Sickness absence in Estonia: determinants and influence of the sick-pay cut reform
Date
2017-04-03
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Abstract
Haiguse tõttu puudumisena (HTP) mõistetakse ajutist töölt ärajäämist juhul, kui inimene ei saa haigestumise tõttu oma tasustatavat tööd jätkata, ehk, nö haiguslehel (HL) olemist. Töötaja sotsiaalne kaitse haigestumise korral on tänapäeval üks inimõigustest. HTP-l on kaks aspekti: inimese õigused ja kohustused. Ühest küljest ei ole haige vastutav haigestumise eest ja tal on õigus haigestununa tööst kõrvale jääda, teisalt on tal kohustus suhtuda haigestumisesse kui mittesoovitavasse olukorda ja vähendada haigeolemist nii suurel määral kui võimalik. HL kasutamist mõjutavad ka individuaalsed, töö ja tervisega seotud tegurid, aga ka rahvastiku demograafiline ja majanduslik olukord ning kehtiv kindlustussüsteem.
Majanduse kasvades, aastatel 2003–2008 suurenesid Eestis väljamakstavad töövõimetushüvitised 15–25% aastas ja jõudsid aastaks 2008 94 miljoni euroni. 2009. aasta 1 juulil jõustus uus töövõimetuslehtede kasutamise ja hüvitamise kord, millega kitsendati HL hüvitamist. HL kulud vähenesid 2010.a 33 miljonile eurole ja haiguspäevade koguarv vähenes 6,35 miljonilt 3,6 miljonile päevale aastal 2010.
HTP epidemioloogiliste näitajate abil uurisime HL kasutamise riskitegureid ja seaduspära Eesti töötajatel ning uue korra mõju HTP-le. Leidsime, et HTP riskitegurid olid halb tervise enesehinnang, kroonilise haiguse olemasolu, madal haridus ja tööga rahulolematus. HTP põhimustrid olid sarnased teiste riikide uuringute tulemustele ja ei muutunud ka pärast uut korda. Erisusena leidsime, et HL kasutajate seas olid meeste HL-d pikemad kui naiste omad. Uue korra järgselt vähenes HTP kolmandiku võrra ja muutus töötajate haiguskäitumine: vähenes HL kasutajate ja korduvate HL hulk. Kõige vähem muutus haiguskäitumine vanemaealistel ja pikkade HL kasutajatel, ehk tõenäoliselt raskete haigestumistega töötajatel. Nn sinikraede, eelkõige madalapalgaliste haiguskäitumine muutus rohkem kui nn valgekraedel. Kokkuvõtteks: HTP mustrid jäid ajas muutumatuks, hüvitiste kitsendamine vähendas haiguspuudumist, kuid avaldas eri sotsiaalsel positsioonil olevatele inimestele erinevat mõju. Selleks, et hinnata, kuidas muutub töötajate haiguskäitumine ajas ja kuidas ühiskondlikud sündmused ning sekkumised HTP-d mõjutavad, on soovitav HTP epidemioloogilisi näitajaid kasutada HTP kestvaks jälgimiseks.
Sickness absence (SA) is usually defined as absence from work in a situation when a person is unable to perform his or her professional tasks because of illness or disease. SA has two perspectives: the person’s rights and obligations. The sick person is not held responsible for his or her illness and can be released form working. At the same time he or she has to consider that being sick is non-desirable and should limit sickness behaviour as much as possible. Apart from the illness, the SA is influenced by demographic, socio-economic, and cultural status of the population, its working environment as well as the conditions in labour market and by the opportunities of social insurance system. Thus, SA reflects population’s health and health behaviour under certain conditions. During the economic growth in Estonia in 2003–2008, the total amount paid for sickness benefits by Estonian Health Insurance Fund increased by 15–25% annually reaching 94 million euros by 2008. From July 1, 2009 sick-pay benefits were cut back (a new regime). Expenditures dropped to 33 million euros, number of sick-leave (SL) days decreased from 6.35 million in 2008 to 3.6 million in 2011. We studied which risk factors influence SA among Estonian employees. By using SA measures we determined the SA patterns and analysed the impact of sick-pay cuts on the use of SA. We found that the SA was associated with poor self-rated general health, presence of chronic disease, lower education, and dissatisfaction with one’s job. Main patterns of the SA were similar to those found in studies of other countries, except the finding that among SL users men’s sick leave was longer. After the new regime, the SA decreased by one third and employees changed their SA behaviour. However, SA of older employees and users of long lasting SL, i.e. persons’ with more serious health problems, was not influenced. Blue-collar employees, especially with low income, changed their health behaviour more than white-collars. In conclusion, SA patterns were stable over time, sick-pay cut policy decreased SA considerably, but had an uneven impact on different socio-economic categories of employees. It is suggested that the SA measures should be monitored continuously in order to find out how the SA behaviour and health of employees change over time and which societal events influence them.
Sickness absence (SA) is usually defined as absence from work in a situation when a person is unable to perform his or her professional tasks because of illness or disease. SA has two perspectives: the person’s rights and obligations. The sick person is not held responsible for his or her illness and can be released form working. At the same time he or she has to consider that being sick is non-desirable and should limit sickness behaviour as much as possible. Apart from the illness, the SA is influenced by demographic, socio-economic, and cultural status of the population, its working environment as well as the conditions in labour market and by the opportunities of social insurance system. Thus, SA reflects population’s health and health behaviour under certain conditions. During the economic growth in Estonia in 2003–2008, the total amount paid for sickness benefits by Estonian Health Insurance Fund increased by 15–25% annually reaching 94 million euros by 2008. From July 1, 2009 sick-pay benefits were cut back (a new regime). Expenditures dropped to 33 million euros, number of sick-leave (SL) days decreased from 6.35 million in 2008 to 3.6 million in 2011. We studied which risk factors influence SA among Estonian employees. By using SA measures we determined the SA patterns and analysed the impact of sick-pay cuts on the use of SA. We found that the SA was associated with poor self-rated general health, presence of chronic disease, lower education, and dissatisfaction with one’s job. Main patterns of the SA were similar to those found in studies of other countries, except the finding that among SL users men’s sick leave was longer. After the new regime, the SA decreased by one third and employees changed their SA behaviour. However, SA of older employees and users of long lasting SL, i.e. persons’ with more serious health problems, was not influenced. Blue-collar employees, especially with low income, changed their health behaviour more than white-collars. In conclusion, SA patterns were stable over time, sick-pay cut policy decreased SA considerably, but had an uneven impact on different socio-economic categories of employees. It is suggested that the SA measures should be monitored continuously in order to find out how the SA behaviour and health of employees change over time and which societal events influence them.
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Keywords
ravikindlustus, töövõimetushüvitised, haigushüvitised, health insurance, disability compensation, medical benefits, Eesti, Estonia