Western Occupational and Environmental Medical Association

Webinar June 17, 2010

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To Work or Not to Work:
The Costs of Presenteeism and Absenteeism

Speaker: Constantine Gean, MD, MS, MBA, FACOEM

Regional Medical Director, Liberty Mutual Group

Faculty Disclosure:
Constantine Gean, MD, MS, MBA, FACOEM has no conflict of interest to disclose.

To Work or Not To Work

The Costs of Presenteeism and Absenteeism

Constantine Gean, MD, MS, MBA, FACOEM

Regional Medical Director, Liberty Mutual Group

WOEMA Webinar - June 17, 2010

Learning Objectives

The Big Picture

The Solar System

Ideas rather than materials or physical brawn have been by far the greatest contributors during the past half-century to our average annual increase of 3-1/4 percent in real gross domestic product.

(Before the Committee on Education and the Workforce, U.S. House of Representatives)

WORKING PAPER NO. 50 - European Central Bank, 2001 http://www.ecb.int/pub/pdf/scpwps/ecbwp050.pdf

Levels of labor Productivity in 1990 US Dollars

WHAT IS PRODUCTIVITY?

Hang On! I just got another nibble!

The Perils of Fishing

Intel income statement - analysis of the value of human capital

36% of revenues

24% of book value of Companies

On a par with fixed capital costs

Group health (47%)

Turnover (37%)

Unscheduled absences (8%)

Non-occ disability (5%)

Workers Comp.(3%)

- Dr. Marc L. Berger VP of Merc Outcomes Research
- Validated by R. Howell, Dean of Dartmouths Bus. School

*

Cost Drivers

(Wall St. Journal)

(Unum 2002 Study)

(DOL/COREl)

*

National, randomized telephone survey; >28,000 worker National, randomized telephone survey; >28,000

households, conducted over 12 month period (2001 households, conducted over 12 month period (2001--2002) 2002)

Lost productive time Lost productive time (LPT) comprised absence and reduced (LPT) comprised absence and reduced

work performance due to personal or family health work performance due to personal or family health

Within a 2 Within a 2--week recall period, personal health caused 10% of week recall period, personal health caused 10% of

workers to be absent, and 38% to report unproductive time workers to be absent, and 38% to report unproductive time

On average, workers lost 2 hours/week LPT; 66% of this was On average, workers lost 2 hours/week LPT; 66% of this was

through reduced work performance due to personal health through reduced work performance due to personal health

Aggregate LPT for US workforce $226 billion in 2002, or an Aggregate LPT for US workforce $226 billion in 2002, or an

average of $1685/employee/year.

PRESENTEEISM
AND
ABSENTEEISM

What are they?

How Measured?

Examples?

Presenteeism Origins

Workforce Optimization

Presenteeism and Absenteeism Unions and Employers Perspectives

Fear of loss of income or employment on the part of the employee

Presenteeism has developed as a result of a gradual relaxation of employment protection laws and reductions in benefits, most notably sickness benefits

Other factors are contribute to presenteeism, including an increase in health care costs, which has rendered employees more reluctant to seek medical attention when it is necessary

Lovell, 2004 - IWPR publication B242

Most Relevant Conditions Impacting Productivity Change Based on POV
(Top 10 Medical Conditions From Various Perspectives )

JOEM Volume 49, Number 7, July 2007

Medications Can Compound Problems

Est. Annual Cost of Presenteeism
(employed Population @ $23.15/hour)

Goetezel, et. Al., JOEM Volume 46, Issue 4, pp398-412 (April 2004)

Absenteeism

Seen as a management problem

Framed in economic or quasi-economic terms

Frequent absence from the workplace may be indicative of poor morale or other issues.

Many employers have implemented absence policies which make no distinction between absences for genuine

Bradford factor, which only takes the total number and frequency of absences into account, not the kind of absence.

Many employees feel obliged to come to work while ill, and transmit communicable diseases to their co-workers.

No call" or "no show." According to Nelson & Quick (2008) people who are dissatisfied with their jobs are absent more frequently.

The psychological model that discusses this is the "withdrawal model," which assumes that absenteeism represents individual withdrawal from dissatisfying working conditions.

Absenteeism is linked with smoking, problem drinking, low back pain, and migraines.[

Absence ascribed to medical causes is often still, at least in part, voluntary

The line between psychological and medical causation is blurry, given that there are positive links between both work stress and depression and absenteeism.[4]

Depressive tendencies may lie behind some of the absence ascribed to poor physical health, as with adoption of a "culturally approved sick role." This places the adjective "sickness" before the word "absence," and carries a burden of more proof than is usually offered.

Evidence indicates that absence is generally viewed as "mildly deviant workplace behavior. people tend to hold negative stereotypes of absentees, underreport their own absenteeism, and believe their own attendance record is better than that of their peers)

*

Commonly used Days Away from Work
(DAFW) Approach

CONCLUSION: Find low hanging fruit just by adding up DAFW.

*

2

Spine Pain, Depression and Fatigue Top List
Top 10 Overall Most Costly Medical Conditions
(Annual medical + drug + Absenteeism + Presenteeism costs per 1000 EE)

JOEM Volume 49, Number 7, July 2007

PRESENTEEISM
AND
ABSENTEEISM

What to do to limit?

How Managed?

Examples?

Productivity management

Health & Productivity Management

Value-based health care provision

Approaches to Absenteeism and Presenteeism Management

Disability management

Wellness & Health promotion

Footnotes:

a, b - 2001 Unscheduled Absence Survey. CCH Inc.

c - 2001 Health Value Initiative, Hewitt Associates

*

MANAGEMENT OF RESOURCES

Plan approaches

Clinical Management approaches

Commonly used

Less commonly used

Productivity management

Health & Productivity Management

Value-based health care provision

Expanded View

Disability management

Wellness & Health promotion

Issues

Approaches

Approaches

Issues

Approaches

Approaches

Footnotes:

a, b - 2001 Unscheduled Absence Survey. CCH Inc.

c - 2001 Health Value Initiative, Hewitt Associates

*

Backache and Depression Most Prevalent Conditions (Focus on the most common conditions)

*

OVERALL UTILIZATION TRENDS - Circulatory Case Types

(ALOD = Average Length of Disability)

Result: 12% ALOD decrease.

*

HIGH IMPACT UTILIZATION TRENDS
- Psychiatric Case Types
(ALOD = Average Length of Disability)

*

Manufacturer - Location Analysis
- ALOD by Location and type (Medical vs MH*)- 4 Qtr Summary(Q3 00-Q201)

Savings Potential: Whats up with San Jose and Orchard Park?

*MH=Mental Health ICD-9s

So What Does this Mean from the Clinicians POV?

Oh, the Pain!

Implications for the Practitioner
(ID problems and be a good doctor)

Understand the continuum of Absenteeism and Presenteeism can help the care of the individual

Do aggressive treatment of common conditions (depression, respiratory illness, hypertension)

Understand/find possible company resources (EAPs, wellness programs, special benefits, etc.)

Encourage employers to use transitional work and focus on defining employee functional level

Chronic Pain (Biopsycosocial Model)

Loeser J.

Managing the Chronic Pain PatientD,, 1989

Implications for the Practitioner
Understand basic disability prevention/management

Understand the Biopsychosocial Model (e.g., emotional reactions accompany temporary disability and should be managed to prevent it becoming permanent).

Understand that a diagnosis alone (without demonstrable functional impairment) may not justify work absence

ID and treat psychiatric issues and teach patients about the interaction of psychiatric and physical problems.

Understand Functional Recovery Programs and use them in cases of delayed recovery

WRAP UP AND QUESTIONS

?

Presenteeism and Absenteeism Literature

Preventing Needless Work Disability by Helping People Stay Employed ACOEM Position Paper - J Occup Environ Med - 01-SEP-2006; 48(9): 972-87http://www.acoem.org/guidelines.aspx?id=566

Healthy Workforce/Healthy Economy: The Role of Health, Productivity, and Disability Management in Addressing the Nation's Health Care Crisis

J Occup Environ Med - 01-JAN-2009; 51(1): 114-9

Health and Productivity as a Business Strategy

J Occup Environ Med - 01-JUL-2007; 49(7): a712-21

Health, Absence, Disability, and Presenteeism Cost Estimates of Certain Physical and Mental Health Conditions Affecting U.S. Employers

J Occup Environ Med - 01-APR-2004; 46(4): 398-412

*

A facilitated early return to work program at a large urban medical center.
Bernacki EJ, Guidera JA, Schaefer JA, Tsai S.

Division of Occupational and Environmental Medicine, Johns Hopkins University, School of Medicine, 600 N. Wolfe Street, Billings Administration 129, Baltimore, MD 21287-1629, USA.

An Early Return to Work Program was initiated at The Johns Hopkins Hospital and Associated Schools of Medicine, Hygiene and Nursing in Baltimore, Maryland, in April 1992 as part of a comprehensive effort to control the incidence and costs of work-related illnesses and injuries. The program was similar to others that incorporate employee and supervisory training and job accommodation, but it also included an industrial hygienist trained in ergonomics to facilitate the placement of individuals with restrictions. The return to work program was studied over a 10-year period, comparing the number of lost workday cases, lost workdays, and restricted duty days before (1989 to 1992) and after (1993 to 1999) initiation of the program. A significant decrease (55%) was observed in the rate of lost workday cases before versus after the return to work program. Furthermore, the number of lost workdays decreased from an average of 26.3 per 100 employees before, to 12.0 per 100 employees after, the return to work initiative, and the number of restricted duty days went from an average of 0.63 per 100 employees to 13.4 per 100 employees (a twentyfold increase). The study suggests that a well-structured early return to work program is an integral part of a comprehensive effort to control the duration of disability associated with occupational injuries and illness. It also indicates that to be most effective, an early return to work program must include participation by medical providers, safety professionals, injured employees, and supervisors. Our work suggests that even with these elements in place, the effectiveness of return to work programs may be increased by including an individual trained in ergonomics to facilitate the job placement process.

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