Skip to main content
Log in

The individual cost of sick leave

  • Original Paper
  • Published:
Journal of Population Economics Aims and scope Submit manuscript

Abstract

This paper aims to estimate the causal effect of sick leave on subsequent earnings and employment, using an administrative dataset for Norway. To obtain experiment-like variation in sick leave among otherwise similar workers, the leniency of these workers’ physicians—certifying sickness absences—is used as an instrumental variable for sick leave. A 1 percentage point increase in a worker’s sick leave rate is found to reduce his earnings by 1.2% 2 years later. Around half of the reduction in earnings can be explained by a reduction of 0.5 percentage points in the probability of being employed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

Notes

  1. For a recent study of performance-related pay, see Gielen et al. (2010).

  2. Hansen (2000) uses several instrumental variables of which the policy reform is arguably the most credible.

  3. Even if cyclical absenteeism is more costly for males than females, the “quantity effect” dominates the “price effect” as females have more cyclical absences than males.

  4. Since health is unobserved, controlling for unobserved heterogeneity is crucial when estimating duration dependence. The workers who first return to work are the ones with best health, meaning that as duration increases, the remaining population on sick leave becomes more and more disadvantaged. This results, almost mechanically, in negative duration dependence.

  5. G is a unit for calculation of social benefits in Norway that is adjusted for inflation.

  6. There is one exception, current earnings, which is measured in year t − 1. Earnings in year t may be affected by sick leave in year t from reduced overtime payment and lost bonuses for absent workers. Earnings exceeding 6G will also not be replaced by the sickness insurance (unless covered by the employer) which also may make earnings in year t dependent on sick leave in year t.

  7. A detailed description of their estimation strategy is provided in the Appendix.

  8. I am grateful to one of the referees for suggesting this approach.

  9. There is a potential caveat regarding the results on employment. If physicians lenient in sickness certification also are lenient when certifying disability insurance, this may lead to the same results, but with a different interpretation. However, normally it takes more than 2 years before a worker receives disability pension, and to qualify for such a pension one must also receive approval from a “neutral” physician, employed by the social security administration.

  10. When Markussen et al. (2011) estimated z i,t they used workplace fixed effects for all workplaces with at least 100 employees. In unreported results the sample is restricted to only include workers in firms large enough to be represented by a separate dummy variable when estimating z i,t . The sample is reduced by around 50%, but the estimated coefficient is not significantly different from the one in column (IV1) where all workers were included. In addition to the reported results the model is also estimated with fixed effects for all combinations of jobs (same 12 categories as in Table 5) and neighborhoods, in total more than 75,000 combinations. The results are almost identical to those reported in column IV2

  11. Unfortunately, jobs are not observed directly in the data. The jobs described in Table 3 are defined using a combination of sector of employment and education.

  12. Workers with small children have a quota of ten sick leave days a year to take care of sick children. These absence spells are not covered by this dataset.

  13. In Ichino and Moretti (2009) employers expect females to have higher sick leave rates than males because of biological differences—the menstrual cycle.

References

  • Altonji JG, Pierret CR (2001) Employer learning and statistical discrimination. Q J Econ 116(1):313–350.

    Article  Google Scholar 

  • Andrén D, Andrén T (2008) Part-time sick leave as a treatment method? HEDG Working Paper 08/011, University of York

  • Andrén D, Andrén T (2009) How to evaluate the impact of part-time sick leave on the probability of recovering. Working Paper 13/2009, Örebro University

  • Biørn E, Godager G (2009) Does quality influence choice of general practitioner? An analysis of matched doctor–patient panel data. Econ Model 27(4):842–853

    Article  Google Scholar 

  • Englund L, Tibblin G, Svärdskudd K (2000) Variations in sick-listing practice among male and female physicians of different specialities based on case vignettes. Scand J Prim Health Care 18(1):48–52

    Article  Google Scholar 

  • Gielen AC, Kerkhofs MJK, van Ours JC (2010) How performance related pay affects productivity and employment. J Popul Econ 23(1):291–301

    Article  Google Scholar 

  • Gorter K, de Poel S, de Melker R, Kuyvenhoven M (2001) Variation in diagnosis and management of common foot problems by GPs. Fam Pract 18(6):569–573

    Article  Google Scholar 

  • Hansen J (2000) The effect of work absence on wages and wage gaps in Sweden. J Popul Econ 13(1):45–55

    Article  Google Scholar 

  • Henningsen M, Hægeland T (2008) Downsizing as a sorting device: are low-productive workers more likely to leave downsizing firms? In: Statistics Norway discussion papers 543

  • Henrekson M, Persson M (2004) The effects on sick leave of changes in the sickness insurance system. J Labor Econ 22(1):87–114

    Article  Google Scholar 

  • Hesselius P (2007) Does sickness absence increase the risk of unemployment? J Socio-Econ 36(2):288–310

    Article  Google Scholar 

  • Høgelund J, Holm A, McIntosh J (2010) Does graded return-to-work improve sick-listed workers’ chance of returning to regular working hours? J Health Econ 29(1):158–169

    Article  Google Scholar 

  • Ichino A, Moretti E (2009) Biological gender differences, absenteeism and the earnings gap. Am Econ J Appl Econ 1(1):183–218

    Article  Google Scholar 

  • Johansson P, Palme M ( 2005) Moral hazard and sickness insurance. J Public Econ 89(9–10):1879–1890

    Google Scholar 

  • Malmivaara A, Häkkinen U, Aro T, Heinrichs ML, Koskenniemi L, Kuosma E, Lappi S, Paloheimo R, Servo C, Vaaranen V, Hernberg S (1995) The treatment of acute low back pain—bed rest, exercises or ordinary activity? N Engl J Med 332:351–355

    Article  Google Scholar 

  • Manski CF (1993) Identification of endogenous social effects: the reflection problem. Rev Econ Stud 60(3):531–542

    Article  Google Scholar 

  • Markussen S, Mykletun A, Røed K (2010) The case for presenteeism. In: IZA discussion paper 4343

  • Markussen S, Røed K, Røgeberg OJ, Gaure S (2011) The anatomy of absenteeism. J Health Econ 30(2):277–292

    Article  Google Scholar 

  • OECD (2008) Are all jobs good for your health? The impact of work status and working conditions on mental health. In: OECD employment outlook 2008, chapter 4. Paris

  • Smith JP (1999) Healthy bodies and thick wallets: the dual relation between health and economic status. J Econ Perspect 13(2):145–166

    Article  Google Scholar 

  • Waddel G (2004) The back pain revolution, 2nd edn. Elsevier, Amsterdam

    Google Scholar 

  • Waddell G, Burton AK (2006) Is work good for your health and well-being? Report for Department for Work and Pensions TSO (The Stationery Office), London

  • Ziebarth N, Karlsson M (2010) A natural experiment on sick pay cuts, sickness absence, and labor costs. J Public Econ 94(11–12):1108–1122

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Simen Markussen.

Additional information

Responsible editor: Erdal Tekin

This paper is part of the project “A viable welfare state” financed by the Norwegian Research Council. I am grateful to Knut Røed, Oddbjørn Raaum, Bernt Bratsberg, Espen Henriksen, Ole Røgeberg, Erik Biørn, Kjell Arne Brekke, Magne Mogstad, Harald Dale-Olsen and Per Johansson for their comments. I am also grateful to two anonymous referees for the comments and suggestions.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

(PDF 447 KB)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Markussen, S. The individual cost of sick leave. J Popul Econ 25, 1287–1306 (2012). https://doi.org/10.1007/s00148-011-0390-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00148-011-0390-8

Keywords

JEL Classification

Navigation