Managing sick leave in Europe

Background: Sick leave of salaried workers is an important economic and public health problem in many European countries. A working group of 20 experts from ten European countries introduced an international exchange concerning this issue. The latest milestone in this project was a meeting in Berlin on the 12th of March 2010 where key questions were extracted. Method The project is mainly based on a structured exchange of information between the participants and a problem-oriented view on the different systems. The first step was to provide information of each nation about the function of professionals who are involved in sick leave certification and the policies used in the different countries to manage sick leave and return to work. Of course professionals play different roles in different institutions throughout the social security and health systems. These had to be described. The following step was to analyze strengths and weaknesses of the current practices and to define common categories of problems. Results: Out of the vast variety of issues two main fields of interest were identified. One was the role of the general physician and the other one was the load of responsibility assigned to the employer or the employee. Concerning the second field the motivational factors, supporting functions and instruments provided by the social security system are relevant. The impairments and social factors that inhibit return to work were also detected as important issues. Furthermore the role of the general physician, the qualification of GPs, the question of doctor hopping and the role of occupational physicians were found to be important. The impact of the introduction of an electronic certificate was also discussed. It is remarkable that in recent years many European countries introduced new methods in managing sick leave. To participate in potential national developments in this policy field further mutual learning is necessary.