costs are compiled (what is included in the costs and concrete data) and measured (e.g. costs of absence as percentage of social security expenditure).
In 2008, the budget of the Health Insurance Fund was EEK 12.9 billion (€824.4 million). According to the fund’s registry data, the cost of temporary incapacity to work benefits was EEK 2.4 billion (€153.4 million); 62% of these allowances were sick leave benefits. The costs of benefits for incapacity to work include benefits for sickness, caring, occupational injury and maternity leave. According to the Estonian Health Insurance Fund, the incapacity to work benefits represent a large part of its budget – about 19% in 2009.
5. National and company measures
(a) Please outline any recent measures at national level intended to reduce the costs of absence through positive policies. An example would be changed social security rules on sick pay. Are any specific actions or measures directed at long-term absence?
Since 1 July 2009, the sick pay benefit system has changed. The first three sick leave days are no longer paid; previously, the payment started from the second day. From the fourth to the eighth day, the employer pays the benefit at a rate of 70% of daily income, calculated on the basis of the employee’s average salary for the previous six months. From the ninth day onwards, the benefit is paid by the Health Insurance Fund and is calculated on the basis of social security tax paid in the last calendar year preceding the illness. This change was implemented to sustain the Health Insurance Fund and save its reserves, as a large part of its expenses were incapacity to work benefits. The care leave benefit was not changed and it is paid from the first day of leave.
The financing system also remained unchanged regarding occupational diseases or injuries: 100% of the benefit is paid by the Health Insurance Fund starting from the second day of absence.
The public, the Estonian Trade Union Confederation (Eesti Ametiühingute Keskliit, EAKL), experts and some politicians have expressed concerns over the influence that the new financing system may have on presenteeism. It is argued that it may have a negative effect on employees’ health and work productivity as people continue to work when they are ill due to the new sick payment rules which would reduce their income significantly. However, it has also been highlighted that the new regulation would have a positive effect on absenteeism, as sick leave would not be taken without careful consideration.
(b) What are companies doing to reduce overall absence from work (e.g. attendance incentives or bonuses)? Are sickness prevention plans elaborated? If so, how are elected employee representatives involved in these plans (e.g. through involvement in their design and implementation, or through being informed about them)? Please illustrate with up to three examples.
The issue of preventing or reducing absenteeism has not been thoroughly discussed among Estonian employers. However, according to the Working Life Barometer 2005 data, respondents feel that many employers (40%) monitor working conditions and try to modify them in accordance with employees’ needs. The survey report showed that most employees reported having taken part in risk preventive activities, such as information and training on occupational health and safety. Furthermore, 40% of employees stated that they have been sent to the occupational health doctors by employers and 25% have participated in first-aid training.
(c) Do companies have any specific policies directed at long-term absence? What is done to encourage the reintegration into work of people who are long-term sick? Is work redesigned to meet the needs of employees?
There is no information on any specific measure directed at long-term absence. The employer has the right to terminate the employment contract in case of the employee’s long-term incapacity to work – that is, if the employee’s health condition does not allow them to fulfil their duties over four months. However, the employer is obliged to offer another job to the employee when and where possible. This includes organising, if necessary, on the job training for the employee, adapting the workplace and changing the employee’s working conditions, unless the changes cause disproportionately high costs for the employer. If there is no other suitable position to offer the employee, the employment contract may be terminated.
6. Well-being at work
(a) Is the concept of well-being at work a feature of debates in your country? Which are the most relevant initiatives in this area, for example in relation to redesigning work to encourage attendance or to promote the health of employees? What are the objectives of such initiatives? How far do they aim to reduce absence levels, and is there any evidence of any reductions? Please provide up to three examples.
According to the Occupational Health and Safety Act (in Estonian), the employer is obliged to ensure compliance with the occupational health and safety requirements in every aspect related to the work, assess the risks surrounding the work environment and apply measures to prevent damage to employees’ health or safety. The employer is also required to organise the provision of occupational health services and bear the costs related to it. In addition, the employer is obliged to transfer the employee to another position temporarily or permanently or ease their working conditions temporarily at the request of the employee and on the decision of a doctor.
Moreover, companies should appoint occupational health and safety representatives, depending on the size of the company. These include a working environment specialist in all companies, a working environment representative in companies with 10 or more employees and a working environment council in companies with 50 or more employees. All of these bodies focus on monitoring and improving the working environment in companies.
The Labour Inspectorate monitors the implementation of occupational health and safety requirements. This supervision includes methods such as inspections of the compatibility of work organisation with national regulations, assessments of the work environment and re-examinations of companies to check the correction of prior deficiencies.
The concept of well-being mostly relates to health and safety issues, while there is a lack of other extensive national-level initiatives to encourage participation beyond that required by law. Overall, the issue of well-being at work has not been thoroughly discussed in Estonia.
(b) To what extent do policies on the management of absence and on well-being engage elected employee representatives? At what stage are representatives involved?
As noted, elected employee representatives on health and safety must be in place in all companies with more than 10 or 50 employees; the smaller company requires a working environment representative, while the larger enterprise must have a working environment council. According to the Working Life Barometer 2005, 21% of the survey respondents state that they have an elected working environment representative at their workplace. However, 53% of the respondents work in companies with at least 20 employees, which means that a significant proportion of the respondents do not have a working environment representative in their enterprise. Furthermore, while – according to the Labour Force Survey – employees are generally well informed of the risks in their working environment, they are not consulted very often in this regard. Between 39% of respondents in micro and small companies and 45% of those surveyed in medium-sized companies reported such consultation. Thus, employee representatives are often not as engaged in the management of well-being at work as they should be.
The position of an elected working environment representative is not common in Estonia: as noted above, only 21% of respondents to the Working Life Barometer 2005 worked in an organisation which had such a representative. In addition, most respondents (60%) reported that the representative was inactive in representing employees’ needs or that their activities did not bring the desired results. Furthermore, most employees (75%) preferred to contact their direct supervisor in the event of some work-related concern in respect of work safety, work arrangements or working conditions, as this was considered a more effective approach.
(c) Please summarise the policy position of social partners, and if relevant other representative bodies, on the management of absence, attendance and well-being at work.
EAKL claims that the changes implemented in the Health Insurance Act of July 2009 have increased the risk of occupational injuries and accidents, and reduced employees’ sense of security and safety. The trade union’s action plan for 2008–2011 aims to introduce occupational injury and disease insurance financed by employers. It would be an insurance that would compensate employees’ health damages and ensure the necessary vocational and social rehabilitation (EE0903019I).
The Estonian Employers’ Confederation (Eesti Tööandjate Keskliit, ETK) expressed concern over the increase in employers’ financial burden due to the changes in health insurance in July 2009. However, ETK believed that the new system would have a positive effect as sick leave would be more carefully considered and therefore the new legislation would curtail absence from work.
Commentary
Please provide an assessment of national debates about absence. What is the balance between controlling high levels of absence, on the one hand, and promoting health and a positive work environment, on the other?
Controlling absence from work has not been the main focus of government policies or the social partners in Estonia. However, with the new financing system for sick leave, considerable attention has been given to the issue, especially among the social partners. Control of absence was not the main aim of the initiative but is rather a side effect. It is too early to assess the real impact on absence of these changes.
Considerably more targeted attention has been given to promoting a healthy and positive work environment in terms of health and safety issues. However, attention has mostly focused on monitoring the implementation of the regulatory requirements in companies and informing the employers. Good practices going beyond legislative requirements are rather rare. In terms of promoting health, presenteeism may potentially be a problem in Estonia, especially among men, as there are some signs that men too seldom turn to the doctor in case of illnesses. Taking into account the very large gap in life expectancies between men and women in Estonia and the long working hours of men, this issue deserves thorough analysis and greater attention.
References
Estonian Health Insurance Fund, Annual reports 2000, 2007 and 2008, available online (in Estonian) at: http://www.haigekassa.ee/haigekassa/aruanded
Estonian Health Insurance Fund, Budget 2008, Tallinn, 2009, available online (in Estonian) at: http://www.haigekassa.ee/uploads/userfiles/Majandusaasta%20aruanne%202008_allkirjadega.pdf
Estonian Health Insurance Fund, The cost of temporary incapacity to work benefits and the most influential indicators affecting the cost [Ajutise töövõimetushüvitise kulud ja kulusid mõjutavad oluliseimad näitajad], Tallinn, 2007, available online (in Estonian) at: http://www.haigekassa.ee/files/est_haigekassa_statistika/TVH_2003_2006_korrigeeritud_vastavalt_juhatuse_ettepanekutele.pdf
Labour Inspectorate, Aastaaruanded 2004–2008 [Annual reports (2004–2008)], available online (in Estonian) at: http://www.ti.ee/index.php?page=766&
Ministry of Social Affairs, Development of a model for calculation of the costs of occupational accidents in Estonia, Tallinn, 2005a, available online at: http://osh.sm.ee/statistics/state.htm
Ministry of Social Affairs, Social and economic losses in Estonia due to illness of workers, Tallinn, 2005b, available online at: http://osh.sm.ee/statistics/losses.htm
National Institute for Health Development (TAI), Health behaviour among the Estonian adult population, 2008, Tallinn, 2009, available online (in Estonian) at: http://www.ti.ee/index.php?page=764&
Saar Poll, Tööelu Barometer 2005, Elanikkonna uuringu aruanne [Working Life Barometer 2005, Population survey report], Tallinn, Ministry of Social Affairs, 2006.
Liina Osila, Marre Karu and Kirsti Nurmela, PRAXIS Centre for Policy Studies
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