Battling sickness or battling the sick?

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The current Czech government has set itself the task of reforming the healthcare system. One key issue in this sphere is continued high levels of absenteeism, with the number of sick days taken among the highest in Europe. The government believes that absenteeism is in part encouraged by state insured sick pay, and has committed to lowering the amounts people receive. But is this a wise choice and what are the potential pitfalls?

In many European countries, your monthly pay check is set in stone – a contract between employer and employee. If the employee is sick, the paycheque is unaffected. Call it a matter of trust. But not in the Czech Republic. Here, sick days are subject to a complex series of deductions and subsidies. Earlier this summer, a government move to reduce to nothing the first three days of sick pay was stuck down by the country’s Constitutional Court. Thus, limited sick pay was again reintroduced. But the result, according to recent statistics, is disturbing. Absenteeism fell by one fifth during the period that the zero sick pay for the first three days was in effect. Since its reintroduction in July, where employees now receive 25% of their pay, some employers are complaining that absenteeism has risen by as much as 15%.

As of next January, as a result of government efforts, the system will change to an even stricter form – again, employees will get nothing from the state for the first three days of illness – a change that required a rewriting of several laws, including the one that the Constitutional Court ruled on earlier this year. The new system will also do away with sick pay for weekends for the first 14 days of illness. But critics argue that such tweaks in the system assume that employees are fundamentally dishonest, and must essentially be punished for falling sick. In fact, is this system based on the idea of a presumption of guilt on the part of the worker? And why, when people pay both health insurance and sick leave insurance are they essentially punished with reduced pay for getting sick?

Another key question relates to the current formula which is used to calculate sick pay. The system divides responsibility between the state and employer to pay a percentage of an employee’s sick pay during illness. Why is the state getting involved at all, one might ask? Should not employers carry the burden of employing honest people who do not pretend to be sick? Even the new system set to begin next January will have the state refunding half of a company’s pay given to a sick employee. One measure set to take effect in January appears to address this concern – after 14 days of illness, the Czech state authorities will no longer investigate if patients are faking – leaving it up to companies to investigate their own staff, potentially with the use of private surveillance agencies – something increasingly being done in the country.

Other initiatives are also set to take off, such as employer education programmes on how staff can stay healthy and avoid getting sick (assuming they are not faking). Perhaps the greatest irony in this system is that it neither fits the right-of-centre mantra of efficiency nor left-of-centre mantra of social equality. For the Czech Republic, that is arguably politics as usual.