1. AN ANALYSIS OF LONG-TERM SICK LEAVE IN SLOVENIA
dr. Ticijana Prijon, dr.med., dr. Tomaž Čakš, dr.med.
Health Insurance Institut of Slovenia
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Prijon, Čakš - Long Term Sick Leave

2. Both authors declare no conflicts of interest.
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Prijon, Čakš - Long Term Sick Leave

3. Prijon, Čakš - Long Term Sick Leave
Introduction
Sick leave is a temporary absence from work due to illness, injury, treatment and other reasons.
Absenteeism does not come exclusively from the health status of an employee, but is also the consequence of work, social, economic and other factors.
Absenteeism is an important indicator of health status of workers, therefore regular monitoring of absenteeism is a prerequisite for its management.
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Prijon, Čakš - Long Term Sick Leave

4. Prijon, Čakš - Long Term Sick Leave
The justification for temporary incapacity for work of insured persons longer than 30 days is granted by selected physicians from ZZZS (Health Insurance Institute of Slovenia) upon the proposal by the patient's selected physician.
On ZZZS (Health Insurance Institute) we are obliged to refer patients to the Invalidity Committee on ZPIZ (Pension and Disability Insurance Institute), if we estimate that there is no improvement in the state of health, which would also enable him/her to recover his/her working ability.
We are obliged to do so even if the insured is detained from work due to illness or injury for a continuous period of one year.
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Prijon, Čakš - Long Term Sick Leave

5. Prijon, Čakš - Long Term Sick Leave
Slovenia has no legally prescribed limit for temporary incapacity for work.
Long-time absentees are a social problem from health, economic, welfare and other perspectives.
The numbers of long-term absentees have been increasing in the last years.
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6. Among possible reasons for the increase in absenteeism:
Increase in the number of employed persons,
the ageing of workforce,
consequently higher morbidity of active workforce,
presenteeism in the past years of economic crisis,
longer procedures for medical diagnostics and treatment,
etc.
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7. Prijon, Čakš - Long Term Sick Leave
Methods
retrospective analysis of long-term absenteeism, with special focus on temporary incapacity for work of insured persons, lasting more than 3 years.
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8. Prijon, Čakš - Long Term Sick Leave
Results
On 30 September 2017:
899 persons (477 men and 422 women) on sick leave more than 3 years (4.17% of all absentees)
Numbers increased proportionately with age.
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9. Trend of movement of the number of LTSL over 3 years from 2013 on
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10. Trend of movement of the number of LTSL over 5 years from 2013 on
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11. Number of LTSCs over 3 years by age groups and sex
LTSC over 3 years: 53,1% M, 46,9% F;
LTSC over 5 years: 64,6% M, 35,4% F
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12. The most common reason for long-term absence in Slovenia:
illness (82.3%),
injury outside work (8.9%)
work injuries (5.6%).
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13. The most common reasons for long-term absence in men in Slovenia:
diseases of musculoskeletal system and connective tissues (30.1%),
recovery after injury or poisoning (28.6%),
neoplasms (8.9%),
circulatory diseases (8.9%)
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14. The most common reasons for long-term absence in women in Slovenia:
diseases of musculoskeletal system and connective tissues (35.1%),
neoplasms (16.9%),
recovery after injury or poisoning (15.3%),
mental and behavioural conditions (10.5%),
neuromuscular diseases (5.6%).
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15. DILEMMAS OF THE MAIN STAKEHOLDERS IN THE RETURN-TO-WORK PROCESS
Stakeholders are:
vocational rehabilitation (VR) providers,
employers
national insurance institutions.
The most important issue of VR provider teams is the variety of professions included
Employer’s activities in the return-to-work process are influenced by economical, legislative and ethical factors, whereby economic factors take priority.
Public institutions have their own ethical principles – they are client-oriented but have to strictly follow the rules and regulations.
The ensuing gap leads to ethical dilemmas.
collaboration of all stakeholders is crucial in vocational rehabilitation.
Source: Teržan M. Ethics in vocational rehabilitation . Rehabilitation (Ljubljana)letn. XVII, supl. 1, 2016:
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16. Prijon, Čakš - Long Term Sick Leave
Conclusions
With respect to the relatively low influence of selected physicians on the number of absentees, a long term solution to the long-term absenteeism is possible only with legal limitation of its duration, as is the case in most of the EU members and the introduction of professional rehabilitation and return-to-work.
In professional rehabilitation, we should focus on the most common diseases, as stated in the results of our analysis.
The introduction of professional rehabilitation and return-to-work should have wider support.
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