Work Absence in Europe

Contributor Notes

Author(s) E-Mail Address: lbonato@imf.org; llusinyan@imf.org

Work absence is an important part of the individual decision on actual working hours. This paper focuses on sickness absence in Europe and develops a stylized model where absence is part of the labor-leisure decision made by workers and the production decision made by profit-maximizing firms, with insurance provisions and labor market institutions affecting the costs of absence. The results from a panel of 18 European countries indicate that absence is increased by generous insurance schemes where employers bear little responsibility for their costs. Shorter working hours reduce absence, but flexible working arrangements are preferable if labor supply erosion is a concern.

Abstract

Work absence is an important part of the individual decision on actual working hours. This paper focuses on sickness absence in Europe and develops a stylized model where absence is part of the labor-leisure decision made by workers and the production decision made by profit-maximizing firms, with insurance provisions and labor market institutions affecting the costs of absence. The results from a panel of 18 European countries indicate that absence is increased by generous insurance schemes where employers bear little responsibility for their costs. Shorter working hours reduce absence, but flexible working arrangements are preferable if labor supply erosion is a concern.

I. Introduction

Low and falling labor utilization has been blamed for the lackluster growth performance of many European countries (OECD, 2003). To a large extent, labor supply erosion can be attributed to the decline in working time. In fact, while participation—possibly owing to labor market reforms—has increased in most European countries in the last twenty years, average working time has continued falling, in line with a long-standing tendency, also common to Japan, but not to the United States or Australia (Figure 1).2

Figure 1.
Figure 1.

Labor Force Participation Rate and Average Hours Annually Worked Per Employee

Citation: IMF Working Papers 2004, 193; 10.5089/9781451859843.001.A001

Source: OECD, Economic Outlook.Notes: AU= Australia; BE=Belgium; CA=Canada; CH=Switzerland; DE=Germany; DK=Denmark; ES=Spain; FI=Finland; FR=France; IE=Ireland; IS=Iceland; IT=Italy; JP=Japan; NL= Netherlands; NO=Norway; SE=Sweden; UK=United Kingdom; US=United States.

Declining hours worked can be a reflection of policies as well as changing preferences. Prescott (2004) finds that differences in the marginal tax rate on labor income can explain most of the historical and cross-country variation in labor supply in the Group of Seven (G-7) countries. Preferences could, however, have also affected the trend of falling working time, which has been a prominent objective of unions in many European countries for some time (Blanchard, 2004). In any case, this trend represents a challenge for European economies in many ways. With a dwindling labor supply, it is not obvious that the current level of potential growth and the financing of large welfare states can be maintained over time. Indeed, the negative consequences for competitiveness are already triggering pressures to change course in France and Germany.

Actual hours worked can be lower because contractual hours are falling or work absence is rising. In Europe, the decline seems to be driven by the reductions in working time negotiated by unions. In 2003, contractual hours ranged from a weekly minimum of 35 hours in France to a maximum of 40 hours in Greece, with most countries having a working week between 37 hours and 39 hours. Over the last five years, the European Union (EU) average (including Norway) has fallen from 38.6 hours to 38 hours.3 Looking ahead, the pressure for working time reductions is likely to continue as unions remain committed to this objective.

If national holidays and annual leave ―for which country provisions vary widely―are excluded, absence can be accounted for essentially by sickness. On average, absence due to sickness is not unusually high in Europe. In the period 1995–2003, the share of employees on sickness leave was 2.8 percent, on average, which is very close to the 2.6 percent registered in the United States (Figure 2). There are wide differences across countries, however. Absence seems to be particularly high in the Netherlands (6 percent), Sweden (5.2 percent), Norway (5.0 percent) and the United Kingdom (3.9 percent). For these countries, reducing sickness absence could provide a substantial boost to the labor supply.

Figure 2.
Figure 2.

Sickness Absence, Average for 1995–2003

(as a percentage of employment)

Citation: IMF Working Papers 2004, 193; 10.5089/9781451859843.001.A001

Source: Eurostat, NewCronos.Notes: AT= Austria; BE=Belgium; CH=Switzerland; DE=Germany; DK=Denmark; ES=Spain; FI=Finland; FR=France; GR=Greece; IE=Ireland; IS=Iceland; IT=Italy; LU=Luxembourg; NL= Netherlands; NO=Norway; PT=Portugal; SE=Sweden; UK=United Kingdom; US=United States.

Containing work absence can be beneficial for a number of reasons. Excessive work absence entails significant social and economic costs. In the presence of institutional constraints affecting the choice between work and leisure―such as minimum working hour requirements—absence can be seen as an efficient individual response to the need for flexibility (Dunn and Youngblood, 1986). When absence costs are not internalized by workers, however, significant efficiency costs may arise. Moral hazard may become widespread if insurance is too generous, altering incentives in a way that may not provide the best trade-off between protection and efficiency. Output and employment are likely to be lower in equilibrium owing to the imperfect substitutability of absent workers. If insurance costs are mainly borne by the government, as is the case in most European countries, significant fiscal costs will also arise.

Theoretical analyses of labor absence and absenteeism mostly focus on labor supply characteristics. Facing a choice between labor supply and leisure, individuals maximize their utility given budget and time constraints (Allen, 1981; Leigh, 1985). Health, age, and gender influence the preference for leisure. If leisure is a normal good, its marginal utility will be decreasing, and the value of an hour of leisure will be higher, the longer is the typical working time. By allowing a more efficient use of the time available, flexible working arrangements are likely to attenuate the preference for leisure. Sickness insurance plays a crucial role. In most countries, the government, the employers, or both provide employees with insurance against the loss of income owing to sickness. With imperfect monitoring, the decision about sick leave is ultimately left to workers, and moral hazard arises. Its impact can be compounded by changing social norms, a weakening work ethic, and a decreasing stigma associated with “benefit cheating” (Lindbeck, 1997). In their decisions about absence, workers face costs in terms of both forgone income, which depend on the generosity of the insurance system, and the possibility of sanctions by the employers, ranging from slow career progression to dismissal.

This paper extends the literature to include labor demand considerations with a role for labor market institutions. The employers’ reaction to absence is likely to depend on the costs they have to bear as a result of it. Absence normally involves some output loss, the magnitude of which depends on the firm’s technology and workers’ heterogeneity. Other costs are related to the characteristics of the insurance scheme. Employers may have to disburse part or all of the cash benefits received by the absentee or pay contributions to the insurance funds. The more costly absence is to the employers, the more likely they are to respond. If absence is clearly connected with the working environment, the employer may attempt to improve it. Otherwise, the employer can increase monitoring or reinforce sanctions for absence. Then labor market institutions come into play. Both employment protection and unemployment insurance reduce the expected cost of work absence to the individual employee either by making it more difficult to sanction absenteeism or by reducing the effective cost of the sanction.

This paper also contributes to the empirical literature by analyzing the determinants of sickness absence on a panel of 18 European countries during the period 1983–2003, using new datasets on sickness insurance provisions and costs to employers. The following section describes the facts regarding sickness absence in Europe. Section III illustrates the model of work absence. Section IV discusses the econometric issues and presents the results from panel data model estimations. Concluding remarks and policy implications follow in Section V.

II. The Facts

As shown in Figure 2, sickness absence on average is not particularly high in Europe, and the problem seems to be confined to a few countries. Furthermore, Figure 3 shows that sickness absence has been generally stable over the last two decades. There are however some exceptions. In Belgium, for example, sickness absence rate surged from 1 to 4 percent between 1990 and 2000. Among the countries with the highest absence rates—the Netherlands, the United Kingdom, Sweden, Norway, and Iceland—Sweden exhibits an upward trend in recent years, while the Netherlands has seen absence declining since 1999. Absence in the United Kingdom has remained broadly stable throughout the period. In most countries, sickness absence is higher for women than for men.

Figure 3.
Figure 3.
Figure 3.

Sickness Absence

(employees absent due to sickness as a percentage of total employed)

(Note the different scale on the vertical axes for the Netherlands, United Kingdom, Sweden, Norway, and Iceland.)

Citation: IMF Working Papers 2004, 193; 10.5089/9781451859843.001.A001

Sources: Eurostat, NewCronos; and U.S. Department of Labor, Bureau of Labor Statistics.

Absence spells tend to be longer than one week in most countries (Figure 4). In the United Kingdom and Iceland, short-term absence is more frequent. In The long-term component fully explains the recent increase in absence in Sweden and Belgium (Figure 5). The increase in long-term sickness is of particular concern because longer absence is likely to be associated with a shift to disability pension. Palme and Svensson (2003) show that this has become one of the most common ways to exit the labor force before the statutory retirement age in Sweden. In Belgium, the increase most likely reflects the extension of various sabbatical leave schemes introduced in 1998.

In most countries, public sector employees are more likely to be on sick leave than those in the private sector (Table 1). To some extent, this reflects the large proportion of women in public employment. The difference in sickness absence between public and private sector is wider in countries characterized by high overall absence. For Nordic countries, where the share of public sector employment is particularly large, this composition effect can be quite important.

Figure 4.
Figure 4.

Short- and Long-Term Sickness Absence

(as a percentage of employment, average for 1995–2003)

Citation: IMF Working Papers 2004, 193; 10.5089/9781451859843.001.A001

Source: Eurostat, NewCronos.Notes: AT= Austria; BE=Belgium; CH=Switzerland; DE=Germany; DK=Denmark; ES=Spain; FI=Finland; FR=France; GR=Greece; IE=Ireland; IS=Iceland; IT=Italy; LU=Luxembourg; NL= Netherlands; NO=Norway; PT=Portugal; SE=Sweden; UK=United Kingdom.
Figure 5.
Figure 5.

Belgium and Sweden: Short- and Long-Term Sickness Absence

(as a percentage of employment)

Citation: IMF Working Papers 2004, 193; 10.5089/9781451859843.001.A001

Source: Eurostat, NewCronos.
Table 1.

Sickness Absence in Public and Private Sectors

(average for 1996–2000)

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Source: Bergendorff and others (2004).

Number of absentees for at least one week in percentage of all employees.

Sickness absence appears to be procyclical in some countries. Table 2 reports the correlation coefficients between sickness absence and the unemployment gap—defined as the percentage deviation of the unemployment rate from its trend (linear and quadratic)—during 1995–2003. The correlation is negative and significant at the 5 percent level for three countries (Belgium, Sweden, and the Netherlands). Pro-cyclicality of work absence may arise due to two main reasons suggested in the literature (Leigh, 1985; Kaivanto, 1997; Audas and Goddard, 2001). High unemployment acts a “disciplining device” (Shapiro and Stiglitz, 1984), raising the expected cost of absence to workers. Others emphasize a “selection” effect, as employers are more likely to lay off absence-prone workers in recessions, and hire them during expansions. Arai and Skogman Thoursie (2001) provide evidence in favor of the market discipline effect in Sweden. However, the strength of procyclicality in countries where employment protection is high may cast some doubt on this interpretation. An alternative explanation could rely on sick leave as a reaction to work pressures, which are likely to be more intense when production volumes are high and labor flexibility is limited.

Table 2.

Cyclicality of Sickness Absence, 1995–2003

(correlation between sickness absence and unemployment gap)

article image
Sources: Eurostat, Labour Force Survey; OECD, Economic Outlook; and Fund staff calculations.

Note:* =significant at 5% significance level.

Work absence has substantial costs for public finances, employers, and workers. Public sickness benefits reach 1½ percent of GDP in the Netherlands (Table 3). For Sweden, the amount of general government’s transfers related to illness, including disability pensions, reaches almost 5 percent of GDP. At the same time, total costs of worker’s ill health to employers can be estimated to be around 4 percent of GDP in Sweden, of which 1/7 is paid directly to employees in cash benefits while the rest are contributions to the public insurance system and collectively-agreed sickness insurance schemes. Workers generally pay a contribution to the public insurance system through their tax bill.

Table 3.

Public Sickness Benefits

(as a percentage of GDP)

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Source: OECD, Social Expenditures Database.

A first glance at the evidence suggests that labor supply characteristics, insurance provisions, and labor market institutions are important. Higher labor force participation and, particularly, higher female participation is normally associated with higher sickness absence (Figure 6). The relationship with age and health indicators, however, is less clear. Figure 6 presents the index of generosity of the sickness insurance system, both alone and combined with the unemployment insurance system, based on Scruggs (2004). The figures indeed show that absence increases with the generosity of sickness insurance and even more so when the unemployment insurance system is considered. Moreover, there is evidence that temporary workers, who enjoy lower employment protection, tend to be less sickness prone than permanent workers (Table 4).

Figure 6.
Figure 6.

Sickness Absence and Its Determinants

(absentees as a percentage of employment)

Citation: IMF Working Papers 2004, 193; 10.5089/9781451859843.001.A001

Sources: Eurostat, NewCronos; International Labour Organization, Key Indicators of the Labour Market; OECD, Health Data; and Scruggs (2004).Notes: AT= Austria; BE=Belgium; CH=Switzerland; DE=Germany; DK=Denmark; ES=Spain; FI=Finland; FR=France; GR=Greece; IE=Ireland; IS=Iceland; IT=Italy; LU=Luxembourg; NL= Netherlands; NO=Norway; PT=Portugal; SE=Sweden; UK=United Kingdom; US=United States.
Table 4.

Ratio of Sickness Absence of Permanent Workers to Temporary Workers

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Source: Bergendorff and others (2004).

The sickness insurance systems are most generous in the Nordic countries and Germany (see Appendix II). Cash benefit replacements rates are high—as high as 100 percent in Norway—with many labor contracts providing for an additional benefit from employers. Coverage tends to be universal and benefits are provided for a long period. Sickness benefit can be generally converted into a disability pension if the illness continues for a long time. In the last twenty years, most countries have cut replacement rates. In Finland, for example, the after-tax replacement rate fell by more than 11 percentage points when comparing the last two decades (Figure 7, left panel). However, the overall generosity of the system―including also other aspects like coverage, duration, qualifying and waiting period―has actually increased in some cases (Figure 7, right panel). In the United Kingdom, for example, the entitlement period has been substantially extended.

Figure 7.
Figure 7.

Changes in Sickness Insurance System, 1983–2002

Citation: IMF Working Papers 2004, 193; 10.5089/9781451859843.001.A001

Sources: Scruggs (2004); and Fund staff calculations.Notes: AT= Austria; BE=Belgium; CH=Switzerland; DE=Germany; DK=Denmark; FI=Finland; FR=France; IE=Ireland; IT=Italy; NL=Netherlands; NO=Norway; SE=Sweden; UK=United Kingdom.

The incentives stemming from the insurance scheme may have a strong impact on absence behavior. There is a large Swedish literature providing empirical evidence of strong moral hazard effects of the insurance scheme.4 Skogman Thoursie (2002), for example, finds a noticeable increase in male sick absence when popular sport events take place. The interaction of sickness insurance with other elements of the social insurance system may also produce perverse incentives. Larsson (2002, 2004) finds that higher compensation in Sweden motivates middle- and high-wage unemployed to report sick, increasing sickness claims by as much as one third in that income group. Harmonization of the replacement rates and income ceilings between sickness and unemployment insurance systems in 2003 largely eliminated this incentive.5 She also finds that unemployed increase sick reporting to preserve their benefit status as the end of the entitlement period for unemployment benefits (60 weeks) approaches. Palme and Svensson (2003) identify a link between sickness insurance, disability pensions, and early retirement in Sweden.

Employers’ responsibility in sharing the costs of the public insurance scheme can create a stronger incentive for employers to reduce sickness absence. Provisions vary widely across countries. Figure 8 shows a measure of costs to employers of the public insurance system, which reflects the gross replacement rate of benefits paid and their average duration.6 Employers’ costs are highest in Austria and the Netherlands. The Netherlands has taken a radical approach in 1996, making employers responsible for the full cash benefit payment up to one year of absence. Most firms, however, opted to reinsure their sick pay liability with private insurance companies, reducing the incentive effect. Nonetheless, De Jong and Lindeboom (2004) do not find any difference in absence rates of firms that opted for reinsurance. Although any conclusion from that experience is still tentative, absence started declining three years later and has now dropped below the Swedish level.

Figure 8.
Figure 8.

Sickness Cash Benefits Paid by Employer

Citation: IMF Working Papers 2004, 193; 10.5089/9781451859843.001.A001

Sources: U.S. SSA, Social Security Programs Throughout the World; Eurostat, NewCronos; and Fund staff calculations.Notes: AT= Austria; BE=Belgium; CH=Switzerland; DE=Germany; DK=Denmark; ES=Spain; FI=Finland; FR=France; GR=Greece; IE=Ireland; IS=Iceland; IT=Italy; LU=Luxembourg; NL= Netherlands; NO=Norway; PT=Portugal; SE=Sweden; UK=United Kingdom.

Long working hours may increase absence, while flexible working arrangements should reduce it. Usual hours of work, as measured by labor force surveys, show a wide range, with Iceland and the United Kingdom at the top (Figure 9, left panel). The United Kingdom, in particular, presents a large difference between usual hours worked (43.2 hours per week in 2003) and the average working time collectively agreed between employers and unions (37.2 hours per week). Figure 9, right panel indicates that the diffusion of part-time arrangements varies widely between the Netherlands (more than 30 percent of employment) and Greece (about 7 percent).

Figure 9.
Figure 9.

Working Time Arrangements

Citation: IMF Working Papers 2004, 193; 10.5089/9781451859843.001.A001

Sources: Eurostat, NewCronos; and International Labor Organization, Key Indicators of the Labour Markets.Notes: AT= Austria; BE=Belgium; CH=Switzerland; DE=Germany; DK=Denmark; ES=Spain; FI=Finland; FR=France; GR=Greece; IE=Ireland; IS=Iceland; IT=Italy; LU=Luxembourg; NL= Netherlands; NO=Norway; PT=Portugal; SE=Sweden; UK=United Kingdom.

In sum, a first glance at the data on sickness absence and on a broad range of variables that may affect absence behavior suggests a presence of large differences across Europe, both in terms of the importance of the problem and of the evolution of the sickness absence and its determinants. Sickness absence rates―being relatively stable over time, higher for women, and mainly lasting longer than a week―appear to be pro-cyclical and higher among the employees who generally enjoy stronger employment protection. High labor force participation and more generous sickness insurance systems tend to be positively associated with higher sickness absence rates. At the same time, a more rigorous investigation of the determinants of sickness absence is needed, taking into account also some demographic characteristics, working time arrangements and employers’ incentives. Hence, while the next section helps us to structure the discussion within a stylized model of work absence, the following section continues the empirical analysis using a multivariate approach.

III. The Model

This section presents an analysis of work absence within a simple stylized model of both labor supply and labor demand.7 On the supply side, the conventional determinants of the labor-leisure choice are augmented to include a number of institutional characteristics. In particular, the generosity of paid leave provisions is included. The penalty for being absent is modeled as (the inverse of) the probability of keeping the job. The latter is assumed to depend upon the absence behavior with its impact on the probability being dependent upon the strictness of employment protection.

The economy is populated by a large number of workers whose mass is normalized to one. The worker’s preference towards absence is given by the desired absence hours, a, such that a ∈ [0,c], where, if contracted hours of work are given by c and total number of hours is normalized to 1, a = 0 indicates no absence, and a = c corresponds to full absence from work.8 On the labor demand side, a profit-maximizing firm chooses its desired input of hours of work, which in case of a given number of contracted hours, translates into a decision on the absence tolerance. As a result of the maximization problems of the worker and the firm, an equilibrium pair of absence rate and wage is determined.

A. Labor Supply (Hours Decision)

Let a worker’s maximization problem be given by

maxU(x,l)(1)

subject to

x=R+P(A,V)w(cβa)+[1P(A,V)][B+G(γ)](2)
l=1(ca)(3)

where x and l are consumption and leisure, respectively, R is non-labor income, w is wage, c is the given contractual hours of work, a is absence hours (due to sickness), β is the inverse of the sickness benefit replacement rate (ratio of sick pay to wage) such that β ∈ [0,1] with β = 0 corresponding to the case when sickness absence is fully compensated (100 percent replacement rate) and β = 1 when there is no compensation. B is unemployment benefits. γ is the degree of employment protection and/or level of unionization, and can in general be regarded as a combination of all those labor market regulations that impose costs for employers to discipline/dismiss employees. Assume γ ∈ [0,1] where γ = 1 is the situation of ‘complete’ employment protection (no firing possibility) and γ = 0 is the case of no protection at all. G is the firing-related entitlements, such that higher entitlements are associated with stronger employment protection, Gγ (γ) > 0, and G(0) = 0. The probability of keeping the job, P(A,V), is a function of the joint impact of absence behavior, a, and employment protection, γ, denoted by A, such that the probability of keeping the job declines with absence, Pa(·) < 0, and increases with the degree of employment protection, Pγ(·) > 0. P(A,V) is also assumed to depend on a joint impact of some business cycle characteristics, v, and employment protection, γ, denoted by V, such that, if v is a procyclical variable, the probability of remaining employed is higher during upswings Pv(·) > 0. Also assume Pav(·) = 0. Finally, the following standard assumptions about the utility function are made: Ux(·) > 0, Ul(·) > 0, Uxx(·) < 0, Ull(·) < 0, Uxl(·) = 0.

Thus, the budget constraint (2) states that income spent on consumption is equal to the sum of non-labor income and wage income if the worker retains her job or unemployment and other firing entitlements if the worker is dismissed.9 In turn, the time constraint (3) assumes that if total hours are normalized to 1, then leisure time is the difference between total and actual hours worked.

B. Labor Demand

The firm maximizes its profit given by

=YP(A,V)w(cθβa)[1P(A,V)]G(γ)(4)

where

Y=Ak1η(ca)η(5)

is the production function, which depends on actual hours worked, (c − a), with the labor share being η. Note that the replacement rate β enters the profit equation (4) with an additional parameter θ, which indicates whether the insurance system is private or public, i.e. whether sick pay is paid by the firm or by the government. In particular, if the employer pays sick pay at the rate β, as set by regulations, then θ = 1. Alternatively, θ = 1/β. We will discuss these two cases separately when deriving the main results below.

C. Solution

From the first-order conditions of the optimization problems (1)-(3) and (4)-(5) with respect to the absence hours, a, we can obtain the optimal wage for the worker and the firm from equations (6) and (7) below, respectively

wW=Pa(B+G)UlUxPa(cβa)Pβ(6)
wF=Ya+PaGPa(cθβa)Pθβ(7)

Case 1: Privately financed insurance

As discussed above, when sickness benefits are paid by the firm, θ = 1, and hence equating (6) and (7) yields

UlUxPaB=Ya(8)

stating that in equilibrium, the marginal product of labor (−Ya) equals the marginal rate of substitution (MRS) between leisure and consumption net of the marginal unemployment benefit. Recall that Pa < 0 hence MPL should be higher or, alternatively, MRS should be lower than in the case when PaB = 0. Graphically, in the latter case the indifference curve shifts down along the production function frontier resulting in an increasing absence time (Figure 10).

Figure 10.
Figure 10.

Model Equilibrium

Citation: IMF Working Papers 2004, 193; 10.5089/9781451859843.001.A001

Using the Implicit Function Theorem it can be shown that equilibrium hours of absence, a*, decline with the inverse of the replacement rate (equivalently, increase with generosity of sickness benefits) and increase with the degree of employment protection and contractual hours. Higher absence is also positively related to cyclical expansions, unemployment benefits, and non-labor income.10 The equilibrium wage is then obtained by evaluating (6) or (7) at the point a = a*.

a*=a(β,γ+,c+,ν+,B+,R+)(9)

Assuming U(x,l) = (1 − σ)ln x + σ ln l, where σ ∈ [0,1] can be interpreted as the value of leisure or sickness index, note that in the special case when B = 0 the solution (9) simplifies to

a*=c11+xYση(1σ)(10)

which, similar to Prescott (2004), suggests that (i) as σ goes to 1 and the worker values leisure more than consumption because of, say, recuperation time, the optimal absence time approaches contractual hours; (ii) the smaller is the labor share in the production function the higher is the absence time; and (iii) as the consumption-output ratio increases the absence time also increases.

Case 2: Publicly financed insurance

Similarly, when the employer does not pay for the sickness absence, and θ = 1/β, from (6) and (7) we have

Pa(B+G)UlUxPa(cβa)Pβ=Ya+PaGPa(ca)P(11)

which after some algebraic transformations yields

Q+N(1β)(Ya+PaG)(MN)=0(12)

where Q=Ya+UlUxPaB,M=Pac, and N = Paa + P. Note that eq. (12) differs from the above case when θ = 1 (eq. 8) by the second term, that is, the difference between equilibrium absence under public and private insurance is given by D=N(1β)(Ya+PaG)MN, which will be equal to zero if β = 1 (no compensation for absence) and/or N = 0.11 Note also that D has the same sign as N and that given our assumptions on the function P, Na < 0. Thus, similar to eq. (8), eq. (12) can be re-written as

UlUxPaB+D=Ya(13)

from which it follows that when N > 0 (N < 0) the absence in the case of the publicly financed system is higher (lower) than in the case of the employer paying all benefits (D = 0). Observe that the condition N > 0 (N < 0) can be re-written as εPa> −1 (εPa< −1) where εPa ∈ (−∞,0] is the elasticity of the probability of keeping the job, P, with respect to absence, a. This implies that privately financed system will yield lower absence than the publicly financed one if the elasticity of the probability of being fired with respect to absence is low. In other words, if the decision on the employment continuation is not very sensitive to the absence behavior, then to achieve a lower absence it is optimal to shift to employers the responsibility for sickness insurance costs.

IV. Econometric Analysis

A. Data

While the empirical literature on work absence in individual countries is vast, only a few cross-country comparative studies exist (Drago and Wooden, 1992; Barmby and others, 2002; Bergendorff and others, 2004). In this paper, we try to identify the determinants of sickness absence in a panel of 18 European countries (Table A.1 in Appendix I).

The data on sickness absence draw on labor force surveys, and particularly, on the Eurostat Labour Force Survey Results, which includes aggregated data on average usual and actual hours of work. Our definition of absence includes both short-term and long-term absentees.12 Data on age, health, unemployment, and participation are drawn from the ILO’s Key Indicators of the Labour Market (KILM). Data on institutional characteristics of social security systems are derived from Scruggs (2004). Data on the cost to employers of the sickness insurance system have been constructed based on information from the U.S. Social Security Administration, Social Security Programs Throughout the World (Table A.2 in Appendix I). Basic descriptive statistics of the variables used in the analysis and their cross-correlations are summarized in Tables A.3 and A.4 in Appendix I, respectively.

B. Empirical Strategy

The econometric exercise is based on standard panel data models. While lacking extensive cross-sectional information typical of microeconomic datasets, this approach allows us to analyze sickness absence developments over time and across countries. The availability of working time data and some of the absence determinants by gender makes it possible to combine sickness absence for males and females and to double the effective cross-sectional dimension of the panel data.

In a general setup, the model is given by

ai,t=j=1kai,tjβ0,j+Xi,tβ1+Wi,tβ2+ηi+εi,t,i=1,N;t=1,,Ti;(14)

where ai,t is the absence rate for country-gender pair i at time t, Xi,t is a vector of exogenous covariates and Wi,t is a vector of predetermined and endogenous covariates treated similarly to the lagged dependent variables. X and W may contain lagged independent variables and time dummies, and can be either gender-country or only country specific. ηi is an unobserved unit-specific fixed effect, and εi,t is the disturbance term.

The determinants of sickness absence have been estimated by both static and dynamic panel data (DPD) models that control for fixed effects. While the former follows the common approach applied in the earlier literature, the latter allows us to build in a richer dynamics into the relationship between absence and its determinants by taking also into account potential persistence in absence rates and endogeneity of some right-hand-side variables. Furthermore, DPD models help us to address the error autocorrelation problem which makes fixed-effects estimates inefficient and biases the inference. Serial correlation, in turn, may occur mainly because of omitting variables that change gradually over time. As the inclusion of lagged dependent variable makes the least squares dummy variable (LSDV) estimator biased, an instrumental variable or a Generalized Method of Moments (GMM) estimation method can be used. Monte Carlo results of Judson and Owen (1999) suggest that in macroeconomic panel data applications the one-step GMM estimator by Arellano and Bond (1991) is a second-best choice.13 Furthermore, as showed in Blundell and Bond (1998), persistence in the dependent variable may result in weak instruments and losses in asymptotic efficiency when using the first-differenced GMM estimator. As an alternative, the so-called system GMM estimator is suggested that combines the regressions in differences used in the standard first-differenced GMM estimation with the regressions in levels.

Our empirical strategy has been the following. For each specification static (Within or LSDV and pooled OLS) and dynamic (GMM and Anderson-Hsiao, 1982) panel data models have been estimated.14 For static models, the appropriateness of random-effects specification has been tested by the Hausman test, together with a test of serial correlation in idiosyncratic error terms (Wooldridge, 2002; Drukker, 2003). In a dynamic setup, we have used one-step GMM estimator, which generally tends to be less biased in small samples than the two-step estimator and outperforms the latter in macroeconomic applications (Judson and Owen, 1999; Lusinyan, 2003). The two-step estimator was however been used for robustness checks. The one-step estimations have been implemented using first-differenced and system GMM estimators with standard errors being both robust and non-robust to general heteroscedasticity over individuals and over time. The results have also been checked by using different sets of GMM instruments.15 Finally, robustness of the results to the exclusion of some countries from the sample have been checked as well. The results from static and dynamic panel data regressions are reported in Table 5 and Table 6, respectively.

Table 5.

Determinants of Sickness Absence: Static Panel Data Model

(Dependent variable: share of persons absent due to sickness in total employed)

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Notes: t-values in brackets.

(*,+,−) = significant at 1 (5, 10, 15)-percent level. All regressions include time fixed effects (not reported).

LSDV estimates with robust errors, fixed effects of other countries are not reported.

Table 6.

Determinants of Sickness Absence: Dynamic Panel Data Model

(Dependent variable: share of persons absent due to sickness in total employed)

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Notes: t-values in brackets.

(*,+,−) = significant at 1 (5, 10, 15)-percent level. Arellano-Bond GMM estimates are reported. Regressions include time fixed effects (not reported). AR(2) test refers to the test of the null of no second-order autocorrelation in the first-differenced residuals. Regressions pass the Sargan test of overidentifying restrictions.

C. Summary of Results

As expected, labor force characteristics are important in determining sickness absence. In particular, good health―proxied here by life expectancy―and low labor force participation reduce absence. Age shows no significant independent impact, suggesting that its effect might already be captured by participation. The significant coefficient for the gender dummy indicates that females are more likely to be on sick leave than males.

Working time arrangements have a significant impact. In particular, while more flexibility— measured by the share of part-time employment and flexible working time arrangements— helps to reduce sickness absence, longer usual hours of work tend to increase it. The results also suggest that more flexible work arrangements reduce the impact of long working hours on attendance. The estimated impact of usual hours worked appears to be close to the findings by Barmby and others (2004) for the United Kingdom, where the estimated coefficient on usual hours is 0.16. A major conclusion of Barmby and others (2004) is that sickness absence is relatively more sensitive to the determinants that measure contractual arrangements than to individual characteristics.

Sickness absence is pro-cyclical, but only in some countries. The unemployment gap enters the regressions with a negative sign, in line with the hypothesis that market conditions exert a disciplining effect on absence. This effect is however reduced by employment protection proxied here by union density―as shown by the negative interaction term. These results can hardly be generalized. When the unemployment gap is interacted with country dummies, the coefficient estimate is negative and significant only for Sweden.

Sickness benefits have a robust and positive impact on absence. The coefficient for sickness benefits, as measured by the after-tax replacement rate, is estimated to be in a range between 0.02 and 0.06. However, a significant and large interaction term of Sweden’s fixed effect with sickness benefit indicates that the impact for Sweden is substantially stronger than the cross-country average, more than twice as large. It can be estimated that a 10-percentage point reduction of the net replacement rate in Sweden would yield a 1-to-2 percentage point drop in the absence rate.

Absence declines when employers bear larger costs of sickness insurance. Measured by the product of the cash benefit replacement rate with the period that falls under the employers’ responsibility, these costs have a clear negative impact. This result suggests that higher costs, by changing employers’ incentives and behavior, may indeed reduce absence.

Characteristics of labor market institutions affect the absence rate in different ways, both directly and through their interaction with the business cycle and sickness insurance provisions. Employment protection has a significant positive impact on absence rates both directly and when interacted with the unemployment gap, which is consistent with the evidence provided by Ichino and Riphan (2004) for Italy. The negative impact of employers’ sick pay provisions is somewhat reduced by employment protection, suggesting that the latter may reduce the employer’s ability to enforce better work attendance. The results for unemployment benefits, while suggesting a possible role, are not robust enough to lead to definite conclusions.

V. Conclusions and Policy Implications

The evidence presented in the paper suggests that sickness absence is very high at least in four countries: the Netherlands, Sweden, Norway, and the United Kingdom. In these countries, between 4 and 6 percent of employees are absent on a given day, with losses in terms of forgone output that are likely to be substantial. Owing to their generous public insurance systems, the Netherlands, Sweden, and Norway bear significant costs in terms of public finances. Containing sickness absence would help prevent the erosion of labor supply stemming from demographics and working time reductions.

High sickness absence reflects, to some extent, high labor force participation, particularly of women and older people. Countries with high sickness absence have generally high participation rates, to which both the traditional Nordic emphasis on social inclusion and the market-oriented approach followed by the United Kingdom may have contributed. Going forward, as populations age, maintaining high employment rates will be increasingly challenging and containing the erosion of labor supply even more urgent. With large changes in the composition of the labor force, the overall impact of these changes on sickness absence is difficult to predict.

The high level of sickness absence, however, is not a necessary price for high participation. The results presented in this paper, as well as the evidence provided by the literature, indicate the existence of a significant incentive problem owing to the generosity and the leniency of the public insurance schemes in the Netherlands, Sweden, and Norway. Streamlining the systems in these countries appears necessary to improve labor supply incentives. Our results show that a modest reduction of the replacement rate would yield a sizable reduction in sickness absence, particularly in Sweden. The benefits of a well-designed reform are likely to be substantial, of the order of 0.5 to 1 percent of GDP for Sweden (Andersen and Molander, 2003). A comprehensive reform of sickness insurance should consider the link with other components of the social insurance system. The Swedish example shows that the interaction of sickness insurance with unemployment insurance creates a perverse incentive for the unemployed to be listed as sick. By harmonizing the replacement rates between the two systems in 2003, the government has largely reduced this incentive. A review of the link between sickness insurance and disability pensions and their role in promoting early retirement is also advisable.

A shift of part of the insurance costs to employers is advisable. The paper shows that higher costs are likely to produce a response by employers, which will ultimately help to reduce absence. This effect, however, is likely to be smaller, the higher is the level of employment protection. To be most effective, the cost shift must affect the employer incentives via an increase in the marginal cost of absence. If the incentive is diluted, and the shift translates into a mere increase in labor costs, negative effects on employment are more likely to result.

One way to achieve a more efficient impact would be to leave more room for workers and employers to determine the level of protection, which could be achieved only by a substantial reduction in the replacement rate of the public insurance scheme. The Netherlands has undertaken a major reform in 1996, shifting all costs to employers, and has seen absence declining in the last few years.

Encouraging flexible work arrangements is likely to pay off. The results presented here suggest that policies promoting shorter working hours may not be inconsistent with the objective of reducing absence. High sickness absence in the United Kingdom, say, seems to be explained mainly by its comparatively long working hours. These policies, however, may still lead to a net reduction of hours worked, even if the accompanying decrease in sickness absence would partly offset their effect. Encouraging the diffusion of flexible work arrangements, which are shown to substantially reduce absence, may be a better policy option.

Data and Descriptive Statistics

Table A.1.

List of Countries and Data Availability

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Note:* denotes missing data for Germany (1984), Italy (1992), and the Netherlands (1984, 1986).

Table A.2.

List of Variables, Definitions, and Sources

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Table A.3.

Descriptive Statistics

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Notes: LFPR=Labor force participation rate. See Table A.2 for the definitions and sources of the variables.
Table A.4.

Cross-Correlations Between Variables of Model

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Notes:* =significant at 5% significance level; LFPR=Labor force participation rate; UE=Unemployment; EP=Employment protection. See Table A.2 for the definitions and sources of the variables.

Sickness Benefits in Europe

Table A.5.

Comparative Table on Sickness Cash Benefits (as of 01.01.2004)

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Source: MISSOC (2004).

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