Determinants of Regional Differences in Sick Leave Duration for Homogeneous Groups in the Netherlands: Their Implications for Social Security Policy-Making

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SUMMARY

Objectives: Regional differences in sick leave duration determinants were studied between in age and profession homogeneous groups in different regions in the Netherlands, i.e. Utrecht and Southern Limburg, in order to find any effects of socio-cultural factors.

Material and methods: 137 participants in Utrecht and Southern Limburg were interviewed. Data of sick leave duration were obtained from the social fund.

Results: A statistical comparison of sick leave duration figures showed that, in Southern Limburg, determinants of 'health status' (questions about perceived health and burnout due to work) and 'individual characteristics and circumstances' (age, gender and satisfaction with private circumstances) were associated with sick leave duration and, in Utrecht, the 'work contents' determinant autonomy.

Conclusions: In the regions studied, different determinants appeared to be associated with sick leave duration and for some of them the European integration was assumed to have a lasting effect. Nationwide policy interventions to reduce sick leave duration should take into account the existence of regional differences in determinants predicting sick leave duration and the potential effects of different socio-cultural characteristics on laying claim to social security.

Key words: regions, sick leave duration, determinants, social security policy

INTRODUCTION

Different socio-cultural characteristics of different regions may play a role in the type of determinants that affect sick leave. This was the result of a study which explored regional differences in sick leave with regard to relevant determinants of sick leave duration (1).

Sick leave duration is associated with many determinants, whereas little is known about region-related factors that possibly play a role in the type of determinants that predominate. Generally, sick leave is associated with illness although the perception of health may differ between or within countries, which may result in different outcomes in sick leave and disability rates. As for differences in health-related determinants between countries, the European Labour Force Survey (2) showed remarkable differences in national percentages of people with self-reported disabilities (Table 1).

Large differences were found between European countries both in individual health perception and in the number of people having disabilities or long-standing health problems. In Ireland, Austria, Slovenia, Norway, Portugal and Denmark 15-30% of the employees perceive themselves as having disabilities or long-standing health problems, while in France, the Netherlands, Finland and the United Kingdom this is even more than 30%.

As for sick leave, Prins (3) performed a study on differences between Belgium, Germany and the Netherlands which showed that cultural differences attributed to differences in sickness behaviour. The author stated that considerable regional differences in lifestyle, health care and economic factors may underlay the general sickness absence levels, including regional differences that were found in the German sick fund (4). Prins (3) also found that sick leave rates were poor indicators of illness and that culture, in the sense of an attitude towards legislation and avoiding uncertainty, produced differences in sick leave behaviour and in regulations for compensating loss of wages. This about the differences in disabilities and sick leave found between countries.

As for differences in sick leave between regions within the same country research appears to be scarce. The most important outcome of studies on regional differences in duration of sick leave is that they are the result of socio-economic class differences or circumstances and development (5-11). Tordoir et al. (12) and Soeters (13) found a longer duration of sick leave in the Dutch region of Southern Limburg as compared to the rest of the country and the regional organisation of health services (e. …