Estonia – a country, where the poor go to work sick

Ida-Tallinna keskhaigla töötervishoiuarst Evelyn Aaviksoo PHOTO: Tairo Lutter

The government’s 2009 decision to cease paying compensation for the first three days of sick leave hit the hardest the low wage earners, who went to work sick – the amount of sick leave taken was suddenly halved. This emerges from the doctor’s paper Evelyn Aaviksoo recently defended in Tartu University.

Q: Evelyn Aaviksoo, you are an occupational health care physician at the East Tallinn central hospital. How frequently do you meet people who look like they did not finish the cure of their disease and did not take sick leave although they should have done so?

EA: We certainly do see it. Even the ordinary cold – highly conscientious people know that others will have to do their job and their salary is low as well; therefore they will go to work at any cost. Going to work sick is an especial problem among single parents and low wage earners. They claim themselves in hindsight that due to the failure to cure the disease or take time off for recovery they were sick for a much longer time or that they were ill for a longer time this year than during the previous one. They just could not afford to take time off for the organism to recover.

I can see in my everyday work that there are enterprises where people are exhausted and fall ill more easily, while the organization of work and working environment re so rational in other firms that people do not exhaust themselves and have less need for sick leave.

Q: Your paper shows that during economic decline and increased unemployment the number of sick leave days decreases even among those still having their job. On the other hand, sick leave is taken more frequently during boom.

EA: Exactly. It has been discussed and one solution may be that the more healthy people are kept employed during decline. Those frequently ill are dismissed more easily. However, there are quite many studies showing that during crisis people still having their job become more conscientious, due to the fear of being dismissed. Life is good during the growth period.

Q: Did you study among the reasons the number of people, who would use sick leave for treating their handover, for example, during the growth period? It is still possible thanks to some general practitioners.

EA: This is certainly possible. I did not study it in my paper – I did not ask for the reasons for taking sick leave. Earlier studies have shown that sick leave is taken more frequently during major sports events and that absence from work is more frequent on Mondays than on other days of the week.

Q: I noticed from your work first of all that losing three day’s compensation because of illness is a real calamity for the lowest-earning blue-collar workers. And the compensation was also cut from 80 to 70 percent.

EA: The changes in Estonia are generally more extensive than in other countries. For example, when they reduced the sickness compensation in Germany from 100 percent to 80 percent of salary, the trade unions raised a row and the earlier compensation was restored.

I like the aspect in Greece that their compensation rate depends on the number of dependents in the family. There are all kinds of systems; in quite many countries the first three days go uncompensated, but in others only the first day is unpaid. Some countries have maximum levels for compensations. Several countries also have minimum sickness compensation levels, which I personally like, considering the lowest-paid workers.

Q: This raises the question, what to do to prevent people from taking sick leave without any reason or going to work while sick. Now it seems that sick people go to work.

EA: I would like to see a discussion about what the state and employers want to achieve, what we are going to change. Do we want to protect the lowest-earning people? I think that they are already too vulnerable. It is already harder for them to find a new job. No one wants them to remain circulating in the social system because their health steadily worsens as they cannot afford sick leave.

Q: Have we then swung to the other extremity with our sickness compensation system, where many people are afraid to take sick leave for any reason and go to work while sick?

EA: We have certainly produced a worse situation for ourselves compared with the so-called old EU member countries – their compensations are higher and the use of sick leave is more frequent. In itself the existence of some disciplining mechanisms is not bad, but there must also be support measures. We should not return our sickness compensation system to 2008, but we should move towards some new solution.

My study also shows that the people not happy with their work take statistically much more frequently groundless sick leave. This means that more attention must be paid to pleasant working environment.

Q: Untreated illnesses may have eventually long-term consequences like chronic diseases in the older age. These consequences cannot be studied so far since the time period has been too short.

EA: Exactly. These diseases are not yet apparent and occupational health specialists cannot determine them easily.

Q: Actually it is not just a problem of the low wage earners that they have to go to work ill. The system has made a lot of people feel that they must go to work at any cost and sick leave is an option only for the really serious situation. People in the Western countries probably stay at home when they feel a little bad.

EA: I agree. A lot of people are conscientious. What differentiates us from the welfare countries – their highly paid people have more to lose due to sick leave and therefore they do not take it even if they should. Taking sick leave is more frequent among the lowly-paid people in their terms.

But the income of the lowly-paid in Estonia is so small that they often try not to take sick leave or their situation becomes really bad. I mean elementary subsistence.

Q: The number of dick days in 2010 declined nearly two times compared with 2008, from 6.35 million to 3.6 million. The situation of economy has improved in recent years; are people now more willing to take sick leave?

EA: I have observed the data up to 2015 and the actual number remained at the same level as in 2010.

Q: It seems that our state’s present approach to sickness compensations is very right-wing.

EA: It is rigid. I can understand that there was an economic crisis in 2009 and the system needed to be changed as the state’s expenses on sickness compensations increased 15-25 percent every year – that was excessive as well and there must have been a share of abuse. But now we have reached an economically more stable period and should revise the compensation system once more.

Q: What is the outcome of the state leaving the payment of sickness compensation between the 4th and 8th day to the employers, besides the fact that this measure helped to save a lot of money? While the state paid 93 million euros worth of compensations in 2008, the sum declined three times by 2010, to 33 million.

EA: The advantage is that employers may become more motivated to study why their workers fall ill, what is the cause. Maybe it depends on the working environment? Of course, the employers already face a high tax burden and it may happen that employees fear to cause extra expenses. A majority of sick leaves last from 4 to 20 days, which means that a large share of compensations is paid by the employers.

Q: My employer Eesti Meedia decided to compensate the second and third days of sick leave to its employees. Hopefully the number of such employers is increasing.

EA: Yes. It is increasing, but their number could be even higher. Unfortunately we also have employers who believe that people should be employed as long as they can work and dismissed if they cannot.

But some employers tell their staff to stay at home at full pay for a couple of days – the smaller the firm, the more flexible it is. Large enterprises often establish three health days which the employees can use as they like. And there are also some like your employer – they ask for the doctor’s certificate, but compensate staring from the second day. This is highly welcome!

(Postimees attempted to receive a comment from Minister of Health and Labor Jevgeni Ossinovski [Social Democratic Party], but he did not answer the reporter’s e-mails or phone calls nor was accessible via the PR official).