Productivity costs before and after absence from work: as important as common?
Introduction
Economic evaluations aim at aiding decision makers in deciding whether or not to implement or fund a new health care technology. In order to provide the decision maker with all relevant information, normally the societal perspective is advocated for economic evaluations (e.g. [7], [8]). This means that all relevant costs and effects need to be incorporated in the analysis, regardless of who bears these costs and who experiences the effects [8]. Therefore, all costs incurred within or outside the health care sector, directly or indirectly, should be part of the analysis and the consensus for taking this societal perspective is broad.
An important and controversial cost category that needs to be incorporated in an economic evaluation taking the societal perspective, are productivity costs (or indirect non-medical costs). Productivity costs can be defined as the costs associated with production loss and replacement due to illness, disability and death of productive persons, both paid and unpaid [3]. These productivity costs can be very substantial when illness and treatment influence the productivity of persons, especially in patients with paid work. Koopmanschap et al. [13] for instance show that productivity costs may constitute a large part of total costs for some diseases and interventions. However, even though the productivity costs may thus strongly influence the results of an economic evaluation, there are still many debates about how to assess the exact costs related to productivity losses. The different measurement methods used lead to substantially different estimations of productivity costs. Therefore, more research on finding and refining appropriate methods to use in economic evaluations is needed, as well as more consensus among analysts on which methods to use. This will enhance the comparability and acceptability of results of economic evaluations.
In this paper, we focus on productivity costs in the period before and after absence from paid work. It is argued that productivity losses may occur before and after absence, during the onset of disease and the recovery from disease when the individual is still at or already back at work. Normally these productivity costs before and after absence are not considered, which may lead to an underestimation of total productivity costs. Furthermore, we will pay attention to compensation mechanisms. Absence or reduced productivity may be compensated for by making up for lost work after return to work (in regular hours or overtime) or by colleagues taking over (some of the) work. This may influence the total costs related to productivity losses, but is normally not considered by analysts, a notable exception being Severens et al. [16].
The structure of this paper is as follows. In Section 2 we will discuss normal measurement methods of productivity costs related to paid work in economic evaluation both in case of absence and without absence. In Section 3 we will introduce the concept of productivity costs before and after absence, while Section 4 presents (limited) empirical evidence on this phenomenon from the questionnaire ‘Ill and Recovered’ and evidence of compensation mechanisms within the firm. Finally, in Section 5 we will conclude this paper.
Section snippets
Productivity costs related to paid work
Often productivity costs related to paid work are calculated on the basis of data on patients’ absence from paid work. However, productivity costs can also occur without absence, when ill workers continue to work. In this paragraph, we will discuss the normally used measurement methods for productivity costs related to absence and productivity costs related to reduced performance at work.
Productivity costs before and after absence: the model
The two types of production losses, those with and without absence, as discussed above, are mostly presented as two distinct types of production losses. The friction cost method and the human capital method are developed to calculate productivity costs related to absence. Costs related to reduced productivity without absence will not be captured by these methods and will have to be calculated separately. One may argue that the US Panel method for calculating productivity costs will pick up
Methods and results: the questionnaire ‘Ill and Recovered’
We investigated the productivity of employees in a Dutch trade-firm, in the period before and after absence. For that purpose, we developed the questionnaire ‘Ill and Recovered’, which asks respondents specifically about the performance before and after absence in terms of quantity and quality of work performed. The questionnaire was handed out to employees of the Dutch trade-firm over the period May 1997–January 1998 upon return to work after having been absent due to illness3
Conclusions
In this paper we have discussed productivity losses before and after absence as a possibly influential cost-item that has gained only little attention. As we have demonstrated, with a notably limited data-set, productivity losses before and after absence occur relatively frequently: 25% of absentees experienced production losses before absence and 20% after absence. Therefore, as hypothesised, direct absence is quite often not the first consequence of illness. In many instances, persons first
Acknowledgements
We are grateful to Ken Redekop and two anonymous reviewers for useful comments. Furthermore, we acknowledge the Dutch Council for Scientific Research (NWO) for funding this research.
References (17)
- et al.
Productivity losses without absence; measurement validation and empirical evidence
Health Policy
(1999) - et al.
On the economic foundations of CEA. Ladies and gentlemen, take your positions
Journal of Health Economics
(2000) - et al.
Towards a new approach for estimating indirect costs of disease
Social Science and Medicine
(1992) - et al.
The friction cost method for measuring indirect costs of disease
Journal of Health Economics
(1995) - et al.
Productivity costs measurement through quality of life? A response to the recommendations of the US Panel
Health Economics
(1997) - et al.
Productivity costs in cost-effectiveness analysis: numerator or denominator: a further discussion
Health Economics
(1997) - et al.
Patient and informal caregiver time in cost-effectiveness analysis. A response to recommendations of the US Panel
International Journal of Technology Assessment in Health Care
(1998) - Drummond MF. Australian guidelines for cost-effectiveness studies of pharmaceuticals: The thin end of the boomerang?...
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