Just 20 per cent of the workforce account for 70 per cent of sick leave in Spain

In Spain, fewer than 20 per cent of workers (16.6%) account for 70 per cent of sick leave (69.6%), a trend that has exacerbated the economic impact of temporary sickness leave. In 2023, these justified absences represented 5.4% of Spanish GDP (gross domestic product). Moreover, lost work days increased by 52% compared to 2018.

The data comes from Ivie, the Valencian institute of economic research, together with the mutual insurance company Umivale Activa, working with over 62 million, anonymised sick leave cases to understand what is happening in the Spanish labour market. This also happens to be at a time when sick leave is increasing social security expenditure. "Not everything can be explained by saying that, if the economy is doing well, sick leave increases. If it's doing badly, more people go to work", said José María Peiró, Professor of applied business psychology at the University of Valencia and co-author of the study. "Nor can it be explained by that Spanish trick of repeating or extending sick leave," said Octavio Granado, former Secretary of State for Social Security.

However, the authors of the research believe that repetition is fundamental to understanding absenteeism due to sick leave and its growth in Spain. According to their data, this characteristic accounted for 64.5% of lost days in 2023 (12.6 points more than in 2018) and was responsible for the entire increase in the absenteeism rate. "It is true that the majority of workers do not take any sick leave throughout the year," said Lorenzo Serrano, Professor of fundamentals of economic analysis at the University of Valencia and also co-director of the study. However, 16.6% of the workforce in 2023, or approximately 3.3 million workers, accumulate 70% of temporary incapacity. "Not only do they have one bout of sick leave, but they accumulate two or even three in a year," noted Serrano.

This percentage has increased by 12.6 points in the last five years, and these workers are responsible for practically the entire increase in the absenteeism rate for sick leave between 2018 and 2023, conclude the study authors. "Repeated absences may be a natural phenomenon, but it may also be related to failings in the treatment and diagnosis process, or it could even hide irregularities, especially in pathologies that are difficult to identify."

Repeat sick leave plays a significant role in the 368.7 million working days lost annually, according to 2023 data, which caused a loss of 81.574 billion euros in Spanish GDP, a 5.4% drop. This figure is 25.9 billion euros more than the total cost in 2018.

If we look at workers who repeat sickness absences, their proportion has grown notably in the last five years. They have gone from representing 50% of the total days lost to 64.5% in 2023, that's nearly two out of every three cases. Most of these 'repeaters' belong to two or more pathological groups. The most common are also the most difficult to identify, such as pain (the 'algias', for example, neuralgia) and, above all, mental health disorders, although there are also pulmonary or digestive conditions. These two categories - algias and mental health - account for more than half of the cases and for almost six out of every ten currently active, long-term conditions.

In 2023, Spain's social security records system, for the first time in its history, logged almost 600,000 temporary incapacities related to mental health, up 110.52% from 2018. According to the data obtained by SUR, anxiety and depressive disorders were the causes that led to most sick leave that year. However, this figure has continued to rise in subsequent years.

The dramatic increase in temporary incapacity benefits in Spain is putting pressure on the social security coffers and also on companies. According to Bank of Spain calculations, the allocation of sick leave benefits has shot up by 78.5% compared to 2019 and is close to 16.5 billion euros. At the same time, the direct cost to companies, which often supplement Social Security assistance, has risen to 4.613 billion euros, 62% more than a year before the outbreak of the pandemic.

The reasons why so many workers are on sick leave compared to before the pandemic are unclear, so say the study's authors. The deterioration in public health following the pandemic, the natural aging of the population and the healthy economic situation are some of the justifications that the Ministry of Social Security has put on the table for dialogue with trade unions and employers to address this issue. "It is also necessary to review the Spanish healthcare system, which is prolonging these absences due to being saturated", said the former Secretary of State for Social Security during the presentation of the Ivie report, adding that "Doctors are not Social Security auditors. They do not study to control spending, it is not their function. We assign them functions that aren't their responsibility."

The Spanish government's reform, however, does not focus on the healthcare sector, but rather on modifying the employment sector. The proposal from Elma Saiz's department is based on two main lines of action: shortening the duration of sick leave and facilitating the return to work of those affected.

In the first area, central government proposes that, for common contingency procedures lasting less than 365 days, mutual insurance companies may propose that the medical inspectorate be notified of the permanent disability, so that the body in charge of the case can assess whether or not it is appropriate to initiate proceedings.

The second area for government attention is on returning to work in cases of long-term sick leave or "progressive discharges" as it is popularly known. In this proposal, the Ministry proposes that the return to work (provided the sick leave has gone over 180 days) be gradual once the worker has recovered their health and after receiving a medical discharge. This progressive return to work will last a maximum of 30 days and will apply to full-time workers and also part-time workers whose work schedule exceeds 80%. "This is standard practice in neighbouring countries", said Granado.

During this period the employee would work half of his or her normal working day, receiving the corresponding portion of their salary and a benefit equivalent to 50% of the benefit for the half of the day not worked. However, for the time being, this proposal faces opposition from the trade unions. "The measure seems hasty and lacks sufficient guarantees to protect the health of workers," is the unions' repeated complaint.

The Ivie and Umivale study also analyses the differences in the amount of sick leave taken in Spain in recent years and by whom, and it clearly points to women. "This is because many of them effectively have a double working day", said Granado.

In 2023, women recorded higher scores on the sick leave indicator (percentage of annual days lost compared to potential days) - they were at 6.4%, with men at 4.8%. It shows that mental health plays a greater role in the number of days lost by women (21% compared to 15% for men). The report also notes the disparity in results according to age: the sick leave indicator is 3% for young people aged 16-29 and 9.6% for workers aged 60-64. In fact, 20% of the increase corresponds to days lost by these workers when close to retirement. "This is normal, because the workforce has aged," said Serrano.

However, the incidence is highest among a younger age group, with 648,000 workers between the ages of 20 and 24. "Young people experience many more sickness episodes, although the duration of their sick leave is shorter in terms of sick days taken", stated the study's authors.

In terms of differences derived from job characteristics, the report finds a slightly higher probability of sick leave occurring among workers with permanent, full-time contracts. Furthermore, the probability is also higher - by up to 17 percentage points - for lower-skilled occupations.

By sector, the study finds the highest rates of absenteeism due to sick leave to be in administrative and support services, water supply and sanitation, plus healthcare work, with percentages of lost days standing at over 7%. In contrast, the lowest rates of absenteeism are recorded in the information and communications sector (2.4%) and in professional, scientific and technical activities (2.6%). Also notable are sectors with lower-than-average absenteeism, such as agriculture, financial activities and education.

Similarly, significant differences are estimated depending on location (regional). The highest sick leave rates were recorded in the Canary Islands, the Basque Country and Galicia, where they exceeded 7% of working days lost in 2023. In contrast, the lowest percentages were in the Balearic Islands, La Rioja and the region of Madrid, where they did not exceed 5%. Regional differences are also evident in the prevalence of long-term sick leave processes (more than 365 days): the Canary Islands, Galicia and Catalonia had a prevalence of more than 11 per 1,000 workers, while it was less than seven in regions such as La Rioja and Madrid.

Likewise, the differences in terms of repeat workers at the provincial level are worth a mention. The highest percentages were recorded in Barcelona, Álava and Navarra, with values above 24% of the protected population. At the other extreme, Cáceres, Jaen and Salamanca had the lowest percentages.

As a result of the combined study of the sector and regional variables, the analyses show that the differences in the absenteeism indicator for sick leave Spain's regions are mostly explained (80% of the total) by regional differences in temporary incapacity within each sector and, to a lesser extent, by differences in the sectoral composition of their economies (the remaining 20%).