Influence of the sickness benefit reform on sickness absence

To analyse short-term changes in sick-leave use after the implementation of sick-pay cut policy in Estonia on July 1, 2009.

The study is based on all sick-leave episodes of 20-64-year-old employees registered by the Estonian Health Insurance Fund in 2008 and 2011, which covers 227,981 persons in 2008 and 152,102 persons in 2011. Population- and absentee-level sickness absence measures were used to describe sickness absence. Multiple logistic regression analysis was performed to explore associations between sick-pay cut and sickness absence measures.

The main impact of the reform was that the total number of sick-leave episodes and sick-listed persons decreased by one third. The number of sick leave episodes lasting 4-20days decreased by half whereas the change in shorter and longer episodes was negligible. Chances of recurrent sick-leave lowered significantly. The mean duration of sick-leave episodes lengthened in a positive correlation with age.

At the population level sickness absence decreased after the sick-pay cut, which was one of the goals of the reform. The sickness absence of absentees with long-lasting illnesses did not change, but people with shorter illnesses adapted their sickness absence behaviour. It indicates that health outcomes of people whose absence has decreased due to policy changes need to be followed.