In the wake of reduced state support for compensating workers for illnesses, the number of certificates for medical leave has been cut by more than half. But the number of actual sick days has increased, prompting concern from health and policy experts.
Workers sought certificates for medical leave on more than 257,000 occasions in 2009, but the number was only 121,000 in 2010.
As of summer 2009, employees no longer receive pay for the first three days they are sick. From the fourth to the eighth day, the employer is required to pay them a minimum 70 percent of their salary; only from the ninth day on does the Health Insurance Fund step in and pay compensation.
While this could merely mean that people in the past called in sick for insignificant or specious reasons, some say it shows that workers are trying to tough out cases of colds and flu, sometimes leading to complications that require hospitalization and long-term absences.
“We always have to think about what an illness is doing inside our bodies,” said general practitioner Eret Jaanson. “For instance in flu season like now, when a person tries to brave out the flu on his feet, he might be incapacitated for two months, as he simply doesn’t have the energy to do his work due to myocarditis.”
The length of time per medical leave certificate is growing, says the Health Insurance Fund’s spokesperson Evelyn Koppel. “It was an average 15 days last year but now it is 19 days.” This could point to more complications, and implications for the nation’s health.
Some employers pay a higher rate than the mandated 70 percent. The Family Doctor Centre pays its employees compensation from the first day. But there have been complaints that other employers are reluctant to accept certificates for medical leave or do not pay.
Some policy experts, such as Ain Aaviksoo of Praxis Centre for Policy Research, say a social contract is needed to provide better balance in the area vacated by the state. Employers and employees must each take on greater responsibility, possibly through reinsurance schemes, he says. “The impact on public health depends on whether people assume that responsibility and whether employers take over the responsibility from the state.”